---
title: "Real-world changes in frontline treatment patterns for multiple myeloma in the VA (2000–2024)"
id: "pubmed-42480210"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42480210"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42480210/"
doi: "10.1182/bloodadvances.2026019843"
published_at: "2026-09-22T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Real-world changes in frontline treatment patterns for multiple myeloma in the VA (2000–2024)
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42480210
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42480210/)
- **DOI:** [10.1182/bloodadvances.2026019843](https://doi.org/10.1182%2Fbloodadvances.2026019843)
- **Published At:** 2026-09-22T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The study is a retrospective analysis of **20,135** patients with newly diagnosed **multiple myeloma** treated within the national Veterans Affairs (VA) health system from 2000 through 2024. - Over the past two decades the number of **FDA-approved treatments** for multiple myeloma has risen substantially, increasing treatment complexity and producing variable uptake of novel agents in clinical practice. - The VA provides an **equal-access** environment in which cost barriers are reduced, enabling assessment of treatment adoption and outcomes across diverse patient groups. - Investigators evaluated **overall survival** by frontline treatment regimen, diagnosis era, and sociodemographic variables. - Despite equal-access care, lower socioeconomic status—approximated by the **area deprivation index (ADI)**—was independently associated with higher mortality. - Randomized clinical trials often exclude older, medically complex, and socioeconomically disadvantaged patients, limiting the direct applicability of trial results to real-world populations observed in this cohort. - Survival outcomes improved across successive treatment eras, but follow-up in the most recent cohort is limited and long-term survival remains incompletely characterized. - The authors emphasize a need to implement strategies addressing structural and social barriers to realize equitable gains in multiple myeloma outcomes.
## Clinical Analysis & Structured Key Points
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Evolution of real-world frontline treatment patterns in multiple myeloma [Alexander Lazzaro](https://pubmed.ncbi.nlm.nih.gov/?term=Lazzaro+A&cauthor_id=42480210)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#full-view-affiliation-1 "Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA."), [Kaelyn Nannini](https://pubmed.ncbi.nlm.nih.gov/?term=Nannini+K&cauthor_id=42480210)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#full-view-affiliation-2 "Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA."), [Cenk Yildirim](https://pubmed.ncbi.nlm.nih.gov/?term=Yildirim+C&cauthor_id=42480210)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#full-view-affiliation-2 "Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA."), [Linden Huhmann](https://pubmed.ncbi.nlm.nih.gov/?term=Huhmann+L&cauthor_id=42480210)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#full-view-affiliation-2 "Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA."), [John M Culnan](https://pubmed.ncbi.nlm.nih.gov/?term=Culnan+JM&cauthor_id=42480210)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#full-view-affiliation-2 "Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA."), [June K Corrigan](https://pubmed.ncbi.nlm.nih.gov/?term=Corrigan+JK&cauthor_id=42480210)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#full-view-affiliation-2 "Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA."), [Danne Elbers](https://pubmed.ncbi.nlm.nih.gov/?term=Elbers+D&cauthor_id=42480210)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#full-view-affiliation-2 "Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA."), [Nhan V Do](https://pubmed.ncbi.nlm.nih.gov/?term=Do+NV&cauthor_id=42480210)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#full-view-affiliation-1 "Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#full-view-affiliation-2 "Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#full-view-affiliation-3 "Section of Hematology, VA Boston Healthcare System, West Roxbury, MA."), [Mary Brophy](https://pubmed.ncbi.nlm.nih.gov/?term=Brophy+M&cauthor_id=42480210)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#full-view-affiliation-1 "Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#full-view-affiliation-2 "Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#full-view-affiliation-3 "Section of Hematology, VA Boston Healthcare System, West Roxbury, MA."), [Nikhil Munshi](https://pubmed.ncbi.nlm.nih.gov/?term=Munshi+N&cauthor_id=42480210)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#full-view-affiliation-3 "Section of Hematology, VA Boston Healthcare System, West Roxbury, MA.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#full-view-affiliation-4 "Jerome Lipper Multiple Myeloma Center, Division of Plasma Cell Neoplasias, Dana-Farber Cancer Institute, Boston, MA."), [Nathanael R Fillmore](https://pubmed.ncbi.nlm.nih.gov/?term=Fillmore+NR&cauthor_id=42480210)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#full-view-affiliation-1 "Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#full-view-affiliation-2 "Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA."), [Camille V Edwards](https://pubmed.ncbi.nlm.nih.gov/?term=Edwards+CV&cauthor_id=42480210)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#full-view-affiliation-2 "Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#full-view-affiliation-5 "Section of Hematology and Oncology, Department of Medicine, Boston Medical Center, Boston, MA.") Affiliations Expand ### Affiliations * 1 Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA. * 2 Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA. * 3 Section of Hematology, VA Boston Healthcare System, West Roxbury, MA. * 4 Jerome Lipper Multiple Myeloma Center, Division of Plasma Cell Neoplasias, Dana-Farber Cancer Institute, Boston, MA. * 5 Section of Hematology and Oncology, Department of Medicine, Boston Medical Center, Boston, MA. * PMID: **42480210** * DOI: [ 10.1182/bloodadvances.2026019843 ](https://doi.org/10.1182/bloodadvances.2026019843) Item in Clipboard # Evolution of real-world frontline treatment patterns in multiple myeloma Alexander Lazzaro et al. Blood Adv. 2026. Show details Display options Display options Format Abstract PubMed PMID Blood Adv Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Blood+Adv%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Blood+Adv%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42480210/) . 2026 Sep 22;10(18):6278-6288. doi: 10.1182/bloodadvances.2026019843. ### Authors [Alexander Lazzaro](https://pubmed.ncbi.nlm.nih.gov/?term=Lazzaro+A&cauthor_id=42480210)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#short-view-affiliation-1 "Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA."), [Kaelyn Nannini](https://pubmed.ncbi.nlm.nih.gov/?term=Nannini+K&cauthor_id=42480210)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#short-view-affiliation-2 "Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA."), [Cenk Yildirim](https://pubmed.ncbi.nlm.nih.gov/?term=Yildirim+C&cauthor_id=42480210)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#short-view-affiliation-2 "Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA."), [Linden Huhmann](https://pubmed.ncbi.nlm.nih.gov/?term=Huhmann+L&cauthor_id=42480210)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#short-view-affiliation-2 "Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA."), [John M Culnan](https://pubmed.ncbi.nlm.nih.gov/?term=Culnan+JM&cauthor_id=42480210)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#short-view-affiliation-2 "Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA."), [June K Corrigan](https://pubmed.ncbi.nlm.nih.gov/?term=Corrigan+JK&cauthor_id=42480210)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#short-view-affiliation-2 "Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA."), [Danne Elbers](https://pubmed.ncbi.nlm.nih.gov/?term=Elbers+D&cauthor_id=42480210)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#short-view-affiliation-2 "Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA."), [Nhan V Do](https://pubmed.ncbi.nlm.nih.gov/?term=Do+NV&cauthor_id=42480210)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#short-view-affiliation-1 "Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#short-view-affiliation-2 "Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#short-view-affiliation-3 "Section of Hematology, VA Boston Healthcare System, West Roxbury, MA."), [Mary Brophy](https://pubmed.ncbi.nlm.nih.gov/?term=Brophy+M&cauthor_id=42480210)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#short-view-affiliation-1 "Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#short-view-affiliation-2 "Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#short-view-affiliation-3 "Section of Hematology, VA Boston Healthcare System, West Roxbury, MA."), [Nikhil Munshi](https://pubmed.ncbi.nlm.nih.gov/?term=Munshi+N&cauthor_id=42480210)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#short-view-affiliation-3 "Section of Hematology, VA Boston Healthcare System, West Roxbury, MA.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#short-view-affiliation-4 "Jerome Lipper Multiple Myeloma Center, Division of Plasma Cell Neoplasias, Dana-Farber Cancer Institute, Boston, MA."), [Nathanael R Fillmore](https://pubmed.ncbi.nlm.nih.gov/?term=Fillmore+NR&cauthor_id=42480210)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#short-view-affiliation-1 "Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#short-view-affiliation-2 "Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA."), [Camille V Edwards](https://pubmed.ncbi.nlm.nih.gov/?term=Edwards+CV&cauthor_id=42480210)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#short-view-affiliation-2 "Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42480210/#short-view-affiliation-5 "Section of Hematology and Oncology, Department of Medicine, Boston Medical Center, Boston, MA.") ### Affiliations * 1 Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA. * 2 Cooperative Studies Program Informatics Center, Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA. * 3 Section of Hematology, VA Boston Healthcare System, West Roxbury, MA. * 4 Jerome Lipper Multiple Myeloma Center, Division of Plasma Cell Neoplasias, Dana-Farber Cancer Institute, Boston, MA. * 5 Section of Hematology and Oncology, Department of Medicine, Boston Medical Center, Boston, MA. * PMID: **42480210** * DOI: [ 10.1182/bloodadvances.2026019843 ](https://doi.org/10.1182/bloodadvances.2026019843) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract The number of Food and Drug Administration-approved treatments for multiple myeloma (MM), the second most common hematologic malignant neoplasm, has increased substantially over the past 2 decades. Treatment decisions have become more complex over time, and there is variable adoption of new agents in clinical practice. Survival trends have improved with novel therapies; however, these trends are not equitably distributed across patient populations. Although randomized clinical trials have guide treatment strategies, their exclusion of older, medically complex, and socioeconomically disadvantaged patients limits applicability to real-world outcomes. Understanding the natural history of MM and how treatment patterns have changed over time is essential for informing optimal MM care in clinical practice. We retrospectively evaluated 20 135 patients with newly diagnosed MM from the national Veterans Affairs (VA) health system between 2000 and 2024. The VA offers a unique setting to study these patterns in the equal-access context, in which cost is less of a factor, allowing us to assess trends in treatment decisions and outcomes across diverse strata. We analyzed overall survival by treatment regimen, diagnosis era, and sociodemographic features. Lower socioeconomic status as approximated by the area deprivation index was independently associated with increased mortality despite equal health care access. Outcomes continue to improve across treatment eras, although follow-up in the most recent cohort is limited and long-term survival remains incompletely characterized. These findings underscore the need for implementing strategies to address the structural and social barriers to optimal MM care. © 2026 American Society of Hematology. Published by Elsevier Inc. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Folic acid supplementation and malaria susceptibility and severity among pe
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