An analysis of worldwide treatment patterns for multiple myeloma (MM) shows that bortezomib-based triplets are the most common frontline treatment for MM. However, regimens used in later lines vary.

These findings, from the INSIGHT MM study, were presented at the 2022 ASH Annual Meeting by Noemi Puig, MD, PhD, of Hospital Universitario de Salamanca Hematología, Instituto de Investigación Biomédica de Salamanca in Spain.

INSIGHT MM ( Identifier: NCT02761187) is the largest global, prospective, observational MM study to date, Dr Puig said. The study includes 4188 patients with newly diagnosed or relapsed/refractory MM enrolled from July 2016 to July 2021 at centers in 15 countries. 

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Data on prior and current treatment were collected at baseline and every 3 months thereafter. The data cutoff for the current analysis was September 2021.

Among the 2286 patients with newly diagnosed MM, triplet therapy was the most common frontline approach across all regions (71.1%). Doublet therapy was used in 12.0% of patients. 

In every region, a bortezomib-based triplet was the most commonly used frontline regimen. In the entire population, the most common regimen was bortezomib, lenalidomide, and dexamethasone (VRd, 23.5%), followed by bortezomib, cyclophosphamide, and dexamethasone (VCd, 21.7%), and then bortezomib, thalidomide, and dexamethasone (VTd, 11.2%).

By region, the most common frontline regimens were VRd in the United States (49.7%), VCd in Europe (28.8%) and Latin America (33.9%), and VTd in Asia (24.6%).

Of the 1758 patients with relapsed or refractory MM, 49.6% received triplet regimens, and 33.7% received doublets. 

In the overall relapsed/refractory population, lenalidomide plus dexamethasone (Rd) was the most common regimen used (15.4%), and ixazomib plus Rd was the most common triplet (7.9%). 

Rd was the most common regimen used in Europe (21.1%) and Asia (28.8%), while VCd was the most common regimen in Latin America (16.8%). The most common regimens in the United States were daratumumab plus Rd (6.1%) and lenalidomide alone (6.1%).

Dr Puig noted that there was a shift from proteasome inhibitor (PI)-based or PI and immunomodulatory drug-based frontline therapy to more varied second-line regimens over time. This was seen in patients who received a transplant upfront and those who did not.

“Acknowledging that treatment use is dependent on local approval status and availability, this analysis shows that, while global frontline standard of care is broadly established, there remains no consistent standard in later lines of therapy,” Dr Puig concluded.

Disclosures: The study was funded by Takeda Development Center Americas, Inc. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Puig N, Hungria VTM, Chari A, et al. Global treatment standard in multiple myeloma remains elusive: Updated results from the INSIGHT MM global, prospective, observational study. Presented at ASH 2022. December 10-13, 2022. Abstract 1859.