Significant differences in access to tests and treatments for multiple myeloma between public and private systems in Latin America. Results of a Latin American survey. GELAMM (Grupo de Estudio Latino Americano de Mieloma Múltiple)

Daratumumab Plus Bortezomib, Melphalan, and Prednisone Versus Standard of Care in Latin America for Transplant-Ineligible Newly Diagnosed Multiple Myeloma: Propensity Score Matching Analysis

“…Similar to the findings of the HOLA study [ 9 ], bortezomib- and thalidomide-based regimens were reported as common first-line treatment options for transplant-ineligible patients with NDMM [ 7 , 8 ]. As of 2018, daratumumab had been approved for MM in eight Latin American countries (in four countries for relapsed refractory MM only); however, access is limited because of reimbursement and local policies [ 8 , 17 ]. Of note, patients with MM who were treated at public centers in Mexico were more likely to be diagnosed with advanced-stage disease and have poorer outcomes than those treated at private centers [ 18 ].…”

“…In an internet-based questionnaire of regional MM reference centers [ 7 ] and a subsequent survey of hematologists from 15 Latin American countries [ 8 ], variation in access to diagnostic tests and treatments in public versus private centers was reported. Similar to the findings of the HOLA study [ 9 ], bortezomib- and thalidomide-based regimens were reported as common first-line treatment options for transplant-ineligible patients with NDMM [ 7 , 8 ]. As of 2018, daratumumab had been approved for MM in eight Latin American countries (in four countries for relapsed refractory MM only); however, access is limited because of reimbursement and local policies [ 8 , 17 ].…”

“…In this PSM analysis, D-VMP showed superior effectiveness compared with bortezomib-and thalidomide-based regimens that are commonly Several challenges have been identified for the management of patients with MM in Latin America. In an internet-based questionnaire of regional MM reference centers [7] and a subsequent survey of hematologists from 15 Latin American countries [8], variation in access to diagnostic tests and treatments in public versus private centers was reported. Similar to the findings of the HOLA study [9], bortezomiband thalidomide-based regimens were reported as common first-line treatment options for transplant-ineligible patients with NDMM [7,8].…”

“…The proportion of patients who were aged 65 years or more was 90% in the D-VMP arm of ALCYONE [4] but only 51% in the cohort of patients who did not receive ASCT in HOLA [9]. Patients evaluated in the HOLA study may not have received ASCT because of underlying medical issues (60% had at least one selected comorbidity documented [9]) and/or because of inconsistent access to ASCT in different Latin American countries [7,8], rather than because of age. Analyses based on propensity scores do have some limitations that must be considered when interpreting these findings.…”

“…In Latin America, the uptake of novel treatments for MM has been slow, in part due to economic constraints and the existence of separate regulatory agencies for each nation in the region [ 7 , 8 ]. Although there is variability between, and sometimes within, countries, bortezomib- or thalidomide-based regimens are generally considered SoC for transplant-ineligible patients with NDMM in Latin America [ 9 ].…”