Quadruplet treatments for multiple myeloma are rising but access varies | ASH 2025

From 2017 to 2024, newly diagnosed multiple myeloma (MM) patients rapidly received quadruplet therapies over triplets, with 39% receiving quadruplets in 2023, according to a 2025 American Society of Hematology (ASH) abstract presented at this year’s meeting in Orlando.

Treatment options for MM, one of the most common blood cancers in the U.S., have evolved increasingly over the past two decades, improving overall survival for many patients. In a 2023 study, it was estimated that 34,470 people were newly diagnosed with MM, and 12,640 died from the disease.

Regardless of these advances, benefits have not been shared equally. For example, Black people experience higher cases and mortality rates and often receive less aggressive treatment than White patients.

Social determinants of health, insurance coverage and geographic factors may contribute to these disparities, but data on their impact in real-world treatment settings, particularly in the uptake of novel triplet and quadruplet regimens, remain limited.

To address this gap, Hamlet Gasoyan, Ph.D., health services researcher and assistant professor of medicine at Cleveland Clinic, as well as his team at the Cleveland Clinic and Case Comprehensive Cancer Center, analyzed trends in the use of triplet and quadruplet regimens among newly diagnosed MM patients, shedding light on how treatment patterns are evolving in routine clinical practice.

The study looked at data from a myeloma patient registry at a large, integrated health system in Ohio and Florida. Researchers focused on adults newly diagnosed with MM between 2017 and 2023 and tracked whether patients received triplet or quadruplet regimens during the first year after diagnosis, using electronic health records through the end of 2024.

They also examined how age, race, insurance coverage and other clinical and sociodemographic characteristics were linked to treatment type, applying statistical models to identify patterns in real-world care.

The study included 1,233 adults with an average age of 67 years. Just over half were men; most were White (74%), 23% were Black and 6% were Hispanic. Most patients had healthy kidney function when they were diagnosed, and their overall health was moderate, with a typical comorbidity score of 2.

Use of any triplet or quadruplet regimen within the first year after diagnosis rose slightly from 57% in 2017 to 66% in 2023, though this change was not statistically significant. Quadruplet regimens grew sharply from 2% to 39%, while triplet regimens fell from 57% to 38%. Patients were less likely to receive these treatments if they were older, lived in more disadvantaged areas or were treated at Florida hospitals. Those with lower kidney function or treated at Ohio regional hospitals were more likely to receive triplet or quadruplet therapy.

Gasoyan shared with Managed Healthcare Executive that the quick rise in quadruplet treatments reflected both clinical advances and growing evidence supporting their use. Particularly, he said that promising phase 2 and phase 3 clinical trial data lead to quadruplet regimens surpassing triplet regimens in 2023 and 2024, with 39% of patients receiving a quadruplet regimen and 38% receiving a triplet regimen.

However, adopting these more intensive treatments didn’t come without challenges.

“While there has been tremendous progress in the development of novel therapeutic regimens for multiple myeloma, factors such as out-of-pocket costs and logistical barriers, concerns about tolerability, and toxicity may impact therapy selection,” Gasoyan added, highlighting the real-world complexities of delivering cutting-edge care.

Gasoyan also discussed the disparities in access to these therapies.

“Although the mechanism is unknown, out-of-pocket costs and logistical barriers might be particularly prohibitive for individuals residing in more deprived areas,” he said.

At Cleveland Clinic, teams work to help patients navigate these challenges by connecting them with copay assistance programs, helping with Medicaid or the Hospital Care Assurance Program and managing other aspects of treatment. Accessing medications such as Revlimid (lenalidomide), a common drug in these combination regimens, can also be difficult, as this process often requires patient and physician surveys, insurance prior authorizations or applications for copay assistance.

Gasoyan shared he and his team are studying these modifiable barriers and their effects on timely care to inform evidence-based policy recommendations.