Real-World Use of 3rd Line Therapy for Multiple Myeloma in Austria: An Austrian Myeloma Registry (AMR) Analysis of the Therapeutic Landscape and Clinical Outcomes prior to the Use of Next Generation Myeloma Therapeutics

Objective: Clinical trials demonstrate improving survival in patients with multiple myeloma (MM) after treatment. However, it is unclear whether increased survival translates to a similar benefit in a real world setting. Methods: We analyzed the overall survival of 347 multiple myeloma patients in Austria by means of a national registry (AMR), focused on results from 3rd and later lines of therapy. This benchmark was chosen to define a baseline prior to the broad application of upcoming 2nd generation drugs (carfilzomib, pomalidomide). Results: Projected 10 years survival for patients with MM in Austria is estimated to be 56% in patients diagnosed in between the years 2011–2014, 21% in patients with a diagnosis made between 2000–2005, and 39% in those with a diagnosis made between 2006–2010). For the same intervals a significant increase in the use of both bortezomib, lenalidomide and thalidomide—so called IMiDs (from 2005 onwards) and their simultaneous use in combination therapies (from 2010 onwards) could be shown. The use of autologous transplantation (ASCT) remained more or less constant at ~ 35% of patients in the 1st line setting over the whole period, comparing well to international practice patterns, while the use of 2nd line ASCT increased from 5.5% to 18.7% of patients. Patients in 3rd or later line treatment (n = 105), showed that even in relapsed and refractory disease median survival was 27 months with a considerable proportion of long-term survivors (~20%). Conclusion & Perspective With the expected emergence of additional active anti-myeloma compounds, we aim to assess survival in patients with relapsed and refractory MM

Patients and treatment lines.

<p>illustrates the distribution of treatment lines and patients (pts.) documented in the Austrian Myeloma Registry (AMR). Patients who had received at least 3 lines of therapy were included in the analysis (yellow boxes).</p

Patient disposition in patients receiving or not receiving 3^rd line therapy for Multiple myeloma in Austria.

<p>Patient disposition in patients receiving or not receiving 3^rd line therapy for Multiple myeloma in Austria.</p

Survival of Multiple Myeloma patients in Austria overtime and extrapolated Weibull model survival estimates.

<p>The upper part (Fig 2A) illustrates the survival of Myeloma patients in Austria respective to the date of their first diagnosis in between 2000–2005 (blue line), 2006–2010 (red line), and 2011–2014 (green line). The x-axis represents time in years, and the y-axis represents the proportion of patients surviving. The dotted lines give the respective Weibull extrapolation of the patients’ 10 years survival. The lower part (Fig 2B) illustrates the survival of Myeloma patients in Austria respective to the date of their first diagnosis in between 2000–2005 (blue line), 2006–2010 (red line), and 2011–2014 (green line). The x-axis represents time in years, and the y-axis represents the proportion of patients surviving. The dotted lines give the respective Weibull extrapolation of the patients’ 10 years survival.</p

Survival of Multiple Myeloma patients in Austria from start of 3^rd line.

<p><b>Therapy.</b> illustrates the survival of Myeloma patients in Austria from start of 3^rd line therapy in 105 patients documented in AMR median survival was found to be 27 months (0–170 months/ongoing).</p