Evolution of Real-World Front-Line Treatment Patterns in Multiple Myeloma

The number of Food and Drug Administration (FDA)-approved treatments for multiple myeloma (MM), the second most common hematologic malignancy, has increased substantially over the past two decades. Treatment decisions have become more complex over time, and there is variable adoption of new agents in clinical practice. Survival trends have improved with novel therapies; however, these trends are not equitably distributed across patient populations. While randomized clinical trials guide treatment strategies, their exclusion of older, medically complex, and socioeconomically disadvantaged patients limits applicability to real-world outcomes. Understanding the natural history of MM and how treatment patterns have changed over time is essential for informing optimal MM care in clinical practice. We retrospectively evaluated 20,135 patients from the national Veterans Affairs (VA) health system with newly diagnosed MM between 2000 and 2024. The VA offers a unique setting to study these patterns in the equal access context where cost is not as much of a factor, allowing us to assess trends in treatment decisions and outcomes across diverse strata. We analyzed overall survival (OS) by treatment regimen, diagnosis era and sociodemographic features. Lower socioeconomic status as approximated by the area deprivation index (ADI) was independently associated with increased mortality despite equal healthcare access. Outcomes continue to improve across treatment eras, although follow-up in the most recent cohort is limited and long-term survival remains incompletely characterized. These findings underscore the need for implementing strategies to address structural and social barriers to optimal MM care.