Overview
The treatment landscape for newly diagnosed multiple myeloma (NDMM) has evolved rapidly with the introduction of anti-CD38 monoclonal antibodies (aCD38), but contemporary treatment patterns remain poorly understood. This longitudinal study evaluated treatment patterns, temporal trends, and patient drop-off across lines of therapy among 7,364 patients with MM in the US Flatiron Health Research Database initiating first-line (1L) therapy between 2020 and 2025.
By 2025, 1L aCD38-containing regimen use reached 94.7%, up from 13.3% in 2020, among stem cell transplant (SCT) recipients and 78.0%, up from 10.6% in 2020, among non-SCT recipients. In subsequent settings, aCD38-containing regimens remained common, received by 69.1% of patients in second-line and 54.2% in third-line care between 2020 and 2026. T-cell-redirecting therapies (CAR T and bispecific antibodies) were used infrequently until later lines (up to 32.9% in fifth-line care). Substantial attrition occurred between lines, with over half of patients failing to advance to a subsequent line.
Why this matters
This research documents the increasingly widespread adoption of frontline anti-CD38 therapy and frequent subsequent re-treatment in US practice. It also highlights that high attrition rates between lines limit the proportion of patients who survive to receive and benefit from novel T-cell-redirecting therapies in later lines.