PF641 CHARACTERIZATION OF TREATMENTS AND REAL‐LIFE OUTCOMES IN PATIENTS WITH NEWLY DIAGNOSED MULTIPLE MYELOMA WHO RECEIVED FRONTLINE AUTOLOGOUS STEM CELL TRANSPLANTATION IN SWEDEN
Authors: Schain F. , Cote S. , Lam A. , Szulkin R. , Dominicus A. , Mozart M. , Björkholm M. 
Published: June 2019

Background:

Although survival outcomes have improved in multiple myeloma (MM) patients over the last decade, the disease remains largely incurable and further optimization of treatment strategies are needed. Population‐based real‐world data is important to understand treatment outcomes outside clinical trials.

Aims:

To characterize patients with newly diagnosed MM (NDMM) who received autologous stem cell transplantation (ASCT), describe frontline treatment patterns and overall survival (OS).

Methods:

All patients ≥18 years of age who were diagnosed with MM in Sweden between June 2005 and December 2016 were identified in the national cancer registry (N = 7,343) and linked to relevant national population registries. Patients that underwent ASCT as first‐line treatment (N = 1,479, 20.1%) were included in the study. Consolidation and maintenance therapy were defined as any treatment initiated within 1 to 6 months post‐ASCT. Tandem ASCT was defined as a second ASCT within 2–6 months from the first ASCT. Patient characteristics and treatment types were described as median and 1st and 3rd quartiles (interquartile range, IQR) for continuous data. For time‐to‐event outcomes, median time and 95% confidence intervals (CI) were estimated using the Kaplan‐Meier method. The last follow‐up dates from the cause of death registry and the prescribed drug registry were August 2018 and December 2017, respectively.

Results:

Baseline patient characteristics and information on transplant are summarized in the Table. Median follow‐up time was 51.4 months (IQR: 29.8, 82.7). Overall, 1,184 patients (80.1%) received one ASCT and 22 patients (1.5%) received tandem ASCT. 276 patients (18.7%) received a second ASCT in any of the subsequent treatment lines (3 of them after receiving a tandem ASCT). For these patients, the median time from frontline ASCT to the second ASCT in any subsequent line was 36.9 months (IQR: 29.4, 53.9). Frontline induction regimens included immunomodulatory drug (IMiD) containing regimens (N = 205, 13.9%) and non‐IMiD containing regimens (N = 1,248, 84.4%). For 26 patients (1.8%) there were no treatment induction records available. A total of 136 patients (9.2%) received either IMiDs and/or cytostatic drugs as consolidation and/or maintenance treatment post‐ASCT. Median OS from the start of induction therapy was 7.5 years (95% CI: 6.8, 8.0). Despite the introduction of novel agents such as thalidomide, lenalidomide and bortezomib, there was no statistically significant difference in survival outcomes for patients diagnosed with MM in the earlier calendar period (2005–2012) versus the later calendar period (2013–2016) (p = 0.069).

Summary/Conclusion:

Although overall survival has significantly increased in MM over the last decade, this study did not show a statistically significant difference in survival outcomes in NDMM patients who have received transplant as part of their frontline treatment in early versus later years. The lack of improvement in outcomes over the last decade emphasizes the need for novel therapy for the treatment of patients who are eligible for transplant.

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