Mapping of Treatment Lines and Regimens for Multiple Myeloma Patients in Sweden

OBJECTIVES: First-line treatment pattern in multiple myeloma (MM) is well documented in Sweden, but for treatment of recurrence, data is limited. We attempted to use electronic records from five regions in Sweden, covering 27% of the national population, to observe how treatment of MM patients varied with line of therapy and with time between the years 2017-2021.

METHODS: Data on patient records from five Swedish regions were linked to the national administrative registers for prescribed drugs, outpatient/inpatient care and causes-of-death-registry. The analysis set contained data from MM patients diagnosed 2015 onward, enabling long-term patient follow-up to assess treatment beyond first line. An algorithm was created to define line advancement. A two-year washout period, and a minimum of 6 months follow-up was implemented. To support secondary insights, myeloma-specific treatment regimens were referenced against recommendations in national treatment guidelines.

RESULTS: Patient selection criteria refined the initially identified 3063 MM patients to 1078 with complete follow-up; 100% first line, 51% second, 27% third, 14% fourth and 7% fifth line respectively. Patient distribution is in line with clinical experts’ experience and previously published European data, validating the algorithm for defining line advancement. Results indicate that lenalidomide regimens are highly used throughout treatment lines. Use of regimens containing daratumumab increases overall, and in earlier lines, over time. Moreover, results show that clinicians are deviating from guidelines already in second line.

CONCLUSIONS: We conclude that it is feasible to utilize regional Swedish data for assessing MM treatment regimens used in lines 1-5. Overall, observed trends are in line with published data and verified by Swedish clinical experts. The observation that clinicians deviate early from current MM treatment guidelines emphasizes the importance of studies of real-life treatment patterns. In fact, these studies can be an important tool to demonstrate the need for clearer practical guidance.