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2385 Treatment of First Relapse of Multiple Myeloma in Australia and New Zealand (ANZ): Treatment Patterns and Outcomes: An ANZ Myeloma and Related Diseases Registry (ANZ MRDR) Analysis

Program: Oral and Poster Abstracts
Session: 907. Outcomes Research: Plasma Cell Disorders: Poster I
Hematology Disease Topics & Pathways:
Research, Adult, Clinical Practice (Health Services and Quality), Clinical Research, Health outcomes research, Real-world evidence, Treatment Considerations, Registries, Biological Processes, Study Population, Human, Pathogenesis
Saturday, December 7, 2024, 5:30 PM-7:30 PM

Betty Gration, BMBCh, MRCP, BSc, M.Bioch1*, Cameron Wellard, BSc (Hons), PhD2*, Elizabeth Moore, PhD, MPH, PgradDip (Nurs Crit Care)2*, Marianne Tan, MBChB3, Matthew Murphy4*, Kenneth J C Lim, MBBS5, James Rowland6*, Nada Hamad, MBBS, MSc, BSc1, Rajeev Rajagopal, MD, MBBS3*, Peter Mollee, FRACP, MBBS, MSc, FRCPA7, Andrew Spencer, MBBS, DM (Lond), FRACP, FRCPA8,9*, Hang Quach, MD, FRACP, FRCPA, MBBS10 and Georgia McCaughan, BMedSc MBBS MMed (Clin Epi) FRACP FRCPA1*

1Haematology Department, The Kinghorn Cancer Centre, St Vincent's Hospital, Darlinghurst, NSW, Australia
2School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
3Middlemore Hospital, Auckland, NZL
4Haematology, The Alfred Hospital, Melbourne, Australia
5Hematology, St Vincent's Hospital Melbourne, Brunswick, Australia
6Princess Alexandra Hospital, Brisbane, AUS
7Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
8Department of Malignant Haematology, Transplantation and Cellular Therapy Services, Alfred Health, Melbourne, Australia
9Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
10St. Vincent's Hospital Melbourne, East Melbourne, Australia

Aim:

There remains lack of consensus regarding whether relapsed multiple myeloma should be treated at clinical progression (CP) or biochemical progression (BP), and the ensuing clinical outcome. We described practices in Australia and New Zealand (ANZ) and the outcomes in these cohorts.

Method:

We conducted a retrospective review of ANZ Myeloma and Related Diseases Registry (ANZ MRDR) patients across 5 sites, that had progressed following first line therapy. Additional information was sought regarding timing of treatment at myeloma relapse (BP or CP) and presence of end organ damage (EOD) at 3-6 months. We determined progression free survival (PFS) and overall survival (OS) in these cohorts using Kaplan Meier methods.

Results:

Among 258 patients, 52% were treated at BP and 48% at CP. There was no significant difference in age, gender, ECOG, stage (ISS-3) or high-risk cytogenetics at diagnosis between groups. There was no significant difference in time to first progression (CP=20.6 months vs BP=21.7 months) or time between progression and initiation of therapy (CP=1.7 vs. BP=2.1 months). Patients treated at CP had a higher rate of persistent opioid requirement at 6 months (CP=32% vs BP=13.9%, p=0.001) and need for a mobility aid at 6 months (CP=12.7% vs. BP=3.5%, p=0.012), but there was no difference in fracture rates between the groups at 6 months (CP=10.6% vs. BP=10.5%, p=0.99). 68% of patients with renal EOD had no renal response as per IMWG at 3 months. There was a trend toward longer PFS and improved OS from initiation of second line therapy for those treated at BP versus those treated at CP however no statistical significance recognised at this study power (PFS: CP=8.5 months vs. BP=11.2 months, p=0.203, OS: CP=23.5 months vs. BP=33.7 months, p=0.06).

Conclusion:

Initial disease characteristics, time to first progression and time from progression to initiation of second line therapy did not differ between patients treated at BP versus those treated at CP. Treatment at CP was associated with more persistent EOD measured by requirement for opioids and mobility aids and the majority of those with renal EOD failed to have a renal response. Those treated at BP showed a trend towards improved PFS and OS compared to treatment at CP. This trend may be related to persistent EOD or more aggressive disease biology. The lack of statistical significance likely reflects poor power and warrants further investigation.

Disclosures: Lim: Sanofi: Research Funding. Mollee: Janssen, Pfizer: Membership on an entity's Board of Directors or advisory committees, Research Funding; Antengene: Research Funding, Speakers Bureau. Spencer: Celgene, Janssen Cilag: Consultancy, Honoraria, Research Funding. Quach: Roche: Consultancy; Pfizer: Consultancy; Sanofi: Consultancy, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding; Karyopharm: Consultancy, Research Funding; GSK: Consultancy, Research Funding; AbbVie: Research Funding; Johnson & Johnson: Consultancy. McCaughan: Pfizer: Honoraria; Janssen: Honoraria.

*signifies non-member of ASH