Long-term follow-up of outcomes including progression-free survival 2 in patients with transplant-ineligible multiple myeloma in the real-world practice: A multi-institutional report from the Canadian Myeloma Research Group (CMRG) database.

Multiple myeloma remains an incurable cancer mostly affecting older adults and is characterized by a series of remission inductions and relapses. This study aims to evaluate the outcomes in newly diagnosed transplant-ineligible patients using bortezomib/lenalidomide-based regimens in the Canadian real world as well as their outcomes in the second line. The Canadian Myeloma Research Group Database (CMRG-DB) is a national database with input from multiple Canadian Centres with now up to 8000 patients entered. A total of 1980 transplant ineligible patients were identified in the CMRG-DB between the years of 2007-2021. The four most commonly used induction regimens are bortezomib/melphalan/prednisone (VMP) (23%), cyclophosphamide/bortezomib/dexamethasone (CyBorD) (47%), lenalidomide/dexamethasone (Rd) (24%), and bortezomib/lenalidomide/dexamethasone (VRd) (6%). After a median follow-up of 30.46 months (0.89-168.42), the median progression-free survival (mPFS) and median overall survival (mOS) of each cohort are 23.5, 22.9, 34.0 months, and not reached (NR) and 64.1, 51.1, 61.5 months, and NR respectively. At the time of data cut-off, 1128 patients had gone on to second-line therapy. The mPFS2 based on first-line therapy, VMP, CyBorD, Rd, and VRd is 53.3, 48.4, 62.7 months, and NR respectively. The most common second-line regimens are Rd (47.4%), DRd (12.9%), CyBorD (10.3%), and RVd (8.9%) with a mPFS and a mOS of 17.0, 31.1, 15.4, and 14.0 months and 34.7, NR, 47.6, 33.4 months, respectively. This study represents the real-world outcomes in newly diagnosed transplant-ineligible myeloma patients in Canada. The spectra of therapy presented here reflect the regimens still widely used around the world. While this is sure to change with anti-CD38 monoclonal antibodies now reflecting a new standard of care in frontline therapy, this cohort is reflective of the type of multiple myeloma patient currently experiencing relapse in the real-world setting.

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© 2024 The Authors. eJHaem published by British Society for Haematology and John Wiley & Sons Ltd.

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Kaedbey: Honoraria: Janssen, BMS, FORUS, Sanofi, and Pfizer. Reece: Research funding: Janssen, Takeda, BMS, and Millennium; Consultancy:  Janssen, Amgen, Takeda, and BMS; Honoraria: BMS, Janssen, Takeda, Sanofi, Pfizer, and GSK. Venner:  Honoraria: Janssen, BMS, Pfizer, Abbvie, Sanofi, Forus, and GSK. McCurdy: Honoraria: Celgene, Janssen, Amgen, Takeda, Sanofi, and GSK. Chu: Honoraria: AstraZeneca, BMS/Celgene, Gilead, Janssen, AbbVie, Pfizer, Sanofi, and Amgen; Research funding: BMS/Celgene and Miltenyi. Louzada: Honoraria: Janssen, Celgene, Amgen, and Pfizer. Jimenez‐Zepeda: Honoraria: Celgene, Janssen, Takeda, Merck, and BMS. Mian: Honoraria: Celgene, Janssen, Amgen, Takeda, Sanofi, and GSK Awards: HHS Research Early Career Award from Hamilton Health Sciences Foundation. Song: Honoraria: Janssen, Sanofi, BMS, Forus, Amgen, GSK, Gilead, and Novartis. Sebag: Membership on an entity's Board of Directors or advisory committees: Janssen Inc., Amgen Canada, Takeda Canada, and Celgene Canada. Stakiw: Honoraria: Janssen, FORUS Therapeutics, Pfizer, and Sanofi. White: Honoraria: Amgen, Antengene, BMS, Forus, GSK, Janssen, Karyopharm, Pfizer, Sanofi, and Takeda. Reiman: Consulting/honoraria/research: Janssen, Sanofi, BMS, Takeda, Pfizer, Regeneron, and AstraZeneca. Aslam: Honoraria: AbbVie, Gilead, Janssen, and Celgene. Bergstrom: Honoraria: Janssen and BMS. Research funding: BMS. Kotb: Honoraria: Akcea, Amgen, BMS, Janssen, Merck, Sanofi, Celgene, Pfizer, and Takeda; Research funding: Merck and Sanofi; Current equity holder in a private company: Karyopharm. LeBlanc: Advisory committees: BMS, Janssen, Amgen, Sanofi, and FORUS Therapeutics; Honoraria: Pfizer