Background: Treatment options for multiple myeloma have evolved rapidly, but little is known about the trends in novel triplet and quadruplet regimen uptake in newly diagnosed patients in a regular clinical setting.

Methods: This retrospective cohort study used a myeloma patient registry at a large, integrated health system in Ohio and Florida to identify adults with newly diagnosed multiple myeloma between January 1, 2017, and December 31, 2023. We captured treatment with triplet or quadruplet regimen during the first year after diagnosis through December 31, 2024 using data from electronic health records and examined the association of sociodemographic and clinical variables with the receipt of either a triplet or quadruplet regimen using multivariable logistic regression.

Results: We identified 1233 patients with a mean age at diagnosis of 67.2 ±11.1 years; 54.2% were male, 74.2% White, 22.7% Black, 6.0% of Hispanic ethnicity, insured by private payer (34.1%), traditional Medicare (29.3%), Medicare Advantage (25.5%), Medicaid (7.5%), dual-eligible (3.0%), and self-pay/other (0.7%). The majority (59.8%) had an eGFR ≥60 ml/min/1.73 m2 at the time of diagnosis and the median Charlson comorbidity index was 2 (interquartile range, 0–6).

There was a statistically non-significant increase in the use of either triplet or quadruplet regimen within 12 months of diagnosis from 56.7% in patients diagnosed in 2017 to 65.9% in those diagnosed in 2023 (P=.5), but use of quadruplet regimens expanded significantly over that time from 2.2% to 39.1% (P<.001), while triplet regimens declined from 56.7% to 38.4% (P<.001).

In the multivariable model, residing in areas with higher area deprivation index scores - indicating higher levels of disadvantage (quartiles two vs. one, adjusted odds ratio [aOR], 0.60, 95% CI, 0.39-0.91; three vs. one, aOR, 0.56, 95% CI, 0.36-0.86; and four vs. one, aOR, 0.56, 95% CI, 0.36-0.89), treatment at Florida hospitals (vs. Taussig Cancer Center, aOR, 0.60, 95% CI, 0.42-0.86), and older age at diagnosis (aOR per 1 year increase, 0.98, 95% CI, 0.96-0.99) were associated with lower odds of a triplet/quadruplet regimen with 12 months. Baseline eGFR <60 ml/min/1.73 m2(vs. ≥60, aOR, 1.78, 95% CI,1.36-2.34), as well as treatment at Ohio regional hospitals (vs. Taussig Cancer Center, aOR, 1.63, 95% CI, 1.13-2.39) were associated with higher odds.

Conclusions: In this large and diverse cohort of patients with newly diagnosed multiple myeloma, quadruplet regimens rose while triplet regimens declined from 2017-2024, with 39% diagnosed in 2023 receiving a quadruplet regimen. Receipt of triplet and quadruplet regimens varied based on social determinants of health, clinical factors, and treatment location.

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2025
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