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    Treatment of Newly Diagnosed Myeloma (excluding t-cell redirection therapy)

    First-Line Treatment Landscape in Multiple Myeloma: Analysis of Stem Cell Transplantation and Drug Utilization in Brazil and Argentina from the TOTEMM-A and TOTEMM-B Real-World Studies

    P-319: First-Line Treatment Landscape in Multiple Myeloma: Analysis of Stem Cell Transplantation and Drug Utilization in Brazil and Argentina from the TOTEMM-A and TOTEMM-B Real-World Studies

    Friday, September 27, 2024
    Introduction: Real-world data on patients with multiple myeloma (MM) are scarce in Latin America; consequently, the treatment landscape remains poorly understood. The TOTEMM study was conducted to describe real-world treatment patterns and clinical outcomes of patients with MM in Brazil (TOTEMM-B) and Argentina (TOTEMM-A). Here, we describe treatment characteristics in patients with MM in both countries.

    Methods: Both studies comprised a retrospective database analysis. TOTEMM-A used a database of electronic private medical records from Hospital Italiano between Jan 2010 and Dec 2021, and TOTEMM-B used administrative claims data from patients with private insurance plans from Orizon between Jan 2015 and Jun 2021. Index was defined as a proxy of diagnosis and could be the first MM-related health term/ICD-10 code, or any related procedure, exam, or treatment for MM. Adults (≥18 years) with ≥1 MM-related health term/ICD-10 code and ≥12 months of follow-up after index were included. Frequencies of stem cell transplant (SCT) or antineoplastic drug (AD) use for incident cases (treatment naïve for ≥1 year before MM index) were described.

    Results: In TOTEMM-A and -B, 134 and 736 patients with MM, respectively, from the incident cohort were included. In TOTEMM-A, 6.0% were diagnosed at <50 years old, whereas in TOTEMM-B this was 14.1%. Mean (standard deviation [SD]) age was 70.9 (11.6) years in TOTEMM-A and 61.9 (11.3) years in TOTEMM-B. Mean (SD) follow-up in TOTEMM-A was 58.9 (32.6) and in TOTEMM-B was 30.6 (14.3) months. In TOTEMM-A, mean (SD) weight was 74.7 (17.8) kg and 71.0% had a body mass index of ≥25 kg/m2 (no data for TOTEMM-B). Median (interquartile range [IQR]) time from index until first treatment was 1.1 (4.4) months in TOTEMM-A and 0.9 (1.5) months in TOTEMM-B. Around one-fifth underwent SCT in TOTEMM-A (17.9%) and one-third in TOTEMM-B (32.2%) during follow-up. In TOTEMM-A, two patients underwent SCT in 1L therapy, and the time from index until SCT was 17.0 months. In TOTEMM-B, 9.6% (n=57) underwent SCT in 1L therapy, and the median (IQR) time from index to SCT was 6.0 (3.3) months. Among those who received ADs in 1L, 69.4% (n=93) received triple therapy and 2.2% (n=3) received quadruple therapy in TOTEMM-A, whereas in TOTEMM-B, 58.2% (n=424) received triple and 8.4% (n=61) quadruple therapy. Median (IQR) number of lines of therapy for the incident cases in TOTEMM-A was 3 (3) and in TOTEMM-B was 3 (2). More than 80% of both populations received ≥2 LOTs: in TOTEMM-A, 82.1% (n=110); and in TOTEMM-B, 82.1% (n=604).

    Conclusions: In Argentina and Brazil, less than two-fifths of treated patients with MM underwent SCT contrasting with studies in Europe and the USA that have a higher rate of SCT. Even in countries within Latin America, there are differences in demography and practices that could further impact patient outcomes. Efforts to better understand the prognostic factors reported here are crucial to support improvements for patients.