INTRODUCTION: Despite the introduction of numerous novel agents and treatment strategies leading to improved response rates and overall survival, virtually all patients with multiple myeloma (MM) eventually relapse. While relapsed/refractory multiple myeloma (RRMM) remains an area of unmet need, little data have been generated describing typical treatment patterns and resource utilization in these patients. To help address this information gap, we analyzed data from an RRMM cohort in France.
METHODS: A retrospective medical record review was conducted in 200 patients with RRMM in France. All patients were ≥18 years of age at initial MM diagnosis and first diagnosed with RRMM (during or following first-line induction therapy) between 01-Jan-2009 and 31-Dec-2011. Cytogenetic risk was defined as follows: high-risk: cytogenetic abnormalities del(17p), t(4:14), or t(14;16); standard-risk: all patients with known cytogenetics not classified as high-risk. Patients were retrospectively assessed on second- and third-line treatment regimens received, treatment duration, reasons for discontinuation, and subsequent health care utilization from date of first relapse.
RESULTS: Altogether, 55 cytogenetic high-risk and 113 standard-risk patients were selected; risk category was unknown for 32 patients. Among all patients, 192 (96%) received ≥1 line of chemotherapy after first relapse; 114 (57%) received ≥2 lines after first relapse. The most common second-line regimen was lenalidomide + dexamethasone (54%), followed by bortezomib + dexamethasone with or without a third agent (23%). Median second-line duration was 9 cycles over 9.4 months. Most patients (92%) discontinued second-line treatment, most often due to progression (37%), to reaching a perceived maximal response with no additional benefit expected (33%), and to lack/loss of response (13%). Among the 114 patients receiving third-line treatment, regimens were more varied, bortezomib + dexamethasone being the most common (27%). From first relapse until death or last medical record, 35% of patients had ≥1 inpatient hospitalization. High-risk patients had greater incidence than standard-risk patients of inpatient hospitalization (34 vs. 15 admissions per 100 person-years; p<0.05) and emergency department utilization (25 vs. 15 visits per 100 person-years; p<0.05).
CONCLUSIONS: Lenalidomide + dexamethasone was the most common second-line regimen in this review. Second-line duration was generally <1 year, indicating a potential unmet need in light of the primary reasons cited for discontinuation (disease progression or loss of response, no perceived additional benefit, and toxicities). Hospitalizations and emergency department visits were common after first relapse, indicating a potentially high cost burden, particularly for patients with high-risk cytogenetics in whom health care utilization was generally higher than for patients with standard-risk.
