Brazilian Real-Life Experience of Multiple Myeloma (MMyBRAve): Improvement in Outcomes, But Remaining Diagnostic and Therapeutic Gaps

Despite recent improvements in prognosis for patients with multiple myeloma (MM), large discrepancies still exist worldwide in terms of access to care and outcomes. In Brazil, management of MM is subject to diagnostic and therapeutic constraints that may impact outcomes, and it is unclear if the influence of such constraints is changing over time. Background: This study aimed at describing the demographic and clinical characteristics, treatment patterns and overall survival of patients with MM in Brazil to identify gaps in the disease diagnosis and treatment. Methods: MMyBRAve (NCT03506386) was a multicenter, observational study of patients diagnosed with MM in Brazil between January 2008 and December 2016, with data collection between August 2018 and September 2019 at 17 participating centers. Results: Of 943 patients included, 914 had complete data for overall survival (OS) analysis. The most used frontline regimens were cyclophosphamide, thalidomide and dexamethasone; bortezomib, cyclophosphamide and dexamethasone; and thalidomide and dexamethasone. After a median follow-up of 63 months, the median OS from diagnosis was 70 months. These results indicate continuous improvements in comparison with previous observational studies from Brazil. The median OS in transplantation-ineligible (N = 491) and eligible (N = 452) patients were 49 and 93 months, respectively (hazard ratio [HR] = 0.52; 95% confidence interval [CI], 0.43 to 0.63; P < .001). The median OS also differed between patients with and without known prognostic factors. Conclusion: Despite the improvements, our results suggest that access to novel agents and transplantation continue to hinder further progress in patient outcomes in Brazil and countries with similar health-care constraints.