Treatment Patterns among Patients with Recently-Diagnosed Multiple Myeloma in a National Registry

Background: Patterns of treatment among patients with recently-diagnosed multiple myeloma have not been described on a population basis. This is of particular interest with the introduction of novel anti-myeloma therapies in the last several years.

Methods: The “Patient Registries at Slone: Myeloma” is a national disease-based observational registry conducted by Boston University. All patients with myeloma diagnosed within 4 months of enrollment are eligible for inclusion. Subjects enroll by mail or over the internet; information on treatment, clinical events, and quality of life is obtained by questionnaire and from medical record review at baseline and at six-month intervals. We report on 314 patients with multiple myeloma residing in 43 states who were enrolled from June 2006-June 2008 and completed a baseline questionnaire (sent to them after enrollment) within six months of diagnosis (median, 68 days; range, 4–171 days). Eleven patients with smoldering myeloma or MGUS were not included.

Results: A total of 231 patients (74%) had received novel therapies or other anti-myeloma agents since diagnosis. The most commonly used of the newer drugs was thalidomide alone or in combination with other agents (e.g., dexamethasone), received by 72 patients (23%), followed by lenalidomide alone or in combination, 58 (18%), bortezomib alone or in combination, 40 (13%), and a separate group who received bortezomib and either thalidomide or lenalidomide (some in combination with other agents), 24 (8%). Among patients not on novel therapies, dexamethasone alone or in combination with other medications was used by 29 (9%), while 6 (2%) received other anti-myeloma agents. There were 35 different therapeutic combinations reported at the time of completion of the baseline questionnaire. Four patients had received a stem cell transplant. The main types of adjunct therapy included bisphosphonates, 104 patients (33%); erythropoeitin stimulating agents (ESAs), 47 (15%); and myeloid growth factors, 13 (4%). Treatment patterns were examined according to sociodemographic factors. Patients receiving bortezomib were significantly younger than those who received other agents or were untreated, with a median age of 55 years vs. 62 for untreated (p=0.016), 61 for lenalidomide (p=0.009) and thalidomide (p=0.04), and 60 for dexamethasone without novel agents (p=0.04). The large majority of patients had insurance that covered prescription drugs, but those who did not received the various treatments at similar or even higher rates. African American patients had a significantly higher prevalence of thalidomide use alone or in combination (48%) than did patients in other racial/ethnic groups (21%)(p=0.02). Patients who received adjunct therapy were more likely to also be treated with novel agents or other anti-myeloma drugs: 91% among ESA-treated patients vs. 70% among other patients (p=0.002); 91% among bisphosphonates vs. 65% among others (p<0.0001).

Conclusions: These results from a national registry show that the initial choice of treatments in multiple myeloma covers a wide range of therapeutic combinations. Most patients receive one or more of the newer therapies within six months of diagnosis. It is noteworthy that although fully three-fourths of patients are treated with novel or other anti-myeloma agents, only one-third report the use of bisphosphonates.