OBJECTIVES: Patients with relapsed/refractory multiple myeloma (RRMM) who are triple-class exposed (TCE) to a proteasome inhibitor (PI), immunomodulatory drug, and anti-CD38 antibody have a poor prognosis. Current understanding around management of these patients and associated healthcare resource utilization (HCRU) is limited outside the US. Here, we report findings from the ITEMISE study regarding management, HCRU, and end-of-life (EoL) care for TCE patients with RRMM in Canada and Europe.

METHODS: This study utilized a 3-phase Delphi-like approach consisting of in-depth interviews with 7 hematology experts, the development of a cross-sectional survey fielded to hematologists across Belgium, Canada, France, Germany, Italy, Netherlands, Spain, Sweden, Switzerland, and the UK from August to October 2020, and a final consensus workshop of hematology experts to validate the results. Hematologists considered HCRU post-TCE, including treatment options, outcomes, and the frequency of hospital visits. Pooled survey findings for all countries were analyzed using descriptive statistics including measures of central tendency and spread.

RESULTS: 202 hematologists completed the survey (60% from academic hospitals, 38% from public hospitals, and 2% from private practice). An estimated 56% of patients received active treatment post-TCE; most frequently immunomodulatory drug-, anti-CD38 antibody-, or PI-based regimens (received by 23%, 18%, and 15% of patients, respectively). Patients were estimated to have a median of 2 outpatient visits prior to and during the first treatment post-TCE, and 2 unplanned hospitalizations. During EoL care, an estimated 79% of patients received care outside of hospital, with 2 unplanned hospitalizations of 6 bed days per stay.

CONCLUSIONS: Survey findings indicate the intent to actively treat TCE patients with a range of combination regimens including PIs, immunomodulatory drugs, and anti-CD38 antibodies. The HCRU burden associated with the management of patients post-TCE highlights the significant need for better treatment options to improve patient prognosis, thereby reducing HCRU across Europe and Canada.