Temporal patterns in US population-based patient survival among adults treated with chemotherapy and/or immunotherapy...

Few population-based studies have rigorously evaluated overall survival (OS) differences among adults treated with chemotherapy and/or immunotherapy (chemo/immunotherapy) for multiple myeloma (MM) during the past two decades when the therapeutic landscape substantially evolved. We evaluated OS among 50 288 adults diagnosed with MM between 2000 and 2019 reported to have received initial chemo/immunotherapy. We calculated hazard ratios (HRs) using multivariable Cox regression to compare OS across calendar periods and within patient demographic groups. OS improved over time (2000-2004 = reference; HR_2005-2009 = 0.77, 95% CI = 0.75-0.79; HR_2010-2014 = 0.65, 95% CI = 0.63-0.67; HR_2015-2019 = 0.56, 95% CI = 0.54-0.58) with a similar pattern across age, sex, racial-ethnic and county-level median household income groups. However, demographic differences were noted within each calendar period and persisted in 2015-2019, with more favourable survival among females (males = reference; HR = 0.91, 95% CI = 0.87-0.96) and consistently higher mortality among older patients (45-64 years = reference; HR_{65-79 years} = 1.69, 95% CI = 1.59-1.80; HR_{≥80 years} = 3.32, 95% CI = 3.08-3.58); Black, Hispanic and Pacific Islander patients (White = reference; HR_Black = 1.07, 95% CI = 1.00-1.15; HR_Hispanic = 1.08, 95% CI = 1.00-1.16; HR_{Pacific Islander} = 1.85, 95% CI = 1.40-2.44); and patients living in counties with household incomes <$75 000. Despite progressive and significant improvement in patient survival following initial chemo/immunotherapy for MM, unmet medical needs persisted among older age groups; males; Black, Hispanic and Pacific Islander patients; and those living in lower income counties.