{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T07:06:19Z","timestamp":1784531179938,"version":"3.55.0"},"reference-count":22,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T00:00:00Z","timestamp":1784419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Background\/Objectives: Multiple myeloma (MM) disproportionately affects older adults and racial\/ethnic minorities, many of whom face socioeconomic barriers to care. Immunomodulators (IMiDs) are central to MM therapy, but their benefit relies on timely initiation and sustained adherence. In safety-net settings, barriers such as insurance approvals, Patient Medication Assistance Program (PMAP) enrollment, and Risk Evaluation and Mitigation Strategy (REMS) requirements may influence adherence. This study evaluated IMiD adherence during the first two years of therapy among socioeconomically vulnerable MM patients in a large safety-net hospital, with attention to PMAP enrollment and treatment delays. Methods: We conducted a retrospective cohort study of adults (\u226518 years) with newly diagnosed MM between October 2010 and January 2022 who initiated lenalidomide or pomalidomide at a safety-net hospital. Adherence was measured using the proportion of days covered (PDC). Delays in initiation were defined as \u22651 month from diagnosis to first IMiD prescription fill. This threshold was selected a priori based on the REMS-mandated 28-day prescription supply limit for lenalidomide and pomalidomide, which establishes a natural monthly treatment cycle; a delay exceeding one full 28-day cycle before therapy initiation is operationally meaningful within the REMS framework. Results: Eighty patients met criteria (mean age 55.1 years; 56.3% Hispanic\/Latino; 31.3% African American). Most were unemployed (63.8%), 42.5% uninsured, and 57.5% enrolled in PMAP. Only 12.5% achieved PDC \u2265 80%. Median PDC was higher among PMAP enrollees (0.40 vs. 0.31; p = 0.0293) and transplant-ineligible patients (0.46 vs. 0.27; p = 0.0218). Delays \u2265 1 month occurred in 65% of patients. Conclusions: Adherence to IMiDs was suboptimal in this younger safety-net cohort. Although PMAP improved adherence, program delays may reduce early treatment benefits, underscoring the need for streamlined access and targeted interventions to address both patient- and system-level barriers.<\/jats:p>","DOI":"10.3390\/curroncol33070432","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T06:09:09Z","timestamp":1784527749000},"page":"432","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Adherence to Immunomodulators in Multiple Myeloma: Retrospective Observations from a Safety-Net Hospital"],"prefix":"10.3390","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5662-4686","authenticated-orcid":false,"given":"Onyebuchi","family":"Ononogbu","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice and Translational Research, College of Pharmacy, University of Houston, Houston, TX 77204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sydney","family":"Mohr","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Translational Research, College of Pharmacy, University of Houston, Houston, TX 77204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4850-9215","authenticated-orcid":false,"given":"Javeria","family":"Khalid","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX 77204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyssa","family":"Glass","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Translational Research, College of Pharmacy, University of Houston, Houston, TX 77204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Emovon","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Translational Research, College of Pharmacy, University of Houston, Houston, TX 77204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA"},{"name":"Lyndon B. Johonson Outpatient Hematology, Harris Health System, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1208-9503","authenticated-orcid":false,"given":"Yaser","family":"Alkhatib","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Cleveland Clinic Abu Dhabi, Abu Dhabi 112412, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Correa","sequence":"additional","affiliation":[{"name":"Lyndon B. Johonson Outpatient Hematology, Harris Health System, Houston, TX 77030, USA"},{"name":"McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,19]]},"reference":[{"key":"ref_1","unstructured":"Lewin, M.E., and Altman, S. (2000). Managed Care, and the Future Viability of Safety Net Providers, National Academies Press. America\u2019s Health Care Safety Net: Intact but Endangered."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e198577","DOI":"10.1001\/jamanetworkopen.2019.8577","article-title":"Comparison of 3 Safety-Net Hospital Definitions and Association with Hospital Characteristics","volume":"2","author":"Popescu","year":"2019","journal-title":"JAMA Netw. Open"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e2611849","DOI":"10.1001\/jamanetworkopen.2026.11849","article-title":"Insulin Patient Assistance Programs and Protected Heath Information","volume":"9","author":"Karakousis","year":"2026","journal-title":"JAMA Netw. Open"},{"key":"ref_4","unstructured":"(2025, September 01). NCCN Clinical Practice Guidelines in Oncology. Multiple Myeloma Version 2.2026. Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/myeloma.pdf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1182\/asheducation-2017.1.498","article-title":"Management of multiple myeloma in the newly diagnosed patient","volume":"2017","author":"Mateos","year":"2017","journal-title":"Hematol. Am. Soc. Hematol. Educ. Program"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Mina\u0159\u00edk, J., and \u0160ev\u010d\u00edkov\u00e1, S. (2022). Immunomodulatory Agents for Multiple Myeloma. Cancers, 14.","DOI":"10.3390\/cancers14235759"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1007\/s11606-020-06447-0","article-title":"The Impact of Social Determinants of Health on Medication Adherence: A Systematic Review and Meta-analysis","volume":"36","author":"Wilder","year":"2021","journal-title":"J. Gen. Intern. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1007\/s11096-023-01609-6","article-title":"Adherence to oral endocrine therapy in racial\/ethnic minority patients with low socioeconomic status before and during the COVID-19 pandemic","volume":"45","author":"Rahimi","year":"2023","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1038\/s41408-023-00961-0","article-title":"Addressing the disparities: The approach to the African American patient with multiple myeloma","volume":"13","author":"Bhutani","year":"2023","journal-title":"Blood Cancer J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1038\/s41408-018-0077-4","article-title":"Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria","volume":"8","author":"Lakshman","year":"2018","journal-title":"Blood Cancer J."},{"key":"ref_11","unstructured":"(2026, July 15). DailyMed. U.S. National Library of Medicine. Updated January 2026, Available online: https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=5fa97bf5-28a2-48f1-8955-f56012d296be."},{"key":"ref_12","first-page":"407","article-title":"Immunomodulator adherence in multiple myeloma patients with lower socioeconomic status: A retrospective study","volume":"32","author":"Ononogbu","year":"2024","journal-title":"Support Care Cancer."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1353\/hpu.2017.0036","article-title":"Financial Strain is Associated with Medication Nonadherence and Worse Self-Rated Health Among Cardiovascular Patients","volume":"28","author":"Osborn","year":"2017","journal-title":"J. Health Care Poor Underserved"},{"key":"ref_14","first-page":"1073","article-title":"Navigating the Wild West of Medication Adherence Reporting in Specialty Pharmacy","volume":"25","author":"Canfield","year":"2019","journal-title":"J. Manag. Care Spec. Pharm."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1038\/s41408-018-0102-7","article-title":"Disease and outcome disparities in multiple myeloma: Exploring the role of race\/ethnicity in the Cooperative Group clinical trials","volume":"8","author":"Ailawadhi","year":"2018","journal-title":"Blood Cancer J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1001\/jamaoncol.2017.0625","article-title":"Interventions to Improve Oral Chemotherapy Safety and Quality: A Systematic Review","volume":"4","author":"Zerillo","year":"2018","journal-title":"JAMA Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1053\/j.seminhematol.2017.07.004","article-title":"Patient assistance programs: A valuable, yet imperfect, way to ease the financial toxicity of cancer care","volume":"55","author":"Yezefski","year":"2018","journal-title":"Semin. Hematol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e341","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":"ref_19","doi-asserted-by":"crossref","unstructured":"Khorana, A.A., Tullio, K., Elson, P., Pennell, N.A., Grobmyer, S.R., Abraham, J., Raymond, D., Kalady, M.F., Almeida, P., and Moreland, A.M. (2019). Time to initial cancer treatment in the United States and association with survival over time: An observational study. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0215108"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Wan, X., Yu, T., Yu, T., and Cai, H. (2025). The impact of multiple myeloma drugs treatments on autologous stem cell transplantation in the era of new drugs. Front. Oncol., 15.","DOI":"10.3389\/fonc.2025.1479164"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2986","DOI":"10.1182\/bloodadvances.2019000308","article-title":"Racial disparities in treatment patterns and outcomes among patients with multiple myeloma: A SEER-Medicare analysis","volume":"3","author":"Ailawadhi","year":"2019","journal-title":"Blood Adv."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1038\/s41408-024-01128-1","article-title":"Disparities in time to treatment with oral antimyeloma medications","volume":"14","author":"Gasoyan","year":"2024","journal-title":"Blood Cancer J."}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/7\/432\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T06:43:21Z","timestamp":1784529801000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/7\/432"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,19]]},"references-count":22,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["curroncol33070432"],"URL":"https:\/\/doi.org\/10.3390\/curroncol33070432","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,19]]}}}