Analysis of Pharmacotherapeutic Approaches for Multiple Myeloma and Correlated Renal and Pulmonary Impairments: A Retrospective Real-World Registry Study in the Greater Gulf Region (REPAIR Study)

Ayman Alhejazi¹Ahmad Alhuraiji²Abdulnaser Nourallah³Abdulrahman Alshehri⁴Binyam Usman⁵Ghada ELGohary⁶Hafiz Malhan⁷Ibraheem Motabi^8,9Khalil Al Farsi¹⁰Mohammed Alshuaibi¹¹Mohanad Diab¹²Mustaqeem Siddiqui¹³Ruba Taha¹⁴Tarek Abouzeid¹⁵Wesam Ahmed¹⁶Ahmed Ramadan Ali³Rasha Ghonema²Sana Faysal Elkhazin¹²Yousra Moussa³Abdullah Alrajhi^17,18Magdy Rabea¹⁹Yahia Aktham¹⁹Nesreen Bawazeer¹⁹Ali Ahmed Ali²⁰Mohamed Zahir Chouikrat^20*

• ¹Division of Adult Hematology and Hematopoietic Stem Cell Transplantation, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
• ²Department of Hematology, Kuwait Cancer Control Center, kuwait, Kuwait
• ³Hematology/Medical Oncology Department, Almana General Hospital, Alkhobar, Saudi Arabia
• ⁴Hematology/Oncology Department, Aseer Central Hospital, Abha, Saudi Arabia
• ⁵Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
• ⁶6. Department of Medicine, Division of Oncology/Hematology, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
• ⁷Department of Adult Hematology, Prince Mohammed bin Nasser Hospital, Jazan, Saudi Arabia
• ⁸Adult Hematology & Bone Marrow Transplant Department, Comprehensive Cancer Center at King Fahad Medical City, Riyadh, Saudi Arabia
• ⁹Alfaisal University, Riyadh, Saudi Arabia
• ¹⁰Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
• ¹¹Adult Hematology and Oncology Divisions, Department of Medicine, King Abdul-Aziz Hospital, Alahsa, Saudi Arabia
• ¹²Hemato-oncology Department, Burjeel Hospital, Abu Dhabi, United Arab Emirates
• ¹³Hematology & Oncology Division at Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates
• ¹⁴14. Department of Hematology-Bone Marrow Transplantation-, National Centre for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
• ¹⁵Internal Medicine Department, Almouwasat Hospital, Dammam, Saudi Arabia
• ¹⁶Cleveland Clinic Abu Dhabi, Oncology Institute, Abu Dhabi, United Arab Emirates
• ¹⁷Clinical Pharmacy Department, King Fahad Medical City, Riyadh, Saudi Arabia
• ¹⁸Department of Pharmacy Practice, College of Pharmacy, Alfaisal University, Riyadh, Saudi Arabia
• ¹⁹Medical Affairs Department, Sanofi, Jeddah, Saudi Arabia
• ²⁰Medical Affairs Department, Sanofi, Dubai, United Arab Emirates

Background: Multiple myeloma (MM) is a plasma cell malignancy with significant unmet medical needs, particularly in the treatment of relapsed and refractory disease. This study aims to describe the disease characteristics, various treatment regimens, and outcomes among patients with Relapsed/Refractory Multiple Myeloma (RRMM) in the Greater Gulf region. Methods: A regional, retrospective study was conducted in Gulf countries to collect real-world data from the medical records of 148 patients with RRMM who relapsed 1-3 times in the past two years before the data collection period (July 2022 and February 2023). Results: The mean age of the study population was 59.4 years, and 64.2% of the participants were male. The VRd regimen (Bortezomib, Lenalidomide, and Dexamethasone) was the most frequent first-line therapy among transplant-ineligible patients (40.2%) and the most common induction and consolidation regimen (43.9% and 66.7%, respectively) in transplant-eligible patients. Meanwhile, Rd (Lenalidomide and Dexamethasone) was the most common maintenance regimen (75%). DKd (Daratumumab, Carfilzomib, and Dexamethasone), KPd (Carfilzomib, Pomalidomide, and Dexamethasone), and PVd (Pomalidomide, Bortezomib, and Dexamethasone) were the most widely used second, third, and fourth treatment lines, respectively (16.6%, 9.2%, and 12.5%). About 52.7% of patients were eligible for stem cell transplantation (SCT), and among them, a complete response (CR) was achieved in 47.7%. Furthermore, CR and very good partial remission rates decreased across all treatment lines. Renal impairment decreased across different treatment lines, from 23.6% in the first line to 6.3% in the fourth line. In contrast, respiratory complications demonstrated the highest incidence (>18%) in the 3rd and 4th treatment lines. Moreover, refractoriness to treatment increased from 1.3% in the first line to 34.6% in the fourth treatment line. Additionally, isatuximab was incorporated into 80%, 15%, and 5% of the regimens administered as second-, third-, and fourth-line treatments, respectively. Conclusion: This study provides valuable insights into the real-world management and treatment choices for RRMM, including the utilization of SCT and novel therapies such as isatuximab.