EHA 2021 | Real-world analysis of treatment patterns and outcomes in newly diagnosed myeloma

This year at EHA we presented this real-world data analysis on upfront therapies in newly diagnosed multiple myeloma patients non-eligible for autologous stem cell transplantation, so in the lack of prospective randomized clinical trials that would never happen because of course things are going on very fast in this context, we performed this retrospective analysis in real life in several European countries of the outcomes of patients treated upfront, either with len-based therapies, so maybe len-dex, or bortezomib-based combination – [inaudible] or, bortezomib, melphalan, prednisone. Just to look out what was the outcome of the patients and also the utilization of resources,

And what it came out from this analysis could be somehow expected ,because the difference in the two treatment, of course, is that len-dex is a continuous treatment, while bortezomib-based treatment, until a few years ago, was a fixed duration treatment coming from an old concept of treatment of multiple myeloma not as a continuous treatment.

So, in the end, it turned out to that len-based treatment is associated to a better outcome in terms of the duration of control of the disease, and this is mainly due to the continuity of the treatment, so to the fact that it is a continuous treatment, but also better utilization of resources. So, we always have to keep in mind that first-line therapy for patients, in particular for elderly patients non-eligible for transplant, can be the unique line of therapy that they receive, because sometimes at the relapse they are not able to be effectively treated because of the age, because of the side effects accumulated, because of the comorbidities, so of course we have to implement and take the best from the first line. And in this way, to keep under control the disease, patients are less exposed to complications or to all the effects, let’s say, that may come from a relapsed disease.

Also, the quality of life seemed better when a patient is in remission. His or her quality of life is perceived as a better one, so all these results are, to my opinion, a good platform to the transition that happened in the last years. In fact, we know that two very important prospective randomized clinical trial were published that inquired the addition of the anti-CD38 monoclonal antibody daratumumab to the backbone.

The results were of course positive for both the trials, so dara plus bortezomib or dara plus len improved significantly the depth of the response and the outcome of patient, but today the combination of len-dex plus daratumumab is the best one in terms of depth of response, but in particular, duration of response and progression-free survival. So, for sure, we can say that the dara-len-dex is currently one of the standard of care, so for sure the platform, the backbone of len-dex it’s a very good platform to add a third agent, probably in the future, why not a fourth agent, to ensure for patients that are not eligible for autologous stem cell transplantation prolonged control of the disease.