OBJECTIVES: Multiple myeloma (MM) treatment continues to evolve rapidly with numerous drug options available. Major changes have also occurred in the diagnostic criteria, staging system, and response criteria in the last decade. These changes, along with the emerging data from randomized clinical trials, influence treatment decisions during the treatment course. In front line, treatment decision impacts on the subsequent treatment lines decisions. This study aimed to explore physicians’ decision drivers for MM front-line transplant eligible (FLTE) patients in a real-world setting.

METHODS: Qualitative in-depth interviews were conducted with a purposive sample of 40 hematologists and onco-hematologists in France, Italy, Spain, and Germany. All interview transcripts were coded with the NVivo software for emergent themes and pattern analysis.

RESULTS: The choice of specific therapy for FLTE patients is affected by many variables. International guidelines and their adaptations to local context primarily influence MM FLTE treatment decisions. Patients-related factors, such as age, comorbidities and personal situation are also part of the treatment decision process like reimbursement and other organizational factors, including access to treatment to transplant facility and minimal residual disease (MRD) testing. Additionally, the individual experience and habits of the physicians, which constitute more subjective factors, also influence MM FLTE treatment rationale. This includes physicians’ treatment goals, their perception of consolidation and maintenance therapy and their interpretation of MRD and transplant eligibility reassessment criteria.

CONCLUSIONS: Even if the treatment algorithm in the FLTE setting is well defined, guidelines, patient-related considerations, organizational factors, and physician’s personal experience greatly shape the decision process. Factors influencing treatment decisions are key to understand the local differences in terms of management process. This also highlight the importance of Real World data in complementing and supporting clinical practice.