P-362: A Real-World Study to Assess Treatment Patterns of Patients with 2L+ Relapsed or Refractory Multiple Myeloma in Italy, Germany, and the United Kingdom

Introduction: Despite available treatments, multiple myeloma (MM) remains incurable, and most pts experience relapses. Pts with relapsed or refractory MM (RRMM) have a poor prognosis, with limited survival. The use of daratumumab (dara) as part of frontline combinations, including with lenalidomide (len), has shifted the treatment landscape for RRMM. This study describes treatment patterns of pts with RRMM who initiated second-line (2L) therapy in Italy, Germany, and the UK, with a focus on dara and len use in first-line (1L) and 2L treatment.

Methods: This was a retrospective, physician panel-based chart review study. Data on clinical and demographic characteristics of pts and treatment patterns were collected from medical charts for pts with RRMM who initiated 2L therapy between Jan 2018 and Dec 2022. Pts were ≥18 years old at the time of 2L initiation.

Results: For participating physicians (N=214; Italy, n=79; Germany, n=69; UK, n=66), most (90.2%) were in urban settings and 67.3% were at academic hospitals. The study cohort included 611 pts, 246 from Italy, 192 from Germany, and 173 from the UK; 69.2% were male. Age at 2L initiation was similar across countries, with a mean ± standard deviation of 66.1 ± 10.2 years overall. The UK had a higher percentage of pts with Black/African/Caribbean ethnicity (19.7%) compared with Italy (0.8%) and Germany (3.6%). Fewer pts in Italy (2.4%) reported a family history of MM versus Germany (6.8%) and the UK (10.4%). Most (51.7%) pts had an ECOG score of 1 (Italy [52.4%], Germany [47.9%], UK [54.9%]). At diagnosis, most pts in Germany presented with ISS/R-ISS Stage II MM (54.2%); in Italy and the UK, the majority presented with ISS/R-ISS Stage III MM (60.2% and 48.6%, respectively). All pts received 2L therapy; 83.0% pts had 2L as last line of therapy (Italy [89.8%], Germany [81.8%], UK [74.6%]), while 17.0% had 3L+ (Italy [10.2%], Germany [18.2%], UK [25.4%]). Overall, stem cell transplantation (SCT) occurred in 25.2% and 7.4% of pts during 1L and 2L. For non-SCT pts, 68.5% and 71.6% received combination therapy in 1L and 2L, with len + bortezomib + dexamethasone (dex) (16.3%) and len + dara + dex (18.3%), respectively, being the most common regimens. Any len use was 40.3% and any dara use was 11.3% in 1L, and 45.2% and 32.2%, respectively, in 2L. Len use was relatively steady from 2018–2022 for 1L (39.8%–47.8%) and from 2019–2022 for 2L (40.2%–52.5%). Dara use (2018–2022) ranged from 8.7%–17.8% for 1L, and 21.8%–37.2% for 2L.

Conclusions: In this EU real-world population, dara use was relatively low for 1L and increased for 2L during the study period. Following regulatory approvals of the MAIA dara + len + dex regimen, it is likely that 1L use of this combination will increase over time, potentially increasing the proportion of pts refractory to len-based treatments. Due to variations in pt profiles observed across countries, results at a country level may not be generalizable to the overall MM population.