{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:08:58Z","timestamp":1785247738848,"version":"3.55.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004339","name":"Sanofi","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004339","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Treatment selection for patients with relapsed Multiple Myeloma (MM) is highly individualized and characterized by diverse treatment patterns. While substantial evidence exists regarding relapsed MM in high-income settings, data on treatment patterns and clinical outcomes at second relapse in Latin American populations remain limited. This study describes the clinical characteristics, treatment patterns, effectiveness, and safety of third-line therapy in patients with MM experiencing a second relapse in routine clinical practice across five Colombian institutions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter retrospective observational study included medical records from five specialized institutions in Colombia. Patients with MM who experienced a second relapse and initiated third-line therapy between 2013 and 2022 were included. Baseline characteristics, treatment patterns, and the effectiveness and safety of third-line therapy were analyzed descriptively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study included 84 participants with multiple myeloma who experienced a documented second relapse. The median age at diagnosis was 63.5 years (IQR 57.0 - 70.0), 56% were male, and bone disease and anaemia were the most frequent presenting features. The median time from diagnosis to second relapse was 3.2 years (IQR 1.8 - 4.9). First-line therapy was mainly bortezomib-based, most frequently the combination of bortezomib, cyclophosphamide, and dexamethasone (36.9%). Second-line treatment shifted toward lenalidomide-based regimens, with lenalidomide plus dexamethasone administered to 29.8% of patients. Autologous stem cell transplantation was performed in 36.9% of patients. Third-line treatment patterns were diverse, with greater use of novel agent\u2013based combinations, including regimens containing daratumumab and carfilzomib. In the third-line setting, the overall response rate was 47.1%. The median overall survival from initiation of treatment at second relapse was 27.5 months, while the median progression-free survival and time to treatment failure were 14.6 months and 5.94 months, respectively. Treatment-emergent adverse events (TEAEs) occurred in 11.9% of patients, mostly moderate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this real-world study of patients with multiple myeloma treated in the third-line setting after second relapse, treatment patterns were heterogeneous, with increasing use of novel agent\u2013based combinations. An objective response was achieved in nearly half of the patients, with a median overall survival of 27.5 months and a median progression-free survival of 14.6 months. Treatment-emergent adverse events were infrequently reported and predominantly hematologic. No health-related quality of life data were available, highlighting an important gap in routine clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1831845","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T06:49:37Z","timestamp":1782888577000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment patterns and outcomes in patients with multiple myeloma in second relapse in Colombia (freedomm): a multicenter observational study"],"prefix":"10.3389","volume":"16","author":[{"given":"Guillermo","family":"Quintero","sequence":"first","affiliation":[{"name":"Fundaci\u00f3n Santa Fe de Bogot\u00e1","place":["Bogot\u00e1, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Aruachan","sequence":"additional","affiliation":[{"name":"Instituto M\u00e9dico de Alta Tecnolog\u00eda Oncom\u00e9dica","place":["Monter\u00eda, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jair","family":"Figueroa Emiliani","sequence":"additional","affiliation":[{"name":"Hospital Mayor M\u00e9deri","place":["Bogot\u00e1, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenny","family":"Galvez","sequence":"additional","affiliation":[{"name":"Hospital Pablo Tob\u00f3n Uribe","place":["Medell\u00edn, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis Antonio","family":"Salazar","sequence":"additional","affiliation":[{"name":"Hematology and Hematopoietic Stem Cell Transplantation Unit, Clinica FOSCAL, Floridablanca","place":["Santander, Colombia"]},{"name":"Facultad de Ciencias de la Salud, Universidad Aut\u00f3noma de Bucaramanga","place":["Bucaramanga, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constanza","family":"Otero Venegas","sequence":"additional","affiliation":[{"name":"Real-World Evidence \u2013 Epidemiology & Clinical Data Management, Latin America, Central America and the Caribbean","place":["Bogot\u00e1, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Buitrago","sequence":"additional","affiliation":[{"name":"Real-World Evidence \u2013 Epidemiology & Clinical Data Management, Latin America, Central America and the Caribbean","place":["Bogot\u00e1, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Humberto","family":"Mart\u00ednez-Cordero","sequence":"additional","affiliation":[{"name":"Centro de Excelencia en Mieloma M\u00faltiple - Unidad de Hemato-Oncolog\u00eda, Instituto Nacional de Cancerolog\u00eda","place":["Bogot\u00e1, Colombia"]},{"name":"Unidad de Hematolog\u00eda y Trasplante de M\u00e9dula \u00d3sea, Hospital Militar Central","place":["Bogot\u00e1, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana","family":"Saavedra","sequence":"additional","affiliation":[{"name":"Sanofi","place":["Bogot\u00e1, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Fernanda","family":"Vargas","sequence":"additional","affiliation":[{"name":"Sanofi","place":["Bogot\u00e1, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA: A Cancer J For Clin"},{"key":"B2","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1186\/s12885-021-08280-y","article-title":"Measuring the global, regional, and national burden of multiple myeloma from 1990 to 2019","volume":"21","author":"Zhou","year":"2021","journal-title":"BMC Cancer"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.1347","article-title":"Epidemiology of multiple myeloma in 17 Latin American countries: an update","volume":"7","author":"Curado","year":"2018","journal-title":"Cancer Med"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2018.08.005","article-title":"Analysis of availability and access of anti-myeloma drugs and impact on the management of multiple myeloma in latin american countries","volume":"19","author":"Pessoa de Magalh\u00e3es Filho","year":"2019","journal-title":"Clin Lymphoma Myeloma Leuk"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(20)30756-7","article-title":"Treatment of relapsed and refractory multiple myeloma: recommendations from the International Myeloma Working Group","volume":"22","author":"Moreau","year":"2021","journal-title":"Lancet Oncol"},{"key":"B6","volume-title":"Relapsed and refractory multiple myeloma","author":"Ahmed","year":"2023"},{"key":"B7","article-title":"Relapsed and refractory multiple myeloma","author":"Ahmed","year":"2023","journal-title":"StatPearls [Internet]"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.14213","article-title":"Multiple myeloma: patient outcomes in real\u2010world practice","volume":"175","author":"Yong","year":"2016","journal-title":"Br J Haematol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1200\/op.22.00214","article-title":"The problem of Hispanic\/Latinx under-representation in cancer clinical trials","volume":"18","author":"Espinoza-Gutarra","year":"2022","journal-title":"JCO Oncol Pract"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1007\/s40487-025-00400-z","article-title":"Burden of treatment, treatment sequencing and healthcare resource utilization in multiple myeloma in Latin America: a targeted literature review","volume":"14","author":"Seehaus","year":"2026","journal-title":"Oncol Ther"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-020-03983-x","article-title":"Significant differences in access to tests and treatments for multiple myeloma between public and private systems in Latin America. Results of a Latin American survey. GELAMM (Grupo de Estudio Latino Americano de Mieloma M\u00faltiple)","volume":"99","author":"Riva","year":"2020","journal-title":"Ann Hematol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2024013838","article-title":"Health care systems as determinants of outcomes in multiple myeloma: final results from the Latin American MYLACRE study","volume":"9","author":"Hungria","year":"2025","journal-title":"Blood Adv"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1002\/jha2.905","article-title":"Multiple myeloma in Latin America: a systematic review","volume":"5","author":"de Moraes Hungria","year":"2024","journal-title":"EJHaem"},{"key":"B14","volume-title":"Multiple myeloma in Latin America: supporting early and equitable access to care to improve patient outcomes [Internet]","year":"2023"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(16)30206-6","article-title":"International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma","volume":"17","author":"Kumar","year":"2016","journal-title":"Lancet Oncol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2022007082","article-title":"Outcomes after biochemical or clinical progression in patients with multiple myeloma","volume":"7","author":"Goldman-Mazur","year":"2023","journal-title":"Blood Adv"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1080\/16078454.2022.2112643","article-title":"Multiple myeloma treatment patterns and clinical outcomes in the Latin America Haemato-Oncology (HOLA) Observational Study, 2008-2016","volume":"188","author":"de Moraes Hungria","year":"2020","journal-title":"Br J Haematol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2019.09.425","article-title":"Demographic characteristics and treatment patterns of relapse \/ refractory multiple myeloma PTS: Charismma study and Insight MM Registry in Spain","volume":"19","author":"Ocio","year":"2019","journal-title":"Clin Lymphoma Myeloma Leukemia"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2354.2011.01248.x","article-title":"Relapsed multiple myeloma in the UK prior to the introduction of novel agents - a response to Koleva et\u00a0al. (2010)","volume":"20","author":"Quinn","year":"2011","journal-title":"Eur J Cancer Care"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3747\/co.27.5385","article-title":"Cyclophosphamide-bortezomib-dexamethasone compared with bortezomib-dexamethasone in transplantation-eligible patients with newly diagnosed multiple myeloma","volume":"27","author":"Figueiredo","year":"2020","journal-title":"Curr Oncol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1080\/16078454.2022.2112643","article-title":"Observational study of multiple myeloma in Latin America","volume":"96","author":"Hungria","year":"2017","journal-title":"Ann Hematol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1080\/17474086.2020.1800451","article-title":"Recent real-world treatment patterns and outcomes in US patients with relapsed\/refractory multiple myeloma","volume":"13","author":"Bruno","year":"2020","journal-title":"Expert Rev Hematol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2021.12.009","article-title":"Real-world evidence of epidemiology and clinical outcomes in multiple myeloma, findings from the registry of hemato-oncologic Malignancies in Colombia, observational study","volume":"22","author":"Abello","year":"2022","journal-title":"Clin Lymphoma Myeloma Leuk"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtct.2023.08.028","article-title":"Overcoming barriers to autologous stem cell transplantation in multiple myeloma: recommendations from a multidisciplinary roundtable discussion","volume":"29","author":"Bashir","year":"2023","journal-title":"Transplant Cell Ther"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(15)01120-4","article-title":"Daratumumab monotherapy in patients with treatment-refractory multiple myeloma (SIRIUS): an open-label, randomised, phase 2 trial","volume":"387","author":"Lonial","year":"2016","journal-title":"Lancet"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1505654","article-title":"Elotuzumab therapy for relapsed or refractory multiple myeloma","volume":"373","author":"Lonial","year":"2015","journal-title":"N Engl J Med"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1516282","article-title":"Oral ixazomib, lenalidomide, and dexamethasone for multiple myeloma","volume":"374","author":"Moreau","year":"2016","journal-title":"N Engl J Med"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1080\/17474086.2018.1437345","article-title":"The multiple myeloma treatment landscape: international guideline recommendations and clinical practice in Europe","volume":"11","author":"Cavo","year":"2018","journal-title":"Expert Rev Hematol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1080\/16078454.2022.2112643","article-title":"Multiple myeloma in latin america","volume":"27","author":"G\u00f3mez-Almaguer","year":"2022","journal-title":"Hematology"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2009.24.3683","article-title":"Relapse\/refractory myeloma patient: potential treatment guidelines","volume":"27","author":"San Miguel","year":"2009","journal-title":"J Clin Oncol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1200\/jop.19.00309","article-title":"Timeliness of initial therapy in multiple myeloma: trends and factors affecting patient care","volume":"16","author":"Kumar","year":"2020","journal-title":"JCO Oncol Pract"},{"key":"B32","doi-asserted-by":"crossref","unstructured":"Hanna\n              MCJ\n            \n            \n              Iheanacho\n              I\n            \n            \n              Gorsh\n              B\n            \n            \n              Wang\n              PF\n            \n            \n              Paka\n              P\n            \n            \n              Perera\n              S\n            \n          \n          Efficacy and safety of third-line or later treatments, including the CD38 monoclonal antibody class, in patients with relapsed\/refractory multiple myeloma: a systematic literature review\n          \n          2023","DOI":"10.1097\/01.HS9.0000936332.73280.e0"},{"key":"B33","doi-asserted-by":"publisher","first-page":"6635","DOI":"10.1182\/blood-2023-180948","article-title":"Real-world analysis of treatment patterns and the effectiveness and safety profile of daratumumab-based regimens in Chinese patients with newly diagnosed or relapsed\/refractory multiple myeloma","volume":"142","author":"Wang","year":"2023","journal-title":"Blood"},{"key":"B34","unstructured":"External assessment of quality of care in the health sector in Colombia\n          \n          2019"},{"key":"B35","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s12939-022-01818-x","article-title":"Characterization of the population affiliated to the subsidized health insurance scheme in Colombia: a systematic review and meta-analysis","volume":"22","author":"Mora-Moreo","year":"2023","journal-title":"Int J For Equity Health"}],"updated-by":[{"DOI":"10.3389\/fonc.2026.1938900","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000}}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1831845\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T13:31:34Z","timestamp":1785245494000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1831845\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":35,"alternative-id":["10.3389\/fonc.2026.1831845"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1831845","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]},"article-number":"1831845"}}