Real-world analysis of multiple myeloma treatments in England using the Cancer Analysis System registry

This retrospective analysis of the Cancer Analysis System registry in England describes the characteristics, systemic anti-cancer therapy (SACT) use, and survival outcomes of patients with multiple myeloma (MM), overall, by therapy line (L), and by autologous stem cell therapy (ASCT) status. Of 20,240 patients not on Cancer Drugs Fund therapies between January 2014 and December 2019, 12,095 had ≥ 1 SACT record and 3,419 received ASCT. Overall, regimens were aligned with national recommendations, but treatment sequencing differed by ASCT status, with 99.3% of ASCT patients subsequently receiving bortezomib-based regimens vs. 83.5% of non-ASCT patients. Time to next treatment or death decreased from 17.3 months at 1 L to 5.6 at 4 L, and was 47.4 months in patients receiving ASCT vs. 13.4 in non-ASCT patients at 1 L. Median overall survival also decreased by line of therapy, from 44.5 months at 1 L to 11.5 at 4 L. Approximately 77% of patients receiving ASCT survived > 60 months vs. 28% of non-ASCT patients. This study describes the real-world treatment landscape and survival outcomes for patients with MM on NHS funded treatments in England, highlighting differences between patients receiving ASCT and those not receiving it. It also demonstrates important data limitations and considerations for improvement.