Real-World Treatment Patterns and Clinical Outcomes in Patients With Multiple Myeloma Previously Treated With Lenalidomide and an Anti-CD38 Monoclonal Antibody

Karthik Ramasamy; Ravi Vij; David Kuter; David Cella; Brian G M Durie; Rafat Abonour; Robert M Rifkin; Sikander Ailawadhi; Hans C Lee; Andrew J Cowan; Carrie Ho; Sujith Dhanasiri; Susan Fish; Edward Yu; Amol D Dhamane; Jiaqi Fang; Thomas S Marshall; Amir Samuel; Liang Liu; Jessica Katz; Tao Gu; Sundar Jagannath

doi:10.1016/j.clml.2024.12.002

Real-World Treatment Patterns and Clinical Outcomes in Patients With Multiple Myeloma Previously Treated With Lenalidomide and an Anti-CD38 Monoclonal Antibody

Clin Lymphoma Myeloma Leuk. 2024 Dec 6:S2152-2650(24)02441-8. doi: 10.1016/j.clml.2024.12.002. Online ahead of print.

Authors

Karthik Ramasamy¹, Ravi Vij², David Kuter³, David Cella⁴, Brian G M Durie⁵, Rafat Abonour⁶, Robert M Rifkin⁷, Sikander Ailawadhi⁸, Hans C Lee⁹, Andrew J Cowan¹⁰, Carrie Ho¹⁰, Sujith Dhanasiri¹¹, Susan Fish¹², Edward Yu¹², Amol D Dhamane¹², Jiaqi Fang¹², Thomas S Marshall¹², Amir Samuel¹², Liang Liu¹², Jessica Katz¹², Tao Gu¹², Sundar Jagannath¹³

Affiliations

¹ Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Oxford Translational Myeloma Centre, NDORMS, University of Oxford, Oxford, UK. Electronic address: kramasamy@nhs.net.
² Siteman Cancer Center, Washington University, St. Louis, MO.
³ Hematology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
⁴ Department of Medical Social Sciences and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL.
⁵ Cedars Sinai Cancer Center, Los Angeles, CA.
⁶ Indiana University School of Medicine, Indianapolis, IN.
⁷ Rocky Mountain Cancer Centers/US Oncology Research, Denver, CO.
⁸ Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL.
⁹ Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX.
¹⁰ University of Washington / Fred Hutchinson Cancer Center, Seattle, WA.
¹¹ Bristol Myers Squibb, Boudry, Switzerland.
¹² Bristol Myers Squibb, Princeton, NJ.
¹³ Icahn School of Medicine at Mount Sinai, New York, NY.

PMID: 39799046
DOI: 10.1016/j.clml.2024.12.002

Abstract

Background: This analysis explored real-world characteristics, treatment patterns and clinical outcomes in patients with relapsed or refractory multiple myeloma (RRMM) previously treated with lenalidomide and an anti-CD38 monoclonal antibody (mAb) and requiring subsequent treatment.

Materials and methods: The PREAMBLE and Connect MM prospective registries of patients with multiple myeloma (MM), and the US nationwide Flatiron Health electronic health record-derived de-identified database were analysed. MM-specific treatment patterns (prior/index therapies) and outcomes (progression-free survival [PFS]/overall survival [OS]) were assessed.

Results: This analysis included: PREAMBLE n = 215; Connect MM n = 232; Flatiron Health n = 845. Median age at index was 69.0 years, median 3 prior lines of therapy; > 50% male. The most common index regimens accounted < 15% of treatments (most common PREAMBLE, Connect MM: carfilzomib±dexamethasone; Flatiron Health: pomalidomide+daratumumab+dexamethasone); most patients received classes that they had previously; ≥ 93% were triple-class exposed (immunomodulatory drug, proteasome inhibitor, anti-CD38 mAb). In PREAMBLE, Connect MM and Flatiron Health, respectively: 80.9%, 68.1% and 77.2% were lenalidomide- and anti-CD38 mAb-refractory; 69.3%, 67.2% and 71.1% were triple-class refractory (TCR); median PFS: 5.2 (95% CI 3.7-6.7), 4.4 (3.5-5.6) and 5.3 months (4.8-6.0); median OS: 19.3 (15.8-26.1), 14.2 (11.0-16.9) and 23.1 months (19.0-28.6). PFS and OS were shorter in lenalidomide- and anti-CD38 mAb-refractory patients versus those who were not refractory to both. A similar pattern was observed for TCR patients versus non-TCR patients.

Conclusion: There is no uniform standard of care for patients with RRMM with prior exposure to lenalidomide and anti-CD38 mAbs. Survival outcomes are poor, with a need for effective treatments for these patients.

Keywords: Immunomodulatory drugs; Monoclonal antibodies; Observational; Relapsed/refractory Multiple myeloma; Standard of care; Survival outcomes.