Treatment pattern among patients with relapsed/refractory multiple myeloma (RRMM) who had received pomalidomide-based regimens in Taiwan

Figures & data

Figure 1. Study design flowchart. Notes: CGMH-KH, Chang Gung Memorial Hospital – Kaohsiung; CMUH, China Medical University Hospital; NCKUH, National Cheng Kung University Hospital; NTUH, National Taiwan University Hospital; RRMM, relapsed/refractory multiple myeloma; TCVGH, Taichung Veterans General Hospital.

Table 1. Patient profiles.

	Total (N = 97)	Doublet regimen (n = 73)	Triplet regimen (n = 24)	p-value
Gender, n (%)
Female	47 (48.5)	32 (43.8)	15 (62.5)	0.113^a
Male	50 (51.5)	41 (56.2)	9 (37.5)
Age at pomalidomide treatment
Mean (SD)	65.5 (9.5)	66.4 (9.1)	62.7 (10.3)	0.099^b
Median (IQR)	65.6 (59.1-72.8)	67.0 (60.9-72.8)	60.7 (56.1-72.8)
>65 years, n (%)	51 (52.6)	42 (57.5)	9 (37.5)	0.088^b
Time to pomalidomide treatment (years)
Mean (SD)	5.5 (3.5)	5.6 (3.7)	5.2 (3.0)	0.660^b
Median (IQR)	4.8 (3.1-6.9)	4.9 (3.1-6.9)	4.3 (2.7-6.8)
ISS stage at diagnosis, n (%)
Stage I	3 (3.1)	2 (2.7)	1 (4.2)	0.136^c
Stage II	8 (8.2)	7 (9.6)	1 (4.2)
Stage III	12 (12.4)	6 (8.2)	6 (25.0)
Unknown	74 (76.3)	58 (79.5)	16 (66.7)
Disease subtypes, n (%)
IgG	52 (53.6)	39 (53.4)	13 (54.2)	0.140^c
IgA	23 (23.7)	20 (27.4)	3 (12.5)
Light chain	21 (21.6)	14 (19.2)	7 (29.2)
Others	1 (1.0)	0 (0.0)	1 (4.2)
Auto-HSCT at front-line treatment, n (%)	48 (49.5)	33 (45.2)	15 (62.5)	0.142^a
Auto-HSCT after relapsed, n (%)	12 (12.4)	8 (11.0)	4 (16.7)	0.484^c
Refractory to prior therapies, n (%)
Bortezomib alone	4 (4.1)	2 (2.7)	2 (8.3)	0.079^c
Lenalidomide alone	9 (9.3)	9 (12.3)	0 (0.0)
Both Bortezomib and Lenalidomide	40 (41.2)	27 (37.0)	13 (54.2)
Any comorbidity, n (%)	55 (56.7)	41 (56.2)	14 (58.3)	0.852^a
Comorbidity, n (%)
Cardiovascular disease	31 (32.0)	25 (34.2)	6 (25.0)	0.399^a
COPD	1 (1.0)	1 (1.4)	0 (0.0)	1.000^c
Diabetes mellitus	17 (17.5)	13 (17.8)	4 (16.7)	1.000^c
Renal impairment	17 (17.5)	14 (19.2)	3 (12.5)	0.551^c
HBV/HCV infection	13 (13.4)	7 (9.6)	6 (25.0)	0.081^c
Treatment line of pomalidomide, n (%)
3L	46 (47.4)	33 (45.2)	13 (54.2)	0.229^a
4L	20 (20.6)	18 (24.7)	2 (8.3)
5L or above	31 (32.0)	22 (30.1)	9 (37.5)
PS at pomalidomide treatment, n (%)
ECOG 0–1	50 (51.5)	42 (57.5)	8 (33.3)	0.117^a
ECOG 2–3	8 (8.2)	5 (6.8)	3 (12.5)
Unknown	39 (40.2)	26 (35.6)	13 (54.2)
Reasons for switching to pomalidomide, n (%)
Progression	66 (68.0)	52 (71.2)	14 (58.3)	0.335^c
Adverse event	8 (8.2)	4 (5.5)	4 (16.7)
Reimbursement limitation	12 (12.4)	9 (12.3)	3 (12.5)
Others	11 (11.3)	8 (11.0)	3 (12.5)

Note: IQR: (Q1-Q3), the data were compared using the ^aChi-squared test, ^bindependent-sample T test, and ^cFisher’s exact test.

Auto-HSCT, autologous hematopoietic stem cell transplantation; COPD, chronic obstructive pulmonary disease; ECOG, Eastern Cooperative Oncology Group; HBV, hepatitis B virus; HCV, hepatitis C virus; IgA, immunoglobulin A; IgG, immunoglobulin G; IQR, interquartile range; ISS, international staging system; PS, performance status; SD, standard deviation; 3L, third-line; 4L, fourth-line; 5L, fifth-line.

Figure 2. Treatment response (A) Progression free survival (B) Duration of response (Patients ≥ PR). Notes: DoR, duration of response; mPFS, median progression free survival; PR, partial response.

Table 2. Pomalidomide-based treatment response comparison.

	Total (N = 97)	Doublet regimen (n = 73)	Triplet regimen (n = 24)	p-value
Response, n (%)
ORR (≥PR)	34 (35.1)	23 (31.5)	11 (45.8)	0.202^a
CR	2 (2.1)	1 (1.4)	1 (4.2)	0.436^b
VGPR	2 (2.1)	0 (0.0)	2 (8.3)	0.059^b
PR	30 (30.9)	22 (30.1)	8 (33.3)	0.769^a
MR	3 (3.1)	3 (4.1)	0 (0.0)	0.572^b
Stable disease	20 (20.6)	16 (21.9)	4 (16.7)	0.773^b
PD	13 (13.4)	11 (15.1)	2 (8.3)	0.509^b
Non-accessible	27 (27.8)	20 (27.4)	7 (29.2)	0.867^a
Reasons for discontinuation, n (%)
Disease progression or death	68 (70.1)	57 (78.1)	11 (45.8)	0.003^a
Adverse events	11 (11.3)	7 (9.6)	4 (16.7)	0.457^b
Reimbursement limitation (pomalidomide and others)	10 (10.3)	3 (4.1)	7 (29.2)	0.002^b
Others	8 (8.2)	6 (8.2)	2 (8.3)	1.000^b
Duration of pomalidomide treatment (months)
Median (IQR)	4.8 (2.1-7.0)	4.0 (1.9-7.5)	5.3 (4.0-6.8)	0.830^c

Note: IQR: (Q1-Q3), the data were compared using the ^a Chi-squared test, ^b Fisher’s exact test, and ^c independent-sample T test.

CI, confidence interval; CR, complete response; IQR, interquartile range; MR, minimal response rate; NE, not estimated; ORR, overall response rate; PD, progression disease; PR, partial response; VGPR, very good partial response.

Table 3. Factors associated with disease-progression on pomalidomide-based treatment.

Factors^a	Univariate analysis			Multivariate analysis
	HR	95% CI	p-value	HR	95% CI	p-value
Age in years (>65 vs ≤65)	1.5	(0.91-2.36)	0.112	1.3	(0.63-2.49)	0.525
Regimens (triplet vs doublet)	0.8	(0.41-1.38)	0.355	0.7	(0.27-1.74)	0.426
Sex (female vs male)	1.2	(0.74-1.85)	0.508	1.2	(0.62-2.22)	0.633
Auto-HSCT at newly diagnosed (yes vs no)	0.6	(0.39-1.00)	0.050^b	0.5	(0.21-1.29)	0.155
Comorbidity (yes vs no)	1.0	(0.60-1.53)	0.863	0.5	(0.24-1.23)	0.144
Performance status (ECOG 2–3 vs 0-1)	2.1	(0.92–4.89)	0.078	2.1	(0.86-5.02)	0.105
Prior lenalidomide refractoriness (yes vs no)	0.9	(0.53-1.36)	0.499	1.0	(0.50-2.01)	0.997

^a Reference parameter for each factor is highlighted in bold.

^b Exact P value is 0.0496.

Auto-HSCT, autologous hematopoietic stem cell transplantation; CI, confidence interval; ECOG, Eastern Cooperative Oncology Group; HR, hazard ratio.

Table 4. Healthcare utilization during pomalidomide-based treatment.

	Total (N = 97)	Doublet regimen (n = 73)	Triplet regimen (n = 24)	p-value^a
Mean number of outpatient visit	11.2 ± 9.6	10.7 ± 10.4	12.4 ± 6.7	0.377
Mean number of hospitalization	1.6 ± 1.0	1.6 ± 1.1	1.4 ± 0.7	0.596
Hospitalization (in days)	21.1 ± 19.6	22.0 ± 19.0	18.0 ± 22.3	0.584
Mean number of ED visit	2.1 ± 1.7	2.1 ± 1.8	2.0 ± 0.9	0.940

^a The data were shown in mean ± SD and compared using the independent-sample T test.

ED, emergency department; SD, standard deviation.