https://orcid.org/0000-0002-0405-7480
Figures & data
Figure 1. Significant factors independently associated with treatment choicea. aCovariates included modified frailty score (0 [fit], 1–2 [intermediate to frail]), baseline CRAB symptoms (hypercalcemia, renal failure, anemia, bone disease [yes vs. no]), cytogenetic risk (high, standard/unknown), ISS stage (I/II, III, unknown), prior IMID exposure, prior PI exposure, prior SCT, history of PN, CVD/uncontrolled HTN, time (months) from diagnosis to start of index LOT, refractory status to last therapy (yes, no [defined as a TFI from end of most previous LOT to initiation of index regimen of ≤60 days]), and time of first relapse (months [i.e. time from start of LOT1 to start of LOT2]). bIncludes those for whom cytogenetics were unknown. cGreater than 96% of all prior IMID exposure was lenalidomide. dDefined as the presence of any CRAB symptoms (hypercalcemia, renal insufficiency, anemia, bone disease) at the start of the index regimen. eDefined as a TFI ≤60 days between most previous LOT and index LOT.
Key: CVD – cardiovascular disease; IMID – immunomodulatory drug; HTN – hypertension; IMID – immunomodulatory drug; IRd – ixazomib, lenalidomide, dexamethasone; ISS – International Staging System; KRd – carfilzomib, lenalidomide, dexamethasone; LOT – line of therapy; OR – odds ratio; PI – proteasome inhibitor; PN – peripheral neuropathy; SCT – stem-cell transplant; TFI – treatment-free interval; VRd – bortezomib, lenalidomide, dexamethasone.
![Figure 1. Significant factors independently associated with treatment choicea. aCovariates included modified frailty score (0 [fit], 1–2 [intermediate to frail]), baseline CRAB symptoms (hypercalcemia, renal failure, anemia, bone disease [yes vs. no]), cytogenetic risk (high, standard/unknown), ISS stage (I/II, III, unknown), prior IMID exposure, prior PI exposure, prior SCT, history of PN, CVD/uncontrolled HTN, time (months) from diagnosis to start of index LOT, refractory status to last therapy (yes, no [defined as a TFI from end of most previous LOT to initiation of index regimen of ≤60 days]), and time of first relapse (months [i.e. time from start of LOT1 to start of LOT2]). bIncludes those for whom cytogenetics were unknown. cGreater than 96% of all prior IMID exposure was lenalidomide. dDefined as the presence of any CRAB symptoms (hypercalcemia, renal insufficiency, anemia, bone disease) at the start of the index regimen. eDefined as a TFI ≤60 days between most previous LOT and index LOT.Key: CVD – cardiovascular disease; IMID – immunomodulatory drug; HTN – hypertension; IMID – immunomodulatory drug; IRd – ixazomib, lenalidomide, dexamethasone; ISS – International Staging System; KRd – carfilzomib, lenalidomide, dexamethasone; LOT – line of therapy; OR – odds ratio; PI – proteasome inhibitor; PN – peripheral neuropathy; SCT – stem-cell transplant; TFI – treatment-free interval; VRd – bortezomib, lenalidomide, dexamethasone.](/cms/asset/a53849d2-9ff4-4594-b060-869061d87755/ierr_a_1729734_f0001_oc.jpg)
Figure 2. Adjusteda,b Time to Next Therapy for All Patients (LOT ≥ 2) and by Modified Frailty Scorec. (a) Adjusted for the following covariates: index regimen type (IRd, KRd, VRd), modified frailty score (0 [fit], 1–2 [intermediate to frail]), prior PI and/or IMID exposure, prior SCT, history of CVD or uncontrolled HTN, history of PN, or baseline CRAB symptoms (hypercalcemia, renal failure, anemia, bone disease [all, yes vs. no]), cytogenetic risk (high, standard/unknown), ISS stage (I/II, III, unknown), ECOG score (0-1, 2-4, unknown), PI/IMID refractory status (PI and/or IMID refractory, refractory to neither), time (months) from diagnosis to start of index LOT, refractory status to last therapy (yes, no; yes was defined as a TFI from end of most previous LOT to initiation of index regimen of ≤60 days), time of first relapse (months [i.e. time from start of LOT1 to start of LOT2]), and year of diagnosis (2007–2011, 2012–2015, 2016–2018). (b) An event was defined as the start of the next line of therapy or death. (c) Adapted from Palumbo et al. (Blood. 2015;125(13):2068–2074) and includes age and CCI score only, as IADL and ADL were not available in the EHR database.
Key: CVD – cardiovascular disease; HTN – hypertension; IMID – immunomodulatory drug; IRd – ixazomib, lenalidomide, dexamethasone; ISS – International Staging System; KRd – carfilzomib, lenalidomide, dexamethasone; LOT – line of therapy; PI – proteasome inhibitor; PN – peripheral neuropathy; SCT – stem-cell transplant; TFI – treatment-free interval; VRd – bortezomib, lenalidomide, dexamethasone.
![Figure 2. Adjusteda,b Time to Next Therapy for All Patients (LOT ≥ 2) and by Modified Frailty Scorec. (a) Adjusted for the following covariates: index regimen type (IRd, KRd, VRd), modified frailty score (0 [fit], 1–2 [intermediate to frail]), prior PI and/or IMID exposure, prior SCT, history of CVD or uncontrolled HTN, history of PN, or baseline CRAB symptoms (hypercalcemia, renal failure, anemia, bone disease [all, yes vs. no]), cytogenetic risk (high, standard/unknown), ISS stage (I/II, III, unknown), ECOG score (0-1, 2-4, unknown), PI/IMID refractory status (PI and/or IMID refractory, refractory to neither), time (months) from diagnosis to start of index LOT, refractory status to last therapy (yes, no; yes was defined as a TFI from end of most previous LOT to initiation of index regimen of ≤60 days), time of first relapse (months [i.e. time from start of LOT1 to start of LOT2]), and year of diagnosis (2007–2011, 2012–2015, 2016–2018). (b) An event was defined as the start of the next line of therapy or death. (c) Adapted from Palumbo et al. (Blood. 2015;125(13):2068–2074) and includes age and CCI score only, as IADL and ADL were not available in the EHR database.Key: CVD – cardiovascular disease; HTN – hypertension; IMID – immunomodulatory drug; IRd – ixazomib, lenalidomide, dexamethasone; ISS – International Staging System; KRd – carfilzomib, lenalidomide, dexamethasone; LOT – line of therapy; PI – proteasome inhibitor; PN – peripheral neuropathy; SCT – stem-cell transplant; TFI – treatment-free interval; VRd – bortezomib, lenalidomide, dexamethasone.](/cms/asset/371e3b7e-adc7-4a44-bf7a-9c6e32061252/ierr_a_1729734_f0002_oc.jpg)
Table 1. Baseline clinical and treatment characteristics by regimen type, index lines of therapy ≥2.