title: Multiple myeloma treatment transformed: a population-based study of changes in initial management approaches in the United States.
abstract: OBJECTIVE
  Despite improved outcomes for multiple myeloma, little is known about changes in initial treatment at the population level for US patients. We report trends in treatment practices.
  
  
  METHODS
  Patients (n = 1,976) with newly diagnosed myeloma in 1999, 2003, and 2007 were examined by using the National Cancer Institute's Patterns of Care Studies. We assessed use of common chemotherapies (melphalan, vincristine, and doxorubicin), novel agents (thalidomide, bortezomib, or lenalidomide), or hematopoietic stem-cell transplantation (HSCT) during the first year after diagnosis. By using logistic regression, we evaluated the association of race and insurance status with receipt of high-cost treatments--transplantation or novel agents.
  
  
  RESULTS
  From 1999 to 2007, use of melphalan alone dropped from 32.0% to 4.1%, and vincristine and doxorubicin use declined from 18.2% to 0.4%. The percentage of patients receiving any novel agent rose from 3.9% in 1999 to 75.5% in 2007. HSCT increased from 11.1% in 1999 to 21.7% in 2007. For white patients, use of novel agents was lower for those with Medicare only (42.6%) than for those with private insurance (50.2%). For patients of other races, those with Medicare only or Medicaid were less likely to receive novel agents or transplantation compared with those with private insurance.
  
  
  CONCLUSIONS
  Initial treatment for multiple myeloma has changed markedly. Most patients now receive novel agents, with a decline in the use of traditional chemotherapy. Use of transplantation and novel agents varies with race and insurance. These findings document rapid changes in patterns of care and highlight addressable disparities in myeloma care.
authors.affiliation: National Cancer Institute, Bethesda, MD 20892-7344, USA. joan_warren@nih.gov
authors.forename: Joan L
authors.initials: JL
authors.lastname: Warren
authors.forename: Linda C
authors.initials: LC
authors.lastname: Harlan
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stevens
authors.forename: Richard F
authors.initials: RF
authors.lastname: Little
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Abel
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001213:Asian / Q000706:statistics & numerical data; D015986:Confounding Factors, Epidemiologic; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D006278:Medicare; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D009101:Multiple Myeloma / Q000188:drug therapy / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000639:trends*; D012189:Retrospective Studies; D018426:SEER Program; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014481:United States; D014750:Vincristine / Q000008:administration & dosage; D044465:White People / Q000706:statistics & numerical data
chemical_list: D000970:Antineoplastic Agents; D014750:Vincristine; D004317:Doxorubicin; D008558:Melphalan