OBJECTIVES

High-dose chemotherapy with subsequent autologous stem cell transplantation (ASCT) was shown to be superior over conventional chemotherapy for patients with multiple myeloma (MM) aged <65 years. We aimed to investigate ASCT rates and overall survival (OS) in MM patients in a real world setting.

METHODS

Using claims data from a German sickness fund (01/01/2010-30/09/2017), we identified patients newly diagnosed with MM (ndMM; inpatient diagnosis ICD-10:C90.00 and no MM diagnosis and no anti-cancer treatment in 12 months baseline period). Anti-cancer treatment in the 12-month follow-up-period was identified using inpatient procedure codes for respective agents/ASCT or outpatient ATC codes. Patient characteristics (age/gender/Charlson Comorbidity Index (CCI)) were compared between patients who received/did not receive an ASCT, OS was compared between these groups using Cox proportional hazards models.

RESULTS Based on above 524 patients, 109 patients (20.8%) received an ASCT. ASCT patients were younger (60.3 versus 74.3 years; p<0.001) and less comorbid than non-ASCT patients (mean CCI: 5.5 versus 7.3; p<0.001). ASCT rate in the age group <65 years (n=121) was 63.6% versus 7.9% for ≥65 years.

Median OS was considerably higher in the ASCT group (54.6 versus 18.5 months; adjusted HR (by age/gender/CCI) 0.370; 95%CI: 0.235-0.583). In the ASCT group, age/gender/CCI were not associated with OS, whereas age was associated with earlier death in the non-ASCT group (HR: 1.030; 95%CI: 1.013-1.048).

CONCLUSIONS

In a real-world setting, 63.6% of treated MM patients aged <65years receive an ASCT. ASCT is a major driver of longer OS. However, even with ASCT, real-world median OS of ndMM patients is slightly higher than 4.5 years.