In Latin America, there has been slower uptake of newer therapies to treat multiple myeloma (MM) in public clinics versus private clinics, which has led to disparities in outcomes.
While 5-year relative survival for patients with multiple myeloma (MM) in the United States and Europe has improved about 20 percentage points, the same trend has not been seen in Latin America, where there has been slower uptake of newer therapies depending on the setting where a patient is being treated, according to a new study published in British Journal of Haematology.
“…in many Latin American countries, the approval of, and access to, newer treatments may be delayed due to cost concerns and resource limitations,” the authors explained.
The Haemato-Oncology Latin America (HOLA) Observational Study was a multicenter, retrospective study of patients with hematological malignancies seen between 2008 and 2015. The study included 30 clinicals in 7 countries: Argentina (5 sites), Brazil (9 sites), Chile (1 site), Colombia (5 sites), Mexico (6 sites), Panama (3 sites), and Guatemala (1 site).
The researchers reported on treatment patterns and clinical outcomes for patients diagnosed between January 1, 2008, and December 31, 2015. Patients had to have follow-up data for at least a year or until death. A total of 1103 patients from HOLA were analyzed. The median age at diagnosis was 61 years, 50.4% were female, 15.4% were stage I, 21.2% were stage II, 31.5% were stage III, and 31.9% did not have a documented International Staging System stage.
One-third (n = 374) of patients underwent autologous stem cell transplant (ASCT). These patients tended to be younger and have fewer major comorbidities. The majority of patients (55.8%) were treated in public clinics, but patients treated at private clinics were more likely to receive ASCT than patients in public clinics.
First-line therapy was primarily thalidomide- or bortezomib-based (84.0%). Newer agents (lenalidomide and carfilzomib) were more common in patients with relapsed or refractory MM, increasing from just 1.3% of first-line therapies to 20.9% of third-line therapies.
After first-line therapy, 30.2% of patients had a complete response, 45.2% a partial response, 8.4% stable disease, and 16.2% progressive disease. Among patients who underwent ASCT, 91.7% had a partial or better response. Patients who received ASCT also had median progression-free survival (PFS) that was approximately twice as long (31.1 months) as patients who did not undergo ASCT (15.0 months).
Median overall survival (OS) after initiating first-line therapy was significantly higher for patients who received ASCT than those who did not (79.3 months vs 52.8 months).
Among the 291 patients who initiated second-line therapy, 14.4% had a complete response, 44.3% had a partial response, 14.8% had stable disease, and 26.5% had progressive disease. For patients who under ASCT, 67.1% had a partial response or better compared with 55.2% of patients who did not get ASCT.
“…differences in treatment patterns by country and clinic type (private vs public) and poor PFS and OS among patients with relapsed MM indicate areas of unmet therapeutic need in Latin America,” the authors concluded.
de Moraes Hungria VT, Martínez-Baños DM, Peñafiel CR, et al. Multiple myeloma treatment patterns and clinical outcomes in the Latin America Haemato-Oncology (HOLA) Observational Study, 2008-2016 [published online August 7, 2019]. Br J Haematol. doi: 10.1111/bjh.16124.