Evolving Patterns of MRD Testing and First-Line Treatment in Multiple Myeloma: Insights from Academic and Community Practices in the US
Authors: Franceschetti Alessandra , Levent Ayse , Moseley Angelena 
Published: December 2024

Background: The management of newly drug-treated multiple myeloma (MM) has advanced considerably with the advent of highly effective therapies, combination therapy approaches, and sensitive minimal residual disease (MRD) assessment. However, real-world adoption of these tools may vary between academic and community settings. This study examined temporal trends and differences in MRD testing and first-line (1L) treatment patterns across practice types.

Methods: Data were extracted from the Ipsos Global Oncology Monitor, an online multi-country, multi-centre study collecting medical charts of cancer patients treated with anti-cancer drug-therapy directly from physicians. We evaluated clinical characteristics, MRD testing, and treatment approaches of newly drug-treated (initiated in the last 3 months) 1L MM patients managed in US academic vs. community practices from Jan 2019-Mar 2024. The latest 12 months of data (April 2023 to March 2024) included 158 patients from academic and 645 from community settings. The physician sample was 49 (academic) and 160 (community), all with at least 5 years of experience in oncology and responsible for treatment decisions.

Results: MRD testing among recently treated 1L MM patients increased over time in both settings but was higher in academic practices (48% vs. 41%, end of March 2024). MRD negativity rates were greater in academic centers (25% vs. 16%, p&lt;0.01). Academic physicians were earlier adopters of novel approaches, with higher use of triple-quadruple regimens (86% vs. 78%, p&lt;0.05), while community physicians more often used 1-2 drug combinations (22% vs. 13%, p&lt;0.01). Patients treated in academic centers were younger (mean age 63.9 vs. 66.7 years, p&lt;0.01) with higher-risk disease (25% vs. 14%, p&lt;0.01). Interestingly, no statistically significant differences were registered in the two sub-groups by ECOG status. This could be attributed to more effective risk stratification and treatment selection in academic centers, allowing them to maintain good performance status in high-risk patients. Additionally, the younger age of patients in academic centers may enable them to tolerate intensive therapies better, confounding the relationship between disease risk and performance status.

Comorbidity burden was greater in community practices, particularly for renal function disorders (17% vs. 9%, p&lt;0.05), cardiovascular diseases (16% vs. 7%, p&lt;0.01), hypertension (53% vs. 46%), and obesity (8% vs. 4%). Since patients treated in community centers were on average older than those treated in the academic ones, to assess if such differences in percentage of comorbidities were driven by the different age ranges, we focused on the same sub-group of patients aged 65-74 (patients aged 65-74 treated in community centers n=275 vs. those treated in academic settings n=63). Similar statistically significant differences between the two groups remained: renal function disorders (14% vs 11%), cardiovascular diseases (16% vs. 10%) hypertension (59% vs 49%), and obesity (12% vs 3%, p&lt;0.05).

Conclusions: This real-world study highlights disparate adoption of MRD testing and novel treatments for 1L newly initiated MM patients between US academic and community practices. Academic centers demonstrate faster uptake and treat younger, fitter patients despite higher disease risk. Tailored education and research are needed to harmonize evidence-based MM management across settings.