Characteristics of patients with Relapsed/Refractory multiple myeloma (RRMM) in europe and the US Free

Introduction: Multiple myeloma (MM) significantly contributes to global disease burden. To facilitate tailoring of treatment strategies and improved patient (pt) management according to regional differences, there is a need for research on geographical distribution of clinical characteristics that may influence tumor expression and treatment response in RRMM. This study aimed to describe the distribution of prognostic characteristics of pts with RRMM in Europe and the US.

Methods: Data were drawn from the Adelphi Real World MM III Disease Specific Programme^TM(DSP), a cross-sectional survey, with retrospective chart review, of physicians and their pts with RRMM. The survey was administered to hemato-oncologists and hematologists in EU4 (France, Germany, Italy, Spain) from July to Nov 2021, the UK (May to Nov 2021), and the US (Sep 2020 to Sep 2021). Physician-reported data (collected via DSP pt record forms) for consulting RRMM pts (second-line or later [2L+]) were analyzed to capture demographics, clinical characteristics, and treatment history. Descriptive analyses were performed to assess key variables.

Results: In total, 236 physicians provided data on 2037 pts with 2L+ RRMM (n=259 US; n=1778 EU4+UK). Demographic characteristics in the US and EU4+UK were generally similar except there were more White pts in EU4+UK than the US (93%/59%). The mean (standard deviation [SD]) age at diagnosis was 65.8 (7.9) years in the US and 65.9 (9.2) years in EU4+UK, and at the time of data collection (i.e., at the most recent RRMM consultation) mean (SD) age was 69.1 (8.1) years in the US and 70.8 (9.1) years in EU4+UK. Most pts were male (62% in the US and 56% in EU4+UK).

Most clinical characteristics were similar between the US and EU4+UK and within regions between White and non-White pts. International Staging System (ISS) stage I/II/III at the time of data collection was 10%/37%/53% in the US and 11%/26%/63% in EU4+UK. There was some variation in other clinical characteristics: ECOG performance status 0–1 at the time of data collection was 80% in the US and 68% in EU4+UK. Bone lesions were experienced by 58% in the US and 65% in EU4+UK, and high-risk cytogenetics were present in 39% in the US and 26% in EU4+UK. The most frequent comorbidities reported at the time of data collection in the US and EU4+UK were hypertension (47%/46%), anemia (24%/26%), hyperlipidemia (19% in both), diabetes (19%/24%), and mild renal disease (12%/18%).

Despite some differences in populations, prescribed therapies were broadly similar between regions and between White and non-White within regions. Common 1L therapy classes prescribed in the US and EU4+UK were proteasome inhibitors (PIs) (22%/27%), immunomodulatory drugs (IMDs) (18%/15%), and PI/IMD (59%/51%). Common 2L therapies prescribed in the US and EU4+UK were PIs (15%/18%), IMDs (4%/21%), PI/IMD combination (28%/20%), and IMD/anti-CD38 combination (25%/20%). Common 3L+ therapies in the US and EU4+UK were PIs (24%/14%), IMDs (8%/20%), PI/IMD (26%/21%), and IMD/anti-CD38 (15%/16%).

Minor variations in prescribed therapies included rates of stem cell transplantation (22% US/30% EU4+UK), exposure to anti-CD38 (63%/71%), exposure to lenalidomide (88%/92%), and exposure to both lenalidomide and anti-CD38 (56%/66%). The US had higher rates of pts refractory to treatments: anti-CD38 refractory (43% US/31% EU4+UK), lenalidomide refractory (32%/27%), and refractory to both lenalidomide and anti-CD38 (40%/13%).

Conclusion: Our study provides critical insights into pts with RRMM across different regions, aligning closely with results from other published large population-based studies. Demographic/clinical characteristics were generally similar across the regions (except proportions of White pts) and between White and non-White pts within regions, including age of diagnosis, ISS staging, and comorbidity burden. Pts were also treated with similar combinations of classes in frontline and second line therapy during the time the study was conducted. Minor variations were seen in level of refractoriness to common therapies, including lenalidomide and anti-CD38. Similarities between the populations enable extrapolation across the regions, to inform treatment strategies.