PB2116 EVOLUTION OF MULTIPLE MYELOMA MANAGEMENT IN NORWAY: EXPERT OPINION 2013–2018
Authors: F. H. Schjesvold
Journal: HemaSphere (2019)

Background: The current decade brought significant advances in multiple myeloma treatment and care. Translation of benefits from an experimental setting to clinical practice is a crucial element for substantial improvements in survival. Aims: To assess changes in multiple myeloma treatment and care ongoing in Norway in the period from 2013 to 2018. Methods In a series of annual surveys treatment choices in different clinical situations and other aspects of myeloma patients care were assessed. Surveys were completed by Norwegian physicians experienced in the multiple myeloma management. Participation in surveys was voluntary. Data from six surveys completed between 2013 and 2018 were analyzed to reveal pattern of changes in myeloma management and care in the current decade. Changes in the pattern of treatment of newly diagnosed patients (transplant eligible and ineligible, and old & frail patient) and patients with their first relapse (after induction with different regimes: MTP, VMP, Rd, VCd/VTd with autologous stem cell transplantation [ASCT]). Results: The number of participants in a single survey ranged from 62 in 2013 to 72 in 2018, out of the around 80 Norwegian haematologists treating myeloma. Treatment schemes based on alkylating agents in combination with steroids (MP) and with bortezomib (VCd) or thalidomide (MTP) were replaced by lenalidomide-based regimes (Rd) with or without bortezomib (VRd). In 2018, the lenalidomide-based combination constituted ≥60% of regimens selected by experts for transplant-eligible/ineligible and old and frail patients with newly diagnosed myeloma (see table). Treatment of relapse also changed over time. Importance of Rd scheme increased in the management of relapse after induction with VCd or VTd and transplant or relapse after MTP. Simultaneously, the use of Vd regimen decreased over time in these cases. Triple therapy with the VRd scheme was the second most commonly indicated treatment option in 2018 (see table). Treatment choice of management of relapse after Rd was monitored only in last two years and bortezomib-based therapies was the mainstay of treatment (see table). However, many approaches involving the new generation of proteasome inhibitors and monoclonal antibodies are emerging in this setting.Summary/Conclusion: The annual follow-up survey results illustrates changes in treatment of multiple myeloma ongoing in Norway in the years 2013 to 2018. The treatment of newly diagnosed multiple myeloma and relapse management have changed dramatically. The VRd combination became one of the preferred frontline triplets for transplant-eligible and ineligible patients, simultaneously limiting use of the alkylating agents-based regimes. The use of lenalidomide in the second-line increased over time and expanded to include newly diagnosed patients (e.g. frail and transplant-ineligible patients). Study results indicate that lenalidomide (Rd, VRd) has become the foundation first-line treatment for myeloma in Norway, and the preferred second line if R was not used upfront. The relapse after Rd therapy is managed using bortezomib-based therapies and use of the molecules registered in relapsed or refractory disease including pomalidomide, carfilzomib and daratumumab. Acknowledgments: The author thanks Marcin Balcerzak of Farenta for providing statistical and editorial support, which was sponsored by Celgene.