Time from diagnosis to treatment in multiple myeloma: A systematic review and meta-analysis.

Abstract

e19539 Background: While delays in systemic therapy initiation adversely impact survival in various malignancies, the magnitude and clinical significance of the diagnosis-to-treatment interval in newly diagnosed multiple myeloma (NDMM) remain poorly characterized. This systematic review synthesizes global evidence on time to first treatment (TTFT) and its association with patient demographics and clinical outcomes in NDMM. Methods: A systematic search was designed and executed by a medical librarian across OVID MEDLINE, CINAHL, Scopus, and Cochrane databases through December 31, 2025. Eligible studies included cohort, registry, or observational designs reporting median TTFT in adults (≥ 18 years) with NDMM; smoldering myeloma was excluded. Following PRISMA 2020 guidelines, title/abstract screening and full-text review were performed. The primary outcome was the weighted pooled median TTFT. Pearson’s correlation coefficient (r) evaluated the relationship between study midpoint and TTFT, and Cohen’s d determined the effect size of differences between data sources. Risk of bias was assessed using the Aarhus Checklist. The study protocol was registered in PROSPERO (CRD420261290973). Results: From 4,878 initial records, 11 studies (119,626 patients) across six countries met the inclusion criteria and were analyzed. Most studies were US-based (n=8; 72%) and many utilized real-world EHR datasets (n=6; 55%), while the remainder utilized registry data (n=5; 45%). Frequently analyzed variables included age/sex (91%), geography (82%), and socioeconomic status (72%); fewer assessed comorbidities (55%), disease stage (36%), survival (36%), or high-risk cytogenetics (19%). The overall weighted pooled median TTFT was 55.9 days. A significant negative correlation was observed between study midpoint year and TTFT (r = −0.45, p = 0.04), indicating improving efficiency over two decades. However, registry-based cohorts demonstrated significantly longer TTFT compared to EHR cohorts (mean difference: 64.73 days; p = 0.0199; Cohen’s d = 1.43). Conclusions: This review identifies a global weighted pooled median TTFT of 55.9 days in NDMM. While systemic efficiency has improved (r=−0.45), the profound discrepancy between data sources (d=1.43) suggests that registry-based benchmarks may inaccurately reflect clinical reality. These findings challenge the reliance on large-scale abstracted databases for quality-of-care assessments. Furthermore, the lack of data on high-risk cytogenetics and survival outcomes represents a critical knowledge gap. Prospective studies are urgently required to establish evidence-based TTFT benchmarks that correlate treatment intervals with clinical outcomes and ensure equitable access.