Evolution of real-world frontline treatment patterns in multiple myeloma

The number of Food and Drug Administration-approved treatments for multiple myeloma (MM), the second most common hematologic malignant neoplasm, has increased substantially over the past 2 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. Although randomized clinical trials have 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 with newly diagnosed MM from the national Veterans Affairs (VA) health system between 2000 and 2024. The VA offers a unique setting to study these patterns in the equal-access context, in which cost is less of a factor, allowing us to assess trends in treatment decisions and outcomes across diverse strata. We analyzed overall survival by treatment regimen, diagnosis era, and sociodemographic features. Lower socioeconomic status as approximated by the area deprivation index was independently associated with increased mortality despite equal health care 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 the structural and social barriers to optimal MM care.