Contributions
Abstract: PB2224
Type: Publication Only
Background
The introduction of novel agents during the last decade has improved the clinical outcome in patients with recurrent/refractory multiple myeloma (R/R MM), which has allowed to increase the number of lines and the types of treatment received. Nevertheless, most studies are performed within clinical trials and there are few data on sequential treatments in real-world clinical practice, where treatments are not completed.
Aims
To study the frequency and reasons for not receiving next line of treatment in a real-life cohort of patients with R/R MM.
Methods
Main clinical-biological characteristics of 108 patients diagnosed of MM between 2010 and 2016 in a tertiary centre were collected. Patients were categorized according to the last line of treatment received, including palliative treatment with cyclophosphamide as a line.The reasons for not receiving a subsequent treatment in each line were defined as: response (not needing further therapy), treatment-related toxicity and death (due to toxicity, disease progression or other causes).Overall survival and time to next treatment curves were calculated by kaplan meier method. A competitive risk analysis was carried out to estimate the projected proportion of patients receiving second and third lines considering death, toxicity disqualifying for further therapy or loss of follow-up as competitive events.
Results
The reasons for not receiving a next line of treatment, at the time of the analysis, are summarized in Table1.Thirty-five out of 108 patients (32%) received only a first line. Thirty-one percent of them (11/35) remained in response without requiring rescue treatment. Fourteen percent (5/35) discontinued treatment due to death in the context of progression and 11.5% (4/35) due to toxicity-related death. Twenty percent (7/35) died due to causes not related to MM, as other neoplasms (9%; 3/35). Only 3% of patients could not receive further treatment due to serious toxicities that did not result in death.Twenty-seven percent of patients (n=29) received only treatment up to the second line. The discontinuation due to death by progression and death by toxicity was 17% (5/29), in both cases.Twenty percent of patients (n=21) received treatment only up to the third line. Death by progression was the most frequent cause of not receiving successive lines (40%; 8/21), whereas severe toxicity and death by treatment-related complications were the reason in 5% and 14% of patients, respectively.Only 12 patients received treatment up to fourth line, 7 up to fifth line and 1 up to sixth line. The cause of not continuing treatment was mainly death by progression (41% and 40% in fourth and fifth lines, respectively). No responses were observed in these lines.The median overall survival of the series was 25 months. Median of time to next treatment were 16, 15 and 13 months in first, second and third line, respectively. The projected probability of receiving a second line of treatment at 60 months was 78% whereas probability of receiving third line at 60 months was 53% by competitive-risk analysis (68% of the 78% remaining).
Conclusion
-In our series, 78 % of patients were estimated, by competitive risk analysis, to receive a second line of therapy at 60 months. Patients do not access a second line mainly due to death.
-While the main reason for discontinuation in the first line was not needing further therapy, the main cause in successive lines was death by progression (25% of the global series) increasing its frequency according to the number of lines received.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Myeloma, Progression, Refractory, Treatment
Abstract: PB2224
Type: Publication Only
Background
The introduction of novel agents during the last decade has improved the clinical outcome in patients with recurrent/refractory multiple myeloma (R/R MM), which has allowed to increase the number of lines and the types of treatment received. Nevertheless, most studies are performed within clinical trials and there are few data on sequential treatments in real-world clinical practice, where treatments are not completed.
Aims
To study the frequency and reasons for not receiving next line of treatment in a real-life cohort of patients with R/R MM.
Methods
Main clinical-biological characteristics of 108 patients diagnosed of MM between 2010 and 2016 in a tertiary centre were collected. Patients were categorized according to the last line of treatment received, including palliative treatment with cyclophosphamide as a line.The reasons for not receiving a subsequent treatment in each line were defined as: response (not needing further therapy), treatment-related toxicity and death (due to toxicity, disease progression or other causes).Overall survival and time to next treatment curves were calculated by kaplan meier method. A competitive risk analysis was carried out to estimate the projected proportion of patients receiving second and third lines considering death, toxicity disqualifying for further therapy or loss of follow-up as competitive events.
Results
The reasons for not receiving a next line of treatment, at the time of the analysis, are summarized in Table1.Thirty-five out of 108 patients (32%) received only a first line. Thirty-one percent of them (11/35) remained in response without requiring rescue treatment. Fourteen percent (5/35) discontinued treatment due to death in the context of progression and 11.5% (4/35) due to toxicity-related death. Twenty percent (7/35) died due to causes not related to MM, as other neoplasms (9%; 3/35). Only 3% of patients could not receive further treatment due to serious toxicities that did not result in death.Twenty-seven percent of patients (n=29) received only treatment up to the second line. The discontinuation due to death by progression and death by toxicity was 17% (5/29), in both cases.Twenty percent of patients (n=21) received treatment only up to the third line. Death by progression was the most frequent cause of not receiving successive lines (40%; 8/21), whereas severe toxicity and death by treatment-related complications were the reason in 5% and 14% of patients, respectively.Only 12 patients received treatment up to fourth line, 7 up to fifth line and 1 up to sixth line. The cause of not continuing treatment was mainly death by progression (41% and 40% in fourth and fifth lines, respectively). No responses were observed in these lines.The median overall survival of the series was 25 months. Median of time to next treatment were 16, 15 and 13 months in first, second and third line, respectively. The projected probability of receiving a second line of treatment at 60 months was 78% whereas probability of receiving third line at 60 months was 53% by competitive-risk analysis (68% of the 78% remaining).
Conclusion
-In our series, 78 % of patients were estimated, by competitive risk analysis, to receive a second line of therapy at 60 months. Patients do not access a second line mainly due to death.
-While the main reason for discontinuation in the first line was not needing further therapy, the main cause in successive lines was death by progression (25% of the global series) increasing its frequency according to the number of lines received.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Myeloma, Progression, Refractory, Treatment