Multiple myeloma treatment patterns and clinical outcomes in the Latin America Haemato-Oncology (HOLA) Observational Study, 2008-2016

Vania Tietsche de Moraes Hungria, Deborah M Martínez-Baños, Christian R Peñafiel, Carlos E Miguel, Jorge Vela-Ojeda, Guillermina Remaggi, Fernando B Duarte, Carmen Cao, Maria S Cugliari, Telma Santos, Gerardo Machnicki, Mariana Fernandez, Mariana Grings, Eric M Ammann, Jennifer H Lin, Yen-Wen Chen, Yu-Ning Wong, Paula Barreyro, Vania Tietsche de Moraes Hungria, Deborah M Martínez-Baños, Christian R Peñafiel, Carlos E Miguel, Jorge Vela-Ojeda, Guillermina Remaggi, Fernando B Duarte, Carmen Cao, Maria S Cugliari, Telma Santos, Gerardo Machnicki, Mariana Fernandez, Mariana Grings, Eric M Ammann, Jennifer H Lin, Yen-Wen Chen, Yu-Ning Wong, Paula Barreyro

Abstract

Limited data are available regarding contemporary multiple myeloma (MM) treatment practices in Latin America. In this retrospective cohort study, medical records were reviewed for a multinational cohort of 1103 Latin American MM patients (median age, 61 years) diagnosed in 2008-2015 who initiated first-line therapy (LOT1). Of these patients, 33·9% underwent autologous stem cell transplantation (ASCT). During follow-up, 501 (45·4%) and 129 (11·7%) patients initiated second- (LOT2) and third-line therapy (LOT3), respectively. In the LOT1 setting, from 2008 to 2015, there was a decrease in the use of thalidomide-based therapy, from 66·7% to 42·6%, and chemotherapy from, 20·2% to 5·9%, whereas use of bortezomib-based therapy or bortezomib + thalidomide increased from 10·7% to 45·5%. Bortezomib-based therapy and bortezomib + thalidomide were more commonly used in ASCT patients and in private clinics. In non-ASCT and ASCT patients, median progression-free survival (PFS) was 15·0 and 31·1 months following LOT1 and 10·9 and 9·5 months following LOT2, respectively. PFS was generally longer in patients treated with bortezomib-based or thalidomide-based therapy versus chemotherapy. These data shed light on recent trends in the management of MM in Latin America. Slower uptake of newer therapies in public clinics and poor PFS among patients with relapsed MM point to areas of unmet therapeutic need in Latin America.

Keywords: Latin America; epidemiology; multiple myeloma; progression-free survival; treatment patterns.

© 2019 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Selection of eligible multiple myeloma patients.
Figure 2
Figure 2
Antineoplastic treatment regimens by line of therapy (LOT) and autologous stem cell transplant (ASCT) status. The newer agents category included lenalidomide‐ and carfilzomib‐based therapies. ASCT status reflects whether patients ever versus never had an ASCT.
Figure 3
Figure 3
Progression‐free survival (PFS) following first‐line (LOT1) and second‐line therapy (LOT2) by autologous stem cell transplant (ASCT) status. P‐values reflect log‐rank tests for differences in PFS across patients treated with chemotherapy, thalidomide‐based therapy, or bortezomib‐based therapy. ASCT status reflects whether patients ever versus never had an ASCT.
Figure 4
Figure 4
Time trends: first‐line therapy (LOT1) by autologous stem cell transplant (ASCT) status and LOT1 initiation calendar year period. The newer agents category included lenalidomide‐ and carfilzomib‐based therapies. ASCT status reflects whether patients ever versus never had an ASCT.

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