# Two Decades of Real-World Study in Newly Diagnosed Multiple Myeloma: Evolving Treatment and Outcomes in China with Reference to the United States

## TL;DR

This study compares 20 years of treatment and survival outcomes for newly diagnosed multiple myeloma patients in China and the U.S., showing improved survival in China with modern therapies.

## Contribution

The study provides the first comprehensive real-world evidence of multiple myeloma treatment and survival trends in China over two decades.

## Key findings

- Chinese patients had higher autologous stem cell transplantation rates compared to U.S. patients.
- Survival improved in China with increased access to modern therapies like proteasome inhibitors and immunomodulatory drugs.
- Older patients in China still face lower treatment rates and survival disparities.

## Abstract

Multiple myeloma is a hematological malignancy whose treatment has improved greatly in recent years. However, long-term real-world evidence from China remains limited. In this study, we analyzed 20 years of data from one of the largest myeloma centers in China to examine changes in treatment patterns and patient survival. We found that survival has improved substantially alongside increased access to modern therapies and autologous stem cell transplantation. By placing these findings in the context of real-world data from the United States, this study highlights progress in myeloma care in China and points to remaining challenges, particularly among older patients.

Background: The survival of newly diagnosed multiple myeloma (NDMM) has improved markedly worldwide with the introduction of proteasome inhibitors (PIs), immunomodulatory drugs (IMiDs), and anti-CD38 monoclonal antibodies. However, real-world progress among Chinese patients remains underexplored. This study evaluated 20-year survival trends in patients with NDMM treated in our institute and benchmarked them against outcomes from the Flatiron Health database in the United States. Patients and methods: Consecutive adults diagnosed with NDMM in our institute between 2003 and 2023 were retrospectively analyzed. U.S. patients were identified from the Flatiron Health database using similar inclusion criteria. Clinical characteristics, first-line regimens, and autologous stem cell transplantation (ASCT) rates were summarized. Overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan–Meier methods. Results: Among 1622 Chinese and 12,582 US patients, median age was 57 vs. 68 years. The median PFS and OS of NDMM patients in our institute was 40.1 months and 99.6 months, respectively. Induction therapy in the NICHE cohort changed markedly from primarily chemo-based therapy to combined PIs + IMIDs-based treatment, whereas these treatments were used much earlier in Flatiron. Uptake of new therapies in China increased rapidly after their inclusion in national health insurance. ASCT utilization was higher overall in China (34.9% vs. 22.1%) but remained lower among patients >65 years (6.7% vs. 12.1%). Conclusions: Two decades of real-world data from a major Chinese myeloma center demonstrate substantial improvements in survival and modernization of NDMM treatment, while highlighting persistent disparities amongst older adults.