Real-world data in multiple myeloma: treating patients beyond 1L

Case study discussions with Prof. Graham Jackson, Dr Senthil Kumar, Dr Denis O’Keeffe & Dr Gerard Crotty

This feature has been commissioned and fully funded by Takeda Products Ireland Ltd. and contains promotional information.
Intended for HCPs in the Republic of Ireland only.

NINLARO®(ixazomib) in combination with lenalidomide and dexamethasone is indicated for the treatment of adult patients with multiple myeloma who have received at least one prior therapy. Click here for the prescribing information for NINLARO

Although the treatment of newly-diagnosed multiple myeloma has advanced in recent years, ultimately patients will experience relapse beyond first-line treatment.1 At this point, the challenge for physicians is to find a treatment regimen which will induce a deep response for the longest possible remission, in a shared physician-patient decision-making environment.

In the first part of our discussion, clinicians treating multiple myeloma from Ireland and the UK share how lessons learned over the last few ‘COVID-19 years’ can continue to benefit their patients with multiple myeloma in the future, such as the use of telemedicine and increased importance given to management away from the clinic on patients’ day-to-day lives.

Part 1: Treating patients beyond 1L in a post-pandemic world

“In terms of the treatment choices, I was certainly more open to using oral treatments that enabled people not to have to come into our day ward, where I felt that there was evidence, in terms of the treatment I could offer and the end points are still the same… best possible response for the longest possible time with the most minimal side effects. That’s what we’re aiming for and that didn’t change during the pandemic.” – Dr Denis O’Keeffe

“I think a lot of these measures are going to continue because these are immunosuppressed patients…particularly while there are a lot of cases of COVID around, they still remain quite vulnerable.” Dr Gerard Crotty

Beyond first-line treatment, both clinical trial data and real-world evidence play a role in guiding treatment decisions for patients.2,3 In Part 2 below, the panel discuss real-world data for the all-oral NRd (ixazomib in combination with lenalidomide and dexamethasone) regimen.

Part 2: Real-world control in patients beyond 1L with NRd

2. Chari A, et al., Expert Review of Hematology, 2020
3. Hajek R, et al., Future Oncology, 2021
4. Moreau P, et al., The New England Journal of Medicine, 2016 

Tailoring of treatment and its adjustment for a more personalized medicine approach is key when managing patients at relapse.5,6
The panel discussed how real-world data, such as the Chari et al. retrospective cohort study (n=733), helps inform their therapeutic decision-making at relapse and that effective control plus tolerability in the long term, along with convenience of taking therapy at home, are important factors for consideration when choosing the next therapy.

“In that study2, the time to next treatment taking the whole population was comparable between those three regimens*. But when you looked at patients with a degree of frailty, either intermediate or frail, there was an advantage in terms of time to next treatment for the ixazomib-lenalidomide-dexamethasone group, compared to carfilzomib-lenalidomide-dexamethasone.” – Dr Gerard Crotty

* VRd (bortezomib, lenalidomide, dexamethasone), KRd (carfilzomib, lenalidomide, dexamethasone), NRd (ixazomib, lenalidomide, dexamethasone)

Part 3: Case study MDT discussion

7. Kumar S, et al., The Lancet Oncology, 2020


In our final video, the panel discuss the case study of a 52-year-old, fit male patient. Following diagnosis, the patient was initially treated with RVd (lenalidomide-bortezomib-dexamethasone).

Upon relapse, there were several options available to the patient and the panel give their thoughts on next steps beyond first-line.

“He was a 52 year old gentleman who was referred to my clinic. He had presented to the GP with two months history of back pain and subsequently went to A&E and got admitted. Radiological investigation showed significant lytic lesions visualized all over the bones. And he had a pathological fracture at T11. He also had a lytic lesion at T12.”
– Dr Senthil Kumar

Click here for the prescribing information for NINLARO®(ixazomib)


This medicinal product is subject to additional monitoring. Adverse events should be reported to the Pharmacovigilance Unit at the Health Products Regulatory Authority. Reporting forms and information can be found at: Adverse events should also be reported to Takeda at:


1. Bobin A, et al. Multiple Myeloma: An Overview of the Current and Novel Therapeutic Approaches in 2020. Cancers (Basel).2020;12(10):2885

2. Chari A, et al. Real-world outcomes and factors impacting treatment choice in relapsed and/or refractory multiple myeloma (RRMM): a comparison of VRd, KRd, and IRd. Expert Rev Hematol 2020;13(4):421–433

3. Hajek R, et al. Ixazomib-lenalidomide-dexamethasone in routine clinical practice: effectiveness in relapsed/refractory multiple myeloma. Future Oncol 2021;17(19):2499–2512

4. Moreau P, et al., Oral Ixazomib, Lenalidomide, and Dexamethasone for Multiple Myeloma. N Engl J Med 2016; 374:1621-1634

5. Gengenbach L, et al. Choosing the Right Therapy for Patients with Relapsed/Refractory Multiple Myeloma (RRMM) in Consideration of Patient-, Disease- and Treatment-Related Factors. Cancers (Basel) 2021;13(17):4320

6. Auclair D, et al. Preferences and Priorities for Relapsed Multiple Myeloma Treatments Among Patients and Caregivers in the United States. Patient Prefer Adherence 2022;16:573–585

7. Kumar S, et al., Venetoclax or placebo in combination with bortezomib and dexamethasone in patients with relapsed or refractory multiple myeloma (BELLINI): a randomised, double-blind, multicentre, phase 3 trial. The Lancet Oncology 2020; 21 (12) 1630-1642

Relevant disclosures:

Graham Jackson – Speaker honoraria engagements: Amgen, Takeda, Johnson & Johnson, Sanofi, Celgene and Roche; Research funding: Takeda, Onyx and Celgene; Advisory Boards: Amgen, Takeda, Johnson & Johnson, Oncopeptides, Pfizer, Sanofi, Celgene, GSK and Roche; Board of directors Myeloma UK.

Gerard Crotty – Advisory boards: AstraZeneca, Astellas, Takeda

Denis O’Keeffe – no relevant disclosures

Senthil Kumar – no relevant disclosures

C-APROM/IE/NINL/0060 | May 2022

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