OBJECTIVES:  To determine the proportion and characteristics of patients with symptomatic MM who experienced a SRE in first- and/or second-line of treatment. METHODS:  Non-interventional, retrospective chart review collected data from patient medical records in 2014. Patients with symptomatic MM were included in reverse chronological order in the study up to three months after completion of the most recent line of anti-tumour drug treatment. Data collection included patient and disease characteristics at diagnosis, treatment patterns and outcomes across all prior treatment lines. RESULTS: Among the 3182 patients who completed a first or second line of therapy, at diagnosis of symptomatic MM, 67% presented with bone-related symptoms (57% bone pain, 19% vertebral fracture, 5% other fracture and 2% spinal cord compression). A third (n=965) of the first- and second-line patients experienced a SRE since MM diagnosis (31% for 1L, 30% for 2L). Of those who had experienced a SRE since diagnosis, 61% had a pathologic fracture (n=587), 53% radiation to bone (n=509), 16% surgery to bone (n=151) and 7% spinal cord compression (n=70). Renal status was similar between those in first-line and second-line at diagnosis, 55% had normal renal status (n=531), 28% mild renal failure (CICr>50 mL/min) (n=266), and 17% moderate or severe renal failure (CICr<49mL/min) (n=167). Patients with moderate or severe renal failure had slightly higher incidence of SREs after diagnosis (32% and 37%, respectively) compared with 29% and 30% for normal or moderate renal status. CONCLUSIONS:  Bone lesion-related symptoms and renal damage are some of the main criteria leading to diagnosis of symptomatic MM. Bone lesion-related symptoms impact a significant proportion of patients despite effective anti-myeloma treatment especially in earlier lines, underlying the need for targeted therapies to prevent SREs.