{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:14:02Z","timestamp":1787501642774,"version":"build-2736575974"},"reference-count":32,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T00:00:00Z","timestamp":1702512000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Democritus University of Thrace Research Account (ELKE)"},{"name":"Takeda Hellas"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Newer methodologies are needed to assess the real-world comparative effectiveness of a \u201cgeneration\u201d of pharmaceutical innovation versus the prior standard of care. This chart review study aimed to first evaluate the cumulative clinical benefits of pharmaceutical innovation in everyday relapse\/refractory multiple myeloma before analyzing findings in the context of respective real-world outcomes from the bortezomib\/lenalidomide era. Study endpoints included the 52-week PFS rate in second and third line of therapy (LOT), mPFS-2 across the first and second LOT, the ORR, reasons for discontinuation, and the treatment duration per therapeutic algorithm. Data from 107 patients were collected. The median follow-up was 2.0 years. Of the subjects who met the selection criteria for the second LOT, 72.2% maintained the PFS at 52 weeks. In the third-line setting, the PFS rate at 52 weeks was 63.5%. The mPFS across the first and second, the second, and the third LOTs were 26, 17, and 15 months, respectively. The ORR was 76.1% in the second and 69.7% in the third LOT. After non-response or progression, the main reason for drug discontinuation was treatment intolerability. The second-line ORR and the 52-week PFS rate were similar to previous real-world findings from the bortezomib\/lenalidomide era. The cumulative mPFS across the second and third LOTs was higher than the respective mPFS across the first and second LOTs. Despite its limitations, the methodology and findings from this study may be used in future clinical and economic evaluations across all hematological malignancies.<\/jats:p>","DOI":"10.3390\/cancers15245846","type":"journal-article","created":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T08:12:57Z","timestamp":1702627977000},"page":"5846","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Does the Simultaneous Introduction of Several Pharmaceuticals in the Post-Lenalidomide Era Translate to Better Outcomes in Relapse Refractory Multiple Myeloma? Findings from the Real-World Innovation in Multiple Myeloma (REAL IMM) Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7678-5164","authenticated-orcid":false,"given":"Ioannis","family":"Petrakis","sequence":"first","affiliation":[{"name":"Laboratory of Hygiene and Environmental Protection, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7835-8246","authenticated-orcid":false,"given":"Christos","family":"Kontogiorgis","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Environmental Protection, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0381-4715","authenticated-orcid":false,"given":"Evangelia","family":"Nena","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Environmental Protection, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sosana","family":"Delimpasi","sequence":"additional","affiliation":[{"name":"Bone Marrow Transplantation Unit, Department of Hematology, Evangelismos Hospital, 10676 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasa E.","family":"Loutsidi","sequence":"additional","affiliation":[{"name":"Bone Marrow Transplantation Unit, Department of Hematology, Evangelismos Hospital, 10676 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanouil","family":"Spanoudakis","sequence":"additional","affiliation":[{"name":"Department of Hematology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stergios","family":"Intzes","sequence":"additional","affiliation":[{"name":"Department of Hematology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7771-7419","authenticated-orcid":false,"given":"Christina","family":"Misidou","sequence":"additional","affiliation":[{"name":"Department of Hematology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianthi","family":"Symeonidou","sequence":"additional","affiliation":[{"name":"Department of Hematology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Giannakoulas","sequence":"additional","affiliation":[{"name":"Department of Hematology, School of Medicine, University of Thessaly, 41110 Larisa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3100-0823","authenticated-orcid":false,"given":"Theodoros C.","family":"Constantinidis","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Environmental Protection, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5133-1422","authenticated-orcid":false,"given":"Evangelos","family":"Terpos","sequence":"additional","affiliation":[{"name":"Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1001\/jama.2022.0003","article-title":"Diagnosis and Management of Multiple Myeloma: A Review","volume":"327","author":"Cowan","year":"2022","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e670","DOI":"10.1016\/S2352-3026(22)00165-X","article-title":"The epidemiological landscape of multiple myeloma: A global cancer registry estimate of disease burden, risk factors, and temporal trends","volume":"9","author":"Huang","year":"2022","journal-title":"Lancet Haematol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Gozzetti, A., and Bocchia, M. (2022). Steps towards a Multiple Myeloma Cure?. J. Pers. Med., 12.","DOI":"10.3390\/jpm12091451"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1159\/000520312","article-title":"Multiple Myeloma: Molecular Pathogenesis and Disease Evolution","volume":"44","author":"Heider","year":"2021","journal-title":"Oncol. Res. Treat."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"101145","DOI":"10.1016\/j.beha.2020.101145","article-title":"Reconstructing the evolutionary history of multiple myeloma","volume":"33","author":"Maura","year":"2020","journal-title":"Best Pract. Res. Clin. Haematol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3487","DOI":"10.1182\/blood-2019-124832","article-title":"The Burden of Relapsed\/Refractory Multiple Myeloma: An Indirect Comparison of Health-Related Quality of Life Burden across Different Types of Advanced Cancers at Baseline and after Treatment Based on HORIZON (OP-106) Study of Melflufen Plus Dexamethasone","volume":"134","author":"Richardson","year":"2019","journal-title":"Blood"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2322","DOI":"10.3390\/curroncol30020179","article-title":"Relapsed\/Refractory Multiple Myeloma: A Review of Available Therapies and Clinical Scenarios Encountered in Myeloma Relapse","volume":"30","author":"Bhatt","year":"2023","journal-title":"Curr. 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Hematol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1080\/17474086.2019.1668763","article-title":"Unraveling innovation potential in the real-world setting: Eighteen novel agents with twenty-six approved European indications, in the management of leukemias, lymphomas, and multiple myeloma","volume":"12","author":"Petrakis","year":"2019","journal-title":"Expert Rev. Hematol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.clml.2021.01.018","article-title":"Real-World Treatment of Patients with Relapsed\/Refractory Myeloma","volume":"21","author":"Gavriatopoulou","year":"2021","journal-title":"Clin. 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Hematol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1002\/hon.2820","article-title":"A Real-World Efficacy and Safety Analysis of Combined Carfilzomib, Lenalidomide, and Dexamethasone (KRd) in Relapsed\/Refractory Multiple Myeloma","volume":"39","author":"Rocchi","year":"2021","journal-title":"Hematol. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"80","DOI":"10.3906\/sag-1611-97","article-title":"Carfilzomib experience in relapsed\/refractory multiple myeloma: A single-center experience","volume":"48","author":"Uysal","year":"2018","journal-title":"Turk. J. Med. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1182\/blood-2020-134475","article-title":"Real-World Evidence of the Use of Carfilzomib Among Multiple Myeloma Patients With at Least One Prior Therapy Across 10 European Countries and Israel","volume":"136","author":"Terpos","year":"2020","journal-title":"Blood"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"844779","DOI":"10.3389\/fonc.2022.844779","article-title":"Beyond clinical trials in patients with multiple myeloma: A critical review of real-world results","volume":"12","author":"Bertamini","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_22","first-page":"777","article-title":"Outcomes of Daratumumab-Containing Regimens in the Treatment of Relapsed Multiple Myeloma: Real-World Data from the Canadian Myeloma Research Group Database","volume":"5","author":"LeBlanc","year":"2021","journal-title":"Hemasphere"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1007\/s00277-020-03981-z","article-title":"Real-World Effectiveness and Safety of Ixazomib-Lenalidomide-Dexamethasone in Relapsed\/Refractory Multiple Myeloma","volume":"99","author":"Terpos","year":"2020","journal-title":"Ann. Hematol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1007\/s00277-020-03985-9","article-title":"Ixazomib-Based Regimens for Relapsed\/Refractory Multiple Myeloma: Are Real-World Data Compatible with Clinical Trial Outcomes? A Multi-Site Israeli Registry Study","volume":"99","author":"Cohen","year":"2020","journal-title":"Ann. Hematol."},{"key":"ref_25","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."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1080\/17474086.2020.1729734","article-title":"Real-world outcomes and factors impacting treatment choice in relapsed and\/or refractory multiple myeloma (RRMM): A comparison of VRd, KRd, and Ird","volume":"13","author":"Chari","year":"2020","journal-title":"Expert Rev. Hematol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2325","DOI":"10.1007\/s00277-021-04534-8","article-title":"Real-world comparative effectiveness of triplets containing bortezomib (B), carfilzomib (C), daratumumab (D), or ixazomib (I) in relapsed\/refractory multiple myeloma (RRMM) in the US","volume":"100","author":"Davies","year":"2021","journal-title":"Ann. Hematol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.clml.2017.06.013","article-title":"Analysis of Common Eligibility Criteria of Randomized Controlled Trials in Newly Diagnosed Multiple Myeloma Patients and Extrapolating Outcomes","volume":"17","author":"Shah","year":"2017","journal-title":"Clin. Lymphoma Myeloma Leuk."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1038\/s41408-018-0141-0","article-title":"Interpreting clinical trial data in multiple myeloma: Translating findings to the real-world setting","volume":"8","author":"Richardson","year":"2018","journal-title":"Blood Cancer J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.clml.2017.05.003","article-title":"New Agents in Multiple Myeloma: An Examination of Safety Profiles","volume":"17","author":"Bringhen","year":"2017","journal-title":"Clin. Lymphoma Myeloma Leuk."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"5288","DOI":"10.1182\/blood-2022-156225","article-title":"Treatment patterns and outcomes in patients with relapsed\/refractory multiple myeloma receiving >3 lines of Therapy: A real world evaluation in the United States","volume":"140","author":"Girvan","year":"2022","journal-title":"Blood"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.2217\/fon-2019-0013","article-title":"INSIGHT MM: A large, global, prospective, non-interventional, real-world study of patients with multiple myeloma","volume":"15","author":"Costello","year":"2019","journal-title":"Future Oncol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/24\/5846\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:38:59Z","timestamp":1760132339000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/24\/5846"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,14]]},"references-count":32,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["cancers15245846"],"URL":"https:\/\/doi.org\/10.3390\/cancers15245846","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,14]]}}}