Factors associated with second-line triplet therapy in routine care in relapsed/refractory multiple myeloma.
J Clin Pharm Ther
; 43(1): 45-51, 2018 Feb.
Article
in En
| MEDLINE
| ID: mdl-28833305
ABSTRACT
WHAT IS KNOWN AND OBJECTIVE:
Second-line therapy (SLT) trials in relapsed/refractory multiple myeloma (RRMM) report superior outcomes with triplet combinations. We sought to determine factors associated with triplet SLT in routine practice.METHODS:
A retrospective cohort with claims for MM between 01/01/2008 and 03/31/2015 was grouped by 1-2 ("doublet") or 3+ ("triplet") agent therapy. Charlson comorbidity index (CCI) and disability status; CRAB symptoms (hypercalcaemia, renal/bone disease, anaemia); and relapse risk were determined.RESULTS:
Among 623 patients, the triplet group (n=146 [23%]) was younger (65.2 vs 69.8 years) and more likely to have high-risk relapse (67% vs 50%), CRAB symptoms (94.5% vs 81.1%), triplet first-line treatment (75% vs 51%) and frontline stem cell transplant (38% vs 20%) (P<0.001 for all). In multivariate analyses, CRAB symptoms (OR 3.22, 95% CI 1.47, 7.10), high-risk relapse (OR 1.71, 95% CI 1.12, 2.62) and prior triplet therapy (OR 2.16, 95% CI 1.38, 3.40), but neither CCI nor disability, were associated with triplet SLT. A trend towards triplets among younger patients (<65 vs >75 years, OR 1.73, 95% CI 0.99, 3.04) was observed. WHAT IS NEW ANDCONCLUSION:
The majority of patients did not receive triplet regimens. Treatment selection with triplet therapy for RRMM should carefully consider comorbidities and patient-specific characteristics.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Antineoplastic Combined Chemotherapy Protocols
/
Multiple Myeloma
/
Neoplasm Recurrence, Local
Type of study:
Observational_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Male
Language:
En
Journal:
J Clin Pharm Ther
Journal subject:
FARMACIA
/
TERAPEUTICA
Year:
2018
Document type:
Article
Affiliation country:
United States