# Emerging Real-World Treatment Patterns and Clinical Outcomes of Multiple Myeloma in Argentina and Brazil: Insights from the TOTEMM Study in the Private Healthcare Sector

## TL;DR

This study analyzed real-world treatment patterns and outcomes for multiple myeloma patients in Argentina and Brazil, showing high relapse rates and the need for better therapies.

## Contribution

The study provides real-world evidence on treatment patterns and outcomes for transplant-ineligible multiple myeloma patients in Latin America.

## Key findings

- Triplet regimens, mainly bortezomib-based, were most commonly used as first-line treatment.
- Over 75% of patients relapsed within a year, with most relapses occurring between first and second treatment lines.
- Disease progression after first-line treatment affected over 65% of patients, highlighting the need for improved therapies.

## Abstract

As multiple myeloma (MM) treatments evolve, real-world data is needed to understand how patients are treated and how they respond. The TOTEMM study looked at treatment patterns and outcomes in newly diagnosed MM patients who could not have transplants, using data from private healthcare in Argentina (72 patients) and Brazil (892 patients). Across both countries, many different drug combinations were used, mostly starting with triplet regimens based on bortezomib. Treatment duration shortened with each new line of therapy, while dropout rates increased. Over 75% of patients relapsed within a year, and most relapses happened between the first and second treatment lines. Many were likely to be treated again with the same drug. Around 65% showed disease progression after first-line treatment. The risk of progression or death rose steadily over time. These findings highlight the urgent need for better treatment options for patients with MM.

As treatments for multiple myeloma (MM) evolve, there is a need for real-world insights into treatment patterns and outcomes. The treatment practices and clinical outcomes in patients with MM (TOTEMM) was a database study (2018–2024) of newly diagnosed transplant-ineligible patients with MM in Argentina (TOTEMM-A) and Brazil (TOTEMM-B) in a private healthcare setting. In TOTEMM-A (n = 72) and TOTEMM-B (n = 892), 37 and 92 different drug regimens were reported, respectively. In each country, treatment duration reduced across lines of therapy (LOT) (TOTEMM-A: range, 6.2–3.4 months; TOTEMM-B: range, 4.4–3.5 months); attrition rates increased across LOT (TOTEMM-A: range, 52.8–86.1%; TOTEMM-B: range, 41.9–88.0%); triplet regimens (mainly bortezomib based) were used most frequently in first-line (1L); >75% relapsed within 12 months, regardless of the drug prescribed; over 90% of relapses occurred between 1L and second-line, and up to half of patients were rechallenged with the same drug; >65% of patients experienced disease progression after 1L; and the 1- to 5-year adjusted cumulative risk of progression or death increased across LOT (TOTEMM-A: range, 47.1–88.5%; TOTEMM-B: range, 40.4–91.7%). The rapid and marked progression underscores the urgent need for novel treatments and regimens.