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Prashant Kapoor, MD, FACP


Is There an International Standard of Care for Triple-Class–Exposed Patients With Multiple Myeloma?

By: Kayci Reyer
Posted: Tuesday, February 1, 2022

According to findings from the ITEMISE study, presented in Clinical Therapeutics, there does not appear to be an international standard of care for patients with multiple myeloma following triple-class exposure treatment. Patients are considered to be triple-class–exposed once they have received immunomodulatory, proteasome inhibitor, and anti-CD38 antibody therapies.

“Substantial [health-care resource use] is associated with management of patients after [triple-class exposure] across Europe and Canada, signifying a high patient and societal impact and a need for better treatment options to reduce this burden,” concluded Paula Rodriguez-Otero, MD, PhD, of Clinica Universidad de Navarra in Spain, and colleagues.

Between August 2020 and October 2020, a physician-developed survey was administered to 202 hematologists across Belgium, Canada, France, Germany, Italy, the Netherlands, Spain, Sweden, Switzerland, and the United Kingdom. The majority (68%) of respondents worked in academic hospitals, whereas 38% worked in other public hospitals and 2% worked in private hospitals. Respondents indicated that approximately 55% of patients undergoing triple-class exposure would go on to receive active fourth-line treatment. Reported preferred first treatment strategies included immunomodulatory (22.5%), anti-CD38 antibody plus immunomodulatory (17.8%), and proteasome inhibitor–based (15.1%) treatment regimens. Pomalidomide, daratumumab, lenalidomide, bortezomib, and carfilzomib were the most commonly administered antimyeloma treatments.

Median overall survival associated with fourth-line treatment was estimated to be 12 months. Progression-free survival was an estimated 4 months, and the approximate objective response rate was 40%. Common health-care resource use associated with triple-class–exposed patients with multiple myeloma included outpatient medical care and unplanned hospitalizations.

“Estimated clinical outcomes are consistent with data from U.S. studies and indicate the poor prognosis for patients after triple-class–exposed [multiple myeloma],” the study authors noted.

Disclosure: For full disclosures of the study authors, visit

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