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Conference Coverage

Increased Use of Maintenance Therapy Following Transplantation for MM in US Clinical Practice

December 08, 2020

Maintenance therapy use following autologous stem cell transplantation (ASCT) in patients with newly diagnosed multiple myeloma (MM) has increased in routine clinical practice in the US since 2011-2013 and is associated with longer time to next myeloma treatment (TNTT), according to study results presented at the virtual 62nd American Society of Hematology (ASH) Annual Meeting and Exposition.

These results were presented by Eric Ammann, PhD, Janssen Scientific Affairs, Horsham, Pennsylvania.

“In patients with newly diagnosed MM receiving frontline stem cell transplant, randomized trials have shown that maintenance therapy prolongs progression free survival. NCCN guidelines also endorse the use of maintenance therapy in this setting,” explained Dr Ammann during his presentation.

“However, there is limited contemporary evidence on the use of maintenance therapy and its impact on clinical outcomes in routine clinical practice,” he continued.

This observational cohort study assessed real-world use of maintenance therapy and associated clinical outcomes following frontline ASCT for MM using the US Flatiron Health (FH) deidentified electronic health record (EHR)-derived database.

Patients were classified as receiving maintenance therapy if they initiated treatment with an NCCN-recommended maintenance therapy regimen or continued to receive a subset of the antimyeloma agents used as induction regimen following ASCT and consolidation.

A total of 528 patients with newly diagnosed MM were included. The most common induction regimens were bortezomib-lenalidomide-dexamethasone (VRd; 60.0%), lenalidomide-dexamethasone (Rd; 16.3%), and cyclophosphamide-bortezomib-dexamethasone (CyBorD; 10.2%).

Following ASCT, 7.2% of patients received consolidation therapy and 74.2% received maintenance therapy. From 2011-2013 to 2017-2018, use of maintenance therapy increased from 69.3% to 79.0% (P = .04). Both lenalidomide maintenance and bortezomib maintenance were associated with longer TNTT (unadjusted hazard ratios [HRs]: 0.29 [95% CI: 0.22, 0.38] and 0.39 [95% CI: 0.25, 0.61], respectively). OS improvements were significant for lenalidomide maintenance compared with no maintenance therapy.

“We found that during the course of the study period, the use of maintenance therapy increased significantly, and we also found that consistent with the clinical trials that the use of maintenance therapy was associated with longer time to next treatment,” said Dr Ammann.

"Finally despite the clinical guidelines we found that 26% of patients in routine clinical practice are not receiving maintenance suggesting a potential unmet clinical need,” he concluded.—Lisa Kuhns

Ammann EM, Lam A, Tang W, et al. Real-World Use of Maintenance Therapy and Associated Outcomes Following Autologous Stem Cell Transplant in US Patients with Newly Diagnosed Multiple Myeloma. Presented at: the 62nd ASH Annual Meeting and Exposition; Dec 5-8, 2020. Abstract 3475.

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