Real-World Practice in the Management of Transplant-Eligible Newly Diagnosed Multiple Myeloma: A US-Based...

Transplant-eligible newly diagnosed multiple myeloma (TE-NDMM) is typically managed with induction therapy, high-dose chemotherapy consolidation, and subsequent maintenance therapy. This survey-based study explored real-world practices by evaluating how a patient's cytogenetic risk stratification, physician's institutional affiliation, sub-specialty, and years of experience influence the choice of regimens.

From May to July 2024, a cross-sectional survey was conducted among US-based hematologists and oncologists, including plasma cell disorder specialists. The survey gathered data on induction, consolidation, and maintenance therapies for TE-NDMM patients with risk stratification based on cytogenetic profiles. Descriptive and inferential statistical analyses identified trends and associations between covariates.

The combination of daratumumab, bortezomib, lenalidomide, and dexamethasone (Dara-VRd) was found to be the predominant induction regimen for high-risk (78%), standard-risk (63%), and fluorescence in situ hybridization (FISH)-status unavailable disease (73%). The most used regimens involved a weekly dose of subcutaneous bortezomib, a lower dose of dexamethasone, and lenalidomide 25 mg given in a 21/28-day cycle. Additionally, post-transplant lenalidomide monotherapy was the frequently used maintenance strategy. Minimal residual disease (MRD) assessment was underutilized among participants. Physician specialty influenced regimen selection, with plasma cell specialists favoring newer quadruplet therapies. Likewise, a physician's institutional affiliation and years of practice further contributed to real-world practice variability.

Real-world practice patterns demonstrate antibody-based four-drug induction regimens as the preferred choice in TE-NDMM, highlighting evidence-based adoption. Doses were modified to optimize patient outcomes, efficacy, safety, and disease control. However, variability in post-transplant maintenance and underutilization of MRD assessment underscores the need for standardized guidelines.