{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T22:49:33Z","timestamp":1782341373402,"version":"3.54.5"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,4,1]],"date-time":"2023-04-01T00:00:00Z","timestamp":1680307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Janssen Global Services, LLC"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Because patients with newly diagnosed multiple myeloma (NDMM) do not always receive any treatment beyond first-line (1L) therapy, it is imperative that patients receive the best treatment in the 1L setting. However, the optimal initial treatment remains to be identified. We performed a clinical simulation to assess potential outcomes with different treatment sequences.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients and Methods<\/jats:title>\n                  <jats:p>We used a partitioned survival model to compare overall survival (OS) with (1) daratumumab, lenalidomide, and dexamethasone (D-Rd) in 1L followed by a pomalidomide- or carfilzomib-based regimen in second line (2L) versus (2) bortezomib, lenalidomide, and dexamethasone (VRd) in 1L followed by a daratumumab-based regimen in 2L versus (3) lenalidomide and dexamethasone (Rd) in 1L followed by a daratumumab-based regimen in 2L. Probabilities of transition between health states (1L, 2L+, and death) were based on published clinical data and real-world data from the Flatiron Health database. The proportion of patients discontinuing treatment after 1L (attrition rates) in the base case was estimated with a binomial logistic model using data from the MAIA trial.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Using D-Rd in 1L conferred a longer median OS compared with delaying daratumumab-based regimens until 2L after VRd or Rd, respectively (8.9 [95% CrI 7.58-10.42] vs. 6.92 [5.92-8.33] or 5.75 [4.50-7.25] years). Results of scenario analyses were consistent with the base case.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Our simulation, which incorporates clinically representative treatments and attrition rates, supports the use of D-Rd as initial therapy, rather than delaying the use of daratumumab until later lines of therapy, in patients with transplant-ineligible NDMM.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/oncolo\/oyad053","type":"journal-article","created":{"date-parts":[[2023,4,1]],"date-time":"2023-04-01T18:20:46Z","timestamp":1680373246000},"page":"e263-e269","source":"Crossref","is-referenced-by-count":27,"title":["Impact of Treatment Sequencing on Overall Survival in Patients with Transplant-Ineligible Newly Diagnosed Myeloma"],"prefix":"10.1093","volume":"28","author":[{"given":"Rafael","family":"Fonseca","sequence":"first","affiliation":[{"name":"Hematology, Mayo Clinic in Arizona , Phoenix, AZ , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Facon","sequence":"additional","affiliation":[{"name":"Hematology, Lille University Hospital , Lille , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Hashim","sequence":"additional","affiliation":[{"name":"Modeling, Janssen Pharmaceutica NV , Beerse, Antwerp , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandhya","family":"Nair","sequence":"additional","affiliation":[{"name":"Modeling, Janssen Pharmaceutica NV , Beerse, Antwerp , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianming","family":"He","sequence":"additional","affiliation":[{"name":"Market Access Analytics, Janssen Pharmaceutica NV , Beerse, Antwerp , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Ammann","sequence":"additional","affiliation":[{"name":"Market Access Analytics, Janssen Pharmaceutica NV , Beerse, Antwerp , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Lam","sequence":"additional","affiliation":[{"name":"Market Access Analytics, Janssen Pharmaceutica NV , Beerse, Antwerp , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Wildgust","sequence":"additional","affiliation":[{"name":"Medical Affairs, Janssen Global Services , Raritan, NJ , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaji","family":"Kumar","sequence":"additional","affiliation":[{"name":"Hematology, Mayo Clinic Rochester , Rochester, MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,4,1]]},"reference":[{"issue":"5","key":"2023050815252996600_CIT0001","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1002\/ajh.25791","article-title":"Multiple myeloma: 2020 update on diagnosis, risk-stratification and management","volume":"95","author":"Rajkumar","year":"2020","journal-title":"Am J Hematol"},{"issue":"3","key":"2023050815252996600_CIT0002","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.annonc.2020.11.014","article-title":"Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up\u2020","volume":"32","author":"Dimopoulos","year":"2021","journal-title":"Ann Oncol"},{"issue":"3","key":"2023050815252996600_CIT0003","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1038\/s41408-018-0065-8","article-title":"Defining cure in multiple myeloma: a comparative study of outcomes of young individuals with myeloma and curable hematologic malignancies","volume":"8","author":"Ravi","year":"2018","journal-title":"Blood Cancer J"},{"issue":"2","key":"2023050815252996600_CIT0004","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1111\/bjh.14213","article-title":"Multiple myeloma: patient outcomes in real-world practice","volume":"175","author":"Yong","year":"2016","journal-title":"Br J Haematol"},{"issue":"4","key":"2023050815252996600_CIT0005","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1097\/HS9.0000000000000045","article-title":"Long-term outcomes in patients with multiple myeloma: a retrospective analysis of the Dutch Population-based Haematological Registry for Observational Studies (PHAROS)","volume":"2","author":"Verelst","year":"2018","journal-title":"Hemasphere."},{"issue":"4","key":"2023050815252996600_CIT0006","first-page":"220","article-title":"The clinical course of multiple myeloma in the era of novel agents: a retrospective, \u00adsingle-center, real-world study","volume":"1","author":"Szabo","year":"2019","journal-title":"Clin Hematol Int"},{"issue":"1","key":"2023050815252996600_CIT0007","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1186\/s12885-020-07503-y","article-title":"Frontline treatment patterns and attrition rates by subsequent 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