Two decades of landscape change in the treatment of multiple myeloma.

Abstract

e19571 Background: The treatment of newly diagnosed multiple myeloma (NDMM) has evolved rapidly over the past two decades. We aimed to describe temporal trends in treatment patterns and clinical outcomes among patients in China. Methods: This retrospective cohort study utilized electronic medical record data from the National Longitudinal Cohort of Hematological Diseases in China. Eligible patients were ≥18 years at diagnosis and received ≥ 4 cycles induction therapy. Patients were excluded if previously treated for MM. Patients were followed until death, study end (June 30, 2023), or last follow-up via telephone. OS and PFS were estimated by Kaplan–Meier methods. Age group stratified Cox proportional hazards regression was performed to identify prognostic factors for survival. Results: A total of 1,622 patients were included. Median age was 57.0 years, and 18.4% were aged >65 years. Most patients were male. At diagnosis, 41.8% had ISS stage III disease. IgG was the predominant subtype, and high-risk cytogenetic abnormalities were present in 24.1% of patients. Induction therapy shifted from mainly chemotherapy to proteasome inhibitor–based regimens by 2009, and to PI+IMiD-based combinations by 2019. By 2023, about 60% of patients received PI+IMiD-based induction and 30% received anti-CD38 antibody–based induction. Utilization of autologous stem cell transplantation (ASCT) also increased steadily over time, ranging from 22% to 48% annually. With median follow-up of 35.6 months, survival improved steadily over time: median PFS increased from 32.3 months (95% CI: 26.7–38.9) in 2008–2012 to 33.6 months (95% CI: 30.7–36.7) in 2013–2017, and to 48.0 months (95% CI: 44.6–52.5) in 2018–2023, while median OS rose from 78.5 months to 85.6 months to not reached. Advanced ISS stage and high-risk cytogenetics were linked to poorer clinical outcomes. In contrast, ASCT and the use of PI+IMiD-based or CD38 antibody–based induction regimens independently correlated with improved PFS and OS. Among patients aged >65 years, treatment pattern shifts were similar to those in the overall cohort, with increasing use of PI+IMiD-based and anti-CD38 antibody–based induction in recent years. Since 2016, roughly 10% of older patients received ASCT. Improvements in PFS and OS across time periods were likewise observed in this age group as well. Conclusions: Over two decades, NDMM treatment in China has transitioned from chemotherapy-based regimens to widespread use of PI+IMiD combinations and increasing use of anti-CD38 antibodies, and expanding application of ASCT. These advances have driven meaningful improvements in PFS and OS across the study period. Similar trends were observed among patients aged >65 years. Continued efforts to expand access to novel agents and optimize treatment strategies are essential to sustain and accelerate these gains.