Real-World Treatment Patterns and Outcomes Among Multiple Myeloma Patients with Asthma and COPD in the United States

Introduction: Multiple myeloma (MM) is the second most frequent hematologic malignancy after lymphoma, contributing to approximately 10% of all hematologic malignancies. The prognosis of patients with MM is impacted by the heterogeneity of the disease, with worse outcomes reported in patients classified as International Staging System stage III, those with high-risk cytogenetics and elevated serum lactate dehydrogenase, and among patients who are elderly and have comorbidities. Previous studies have demonstrated an association between the presence of lung disease and worse outcomes; however, this impact in a real-world setting is not well understood. Methods: This retrospective, observational, cohort study included data from the nationwide US Optum (R) de-identified electronic health record (EHR) database from January 1, 2006, to December 31, 2019. MM patients with asthma or chronic obstructive pulmonary disease (COPD) were compared with MM patients without asthma or COPD for time to next treatment and overall survival using one-sided log-rank tests stratified by age and multivariable Cox proportional hazard models. Results: Among 5186 patients with MM, approximately 15% had an asthma or COPD diagnosis (asthma/COPD) at baseline. The most commonly observed comorbidities among all MM patients and among those MM patients with asthma/COPD were cardiovascular disease, diabetes, and renal impairment. Time from firstto second-line treatment was significantly longer for patients with a diagnosis of COPD. Overall survival from first-line therapy was significantly worse among patients with COPD, with numerically worse overall survival from second-line therapy. Conclusion: These real-world data suggest that patients with asthma or COPD do not experience a shorter time interval to next treatment, but have significantly worse overall survival from start of first-line therapy and numerically worse survival from the start of later lines. Future investigations with larger datasets may improve the understanding of the influence of individual treatments on outcomes in these patients.