REAL world multiple myeloma outcomes in England show marked differences in survival and treatment sequencing by therapy line and autologous stem cell transplant status, according to a large retrospective registry analysis.
Multiple Myeloma Treatment Patterns in England
This retrospective analysis examined data from the Cancer Analysis System registry in England to describe treatment characteristics, systemic anti-cancer therapy use, and survival outcomes among patients with multiple myeloma. The study included 20,240 patients not receiving Cancer Drugs Fund therapies between January 2014–December 2019. Of these, 12,095 had at least one systemic anti-cancer therapy record and 3,419 received autologous stem cell transplant.
Overall, treatment regimens were broadly aligned with national recommendations. However, treatment sequencing varied notably depending on autologous stem cell transplant status. Among patients receiving autologous stem cell transplant, 99.3% subsequently received bortezomib based regimens, compared with 83.5% of patients who did not undergo transplant. These data highlight consistent use of established therapies alongside distinct clinical pathways for transplant eligible and non-eligible populations.
Survival Outcomes by Line of Therapy
Survival outcomes declined with each successive line of therapy in multiple myeloma. Time to next treatment or death decreased from 17.3 months at first line to 5.6 months by fourth line. Median overall survival followed a similar pattern, falling from 44.5 months at first line to 11.5 months at fourth line. These findings reflect the progressive nature of disease and diminishing durability of response with later treatment lines in routine clinical practice.
Impact of Autologous Stem Cell Transplant
Autologous stem cell transplant was associated with substantially improved outcomes. At first line, time to next treatment or death was 47.4 months in patients receiving autologous stem cell transplant, compared with 13.4 months in those who did not. Approximately 77% of patients who underwent transplant survived beyond 60 months, versus 28% of non-transplant patients. These data reinforce the long-term survival benefit associated with autologous stem cell transplant in appropriate patients with multiple myeloma.
The study provides a comprehensive overview of real-world treatment and survival outcomes for patients with multiple myeloma receiving NHS funded therapies in England. It also underscores important data limitations within registry analyses and identifies areas for future improvement in capturing longitudinal treatment outcomes.
Reference
Babu EM et al. Real-world analysis of multiple myeloma treatments in England using the Cancer Analysis System registry. Scientific Reports. 2026; doi: 10.1038/s41598-025-34147-4.
