Dr. Rifkin is a board-certified medical oncologist and hematologist who treats blood malignancies and diseases, both malignant and benign. He specializes in coagulation diseases, multiple myeloma, and biosimilars at the advanced subspecialty level. Dr. Rifkin follows the National Comprehensive Cancer Network’s (NCCN) standards and performs evidence-based care. In this video Dr. Rifkin discusses the Real-World Treatment Patterns and Clinical, Economic, and Humanistic Burden in Triple-Class Refractory Multiple Myeloma: Analysis of the Connect® Multiple Myeloma (MM) Disease Registry.
Introduction: Treatment resistance is a problem that most MM patients (pts) will face at some point during their illness. Patient outcomes and health-related quality of life (HRQoL) deteriorate with each consecutive line of treatment (LOT). Patients with MM who are resistant to immunomodulatory medications, proteasome inhibitors (PIs), and anti-CD38 antibodies (triple-class refractory; TCR) have a poor prognosis, and the overall burden of the disease is unknown. The ongoing prospective Connect® MM Disease Registry was used to record treatment patterns and results in patients with TCR MM in order to capture these factors.
Methods: The data was collected between September 28, 2009 and February 4, 2021. Eligible patients were 18 years old at the time of their first documented diagnosis of MM, which progressed to TCR over time. According to the International Myeloma Working Group Criteria, MM is refractory to therapy. The index date was defined as the first time TCR was detected during the course of the disease. Patient characteristics, treatment patterns before and after the index, overall survival (OS), healthcare resource use (HCRU), and HRQoL were also examined. The EQ-5D-3L utility index (range 0.11–1), EQ-5D visual analog scale (VAS) score (range 0–100, “worst possible” to “best imaginable” health state), and FACT-G total score (range 0–108) were used to measure general HRQoL. FACT-MM total score (range 0–164), FACT-MM Trial Outcome Index (TOI) (range 0–112), and the Brief Pain Inventory (BPI) average pain item (range 0–10, “no agony” to “worst pain you can conceive”) were used to assess disease-specific HRQoL. For all FACT-related index scores, higher scores indicated improved HRQoL. The EQ-5D utility index, 7 for the EQ-5D VAS, and 6–8 points for the FACT-G total score were used to identify clinically relevant change in HRQoL at the cohort level during post-index year 1. For other index scores, validated thresholds were unavailable. The statistical studies were all descriptive in nature.
The Registry yielded 240 points, which were used in this study. The average age at the index date was 68.1 years (standard deviation [SD] 10.4). The average period from initial MM diagnosis was 64.1 months (SD 26.9). Prior stem cell transplantation was done in 63.3 percent of the patients. The average number of previous LOTs was four (SD 1.7). Since the index date, 64.6 percent of points had got a later MM LOT. After the index date, the median follow-up period was 4.6 months. Treatment pattern analysis of post-index treated patients (Table A) found that retreatment with an immunomodulatory medication, PI, or anti-CD38 agent was common after the index date, with carfilzomib (47.1 percent) and pomalidomide (47.1 percent) leading the way (40.0 percent ). In this patient population, however, no treatment combination was recommended. 70.3 percent and 22.6 percent of patients were on triplet and quadruplet combination therapy, respectively, while 3.2 percent started belantamab mafodotin, selinexor, melflufen, and/or idecabtagene vicleucel, with a mean treatment duration of 5.6 (SD 6.1) months. The median OS for all points was 8.9 months, with 10.0 and 8.0 months for those who had 4 or more prior LOTs (43.8%) and those who had 4 or more prior LOTs (56.2%), respectively.
All-cause and MM-related hospitalizations were observed in 49.6% and 23.8 percent of all eligible pts, respectively, during the post-index follow-up. Annualized mean number of all-cause/MM-related hospitalizations and length of hospital stay were estimated to be 8.5 (SD 18.2)/11.0 (SD 25.2) and 64.0 (SD 80.0)/69.2 (SD 83.7) days, respectively, among these pts.
Across all HRQoL instruments investigated, there was a numerical drop in HRQoL relative to index during the 1-year post-index period. Based on the EQ-5D utility index, EQ-5D VAS, and FACT-G total score, there was a clinically substantial deterioration in HRQoL from baseline following the index date (Table B).
Conclusion: Patients with TCR MM had a poor prognosis, frequent hospitalizations, and a clinically significant reduction in HRQoL. Since the condition became TCR, 35.4 percent of patients have not received any fresh LOTs. Re-treatment with an immunomodulatory medication, PI, or anti-CD38 antibody therapy was common among individuals who received subsequent LOTs, indicating a paucity of innovative treatment choices. To address the burden of sickness in patients with MM, more tolerable and effective treatment drugs are needed, according to this study.