OBJECTIVES: Survival of patients with multiple myeloma (MM) has improved significantly with access to autologous stem cell transplant (SCT) and new treatments. This study aims to describe the real-world epidemiology, treatment patterns and outcomes of MM.

METHODS: A retrospective database study was conducted in Maccabi Healthcare Services (MHS), a 2-million-member nationwide health plan in Israel. MM was defined by cross-linking data on MM diagnoses, dispensed treatments, and serum free light-chain assays. Prevalence (31/12/2016) and incidence (2012-2016) rates were age-standardized (WHO). Newly diagnosed and treated patients (2009-2015) were followed through 31/12/2016 for overall survival (OS) and cumulative incidence of progression to second-line (L2), with death as a competing risk.

RESULTS: MM prevalence and incidence rates were 2.6 per 10,000 and 4.6 per 100,000 population, respectively. In the treatment cohort (N=552), mean (SD) age was 65.6 (11.3) years (60.1% male), with a median of 6 weeks from diagnosis to treatment. Median (95% CI) OS was 5.2 (4.3-6.1) years overall and 6.5 (4.9-8.1) years for first-line (L1) bortezomib (N=421). In a multivariable analysis adjusting for L1 regimen and patients characteristics and comorbiditeis, OS was significantly higher among patients who initiated L1 in 2012-2015 vs. 2009-2011. Within a year, 38.4% underwent SCT. Cumulative incidence of L2 was 38.2% and 51.4% within 1 and 2 years, respectively, and was associated with older age (≥65y; P<0.001).

CONCLUSIONS: The results of this real-world analysis in a large heterogeneous population demonstrate MM incidence and survival rates that are in line with the literature, together with a significant improvement in overall survival over time. Approximately half of newly treated patients progressed to L2 within two years and older patients progressed significantly faster. These results will serve as a baseline for further research to evaluate the clinical impact of new interventions.