Health care systems as determinants of outcomes in multiple myeloma: final results from the Latin American MYLACRE study

Although systemic therapy for multiple myeloma (MM) has evolved considerably over the past 2 decades, state-of-the-art treatment is not uniformly available in Latin America. In some countries, disparities between the public and private sectors in clinical presentation, access to novel agents, and transplantation are striking, with the public sector lagging. We conducted a multicenter, observational study of patients with MM in 5 Latin American countries (Argentina, Brazil, Colombia, Mexico, and Panama). We enrolled patients aged ≥18 years diagnosed with MM between January 2016 and June 2021, using data collected between May 2019 and June 2022. We categorized institutions as "public" when primarily funded by federal or local government, and "private" when financed mostly or completely by other sources. We analyzed 1029 patients, 1021 of whom could be classified into public (n = 339) and private (n = 682) institutions. These 2 groups differed in many respects, with patients from the latter having better baseline prognostic features (including eligibility to transplantation) and receiving combinations of immunomodulatory drugs and proteasome inhibitors, as well as anti-CD38 antibodies, more frequently than patients from public institutions. Among 960 patients with complete data for this analysis, the median overall survival was 44.6 months in public institutions and 53.3 months in private institutions (hazard ratio, 0.84; 95% confidence interval, 0.67-1.04; P = .109). Our results indicate diagnostic and therapeutic shortcomings in the management of MM in Latin America, with important gaps in patient profile, treatment patterns and long-term outcomes between public and private institutions. This trial was registered at www.clinicaltrials.gov as #NCT03955900.

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Publication Details

Journal
Blood Advances
Published
2024-12-10
DOI
https://doi.org/10.1182/bloodadvances.2024013838
Citations
2
Primary Topic
Multiple Myeloma Research and Treatments
Type
article
Field-Weighted Citation Impact
0.91

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article

Health care systems as determinants of outcomes in multiple myeloma: final results from the Latin American MYLACRE study

Damila Cristina Trufelli, Guillermina Remaggi, Gastón Caeiro, A. Enrico et al.
2 citations
Blood Advances
Multiple Myeloma Research and Treatments
0.91
article

Health care systems as determinants of outcomes in multiple myeloma: final results from the Latin American MYLACRE study

Damila Cristina Trufelli, Guillermina Remaggi, Gastón Caeiro, A. Enrico, Jandey da Glória Bigonha, Carolina Colaço Villarim, Ângelo Maiolino, María Silvana Cugliari, Kenny Gálvez, Jair Figueroa Emiliani, Huiling Pei, Guillermo Quintero, Rafael Dezen Gaiolla, Rosane Bittencourt, Jaqueline Saes, Natalia Schütz, Claudia Sossa, Edvan de Queiroz Crusoé, Milton Lombana, Mariana Fernandez, Vania Tietsche de Moraes Hungria, Walter Moisés Tobias Braga, Fernanda Lemos Moura
article en
2 citations

Abstract

Although systemic therapy for multiple myeloma (MM) has evolved considerably over the past 2 decades, state-of-the-art treatment is not uniformly available in Latin America. In some countries, disparities between the public and private sectors in clinical presentation, access to novel agents, and transplantation are striking, with the public sector lagging. We conducted a multicenter, observational study of patients with MM in 5 Latin American countries (Argentina, Brazil, Colombia, Mexico, and Panama). We enrolled patients aged ≥18 years diagnosed with MM between January 2016 and June 2021, using data collected between May 2019 and June 2022. We categorized institutions as "public" when primarily funded by federal or local government, and "private" when financed mostly or completely by other sources. We analyzed 1029 patients, 1021 of whom could be classified into public (n = 339) and private (n = 682) institutions. These 2 groups differed in many respects, with patients from the latter having better baseline prognostic features (including eligibility to transplantation) and receiving combinations of immunomodulatory drugs and proteasome inhibitors, as well as anti-CD38 antibodies, more frequently than patients from public institutions. Among 960 patients with complete data for this analysis, the median overall survival was 44.6 months in public institutions and 53.3 months in private institutions (hazard ratio, 0.84; 95% confidence interval, 0.67-1.04; P = .109). Our results indicate diagnostic and therapeutic shortcomings in the management of MM in Latin America, with important gaps in patient profile, treatment patterns and long-term outcomes between public and private institutions. This trial was registered at www.clinicaltrials.gov as #NCT03955900.

Blood AdvancesVol. 9(6)
Universidade Federal da Bahia (BR), Hospital Italiano de Buenos Aires (AR), AC Camargo Hospital (BR), Universidad Distrital Francisco José de Caldas (CO), Complexo Hospitalar Universitário Professor Edgard Santos (BR), Liga Contra el Cancer (PE), Hospital de Clínicas de Porto Alegre (BR), D’Or Institute for Research and Education (BR), São Germano Oncologia (BR), Hospital Pablo Tobon Uribe (CO), Unidades Centrales Científico-Técnicas (ES), Hospital Italiano La Plata (AR), Fundación para la Investigación, Docencia y Prevención del Cáncer (AR), Fundación Santa Fe de Bogotá (CO), Hospital do Servidor Público Estadual (BR), Janssen (United States) (US), Foscal Hospital (CO), Hospital Privado (AR), Sociedade Brasileira de Oncologia Clínica (BR), Instituto de Oncología de Rosario (AR), Hospital São Paulo (BR), Centro de Inovação, Empreendedorismo e Tecnologia (BR), Universidad Autónoma de Occidente (CO), Universidade Estadual Paulista (Unesp) (BR), Universidade Federal de São Paulo (BR)
Amgen, Bristol-Myers Squibb, Pfizer, AstraZeneca, Sanofi, Alexion Pharmaceuticals, BeiGene, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Novo Nordisk, Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro, Astellas Pharma, Cilag
Partnerships for the goals
Openalex Percentile: Top 21%
Multiple Myeloma Research and Treatments
0.91
DOIOpen Access PDFOpenAlex
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