scholarly journals Utilization Patterns of Bone-Targeting Agents Among Patients with Multiple Myeloma: Analysis of Real-World Data

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4501-4501 ◽  
Author(s):  
Yi Qian ◽  
Debajyoti Bhowmik ◽  
Nandita Kachru ◽  
Rohini K. Hernandez ◽  
Paul Cheng ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Zoledronic Acid ◽  
Real World ◽  
The United States ◽  
Treatment Patterns ◽  
Prescribing Patterns ◽  
Bone Targeting ◽  
Real World Setting ◽  
Increased Risk

Abstract Background: At diagnosis, 80% of patients with multiple myeloma (MM) are reported to have osteolytic lesions.MM is characterized by substantial bone destruction, resulting in increased risk of skeletal-related events (SREs), defined as pathological fracture, spinal cord compression, radiation or surgery to bone. SREs are associated with debilitating bone pain, significant morbidity, and increased mortality. SREs also have substantial economic consequences on patients and healthcare systems. Bone-targeting agents (BTAs) approved for the prevention of SREs in MM include intravenous bisphosphonates (IV BPs) zoledronic acid (ZA) and pamidronate (PA). ZA and PA may be used monthly for up to two years and longer for patients who continue to have active or relapsed disease. Given the increased risk of atypical femoral fracture and osteonecrosis of the jaw (ONJ) with cumulative dosing, and medical contraindications (e.g., renal function deterioration), there may be clinician preference to reduce or limit IV BPs. Limited information is available regarding compliance to BTAs in real-world setting in the US. The objective of this study is to examine BTA treatment patterns, including compliance and time to non-persistence among MM patients. Methods: This retrospective cohort study was conducted using the Oncology Services Comprehensive Oncology Records (OSCER) electronic medical records database, including over 750,000 patients from >200 hematology/oncology practices across the United States. The following selection criteria were used: (1) MM diagnosis (ICD-9CM: 203.0x) between 1st January 2012 and 31st December 2014; (2) ≥18 years of age at MM diagnosis; and (3) initiation of BTA therapy between 1-Jan-2012 and 31-Dec-2014. Patients with solid tumors were excluded. Compliance with BTA therapy was defined as ≥12 administrations in each year of follow-up. Non-persistence was operationalized as either a gap in therapy of ≥90 days or ≥90 days between last administration and last date of follow-up (i.e., discontinuation), or switch from initial BTA. Kaplan-Meier method was used for analysis of time to non-persistence. Results: Out of 9,617 patients diagnosed with MM, a total of 3,394 (35.3%) patients treated with ZA therapy and 341 (3.6%) treated with PA met inclusion criteria. Majority of the patients were male (ZA: 54.1%, PA: 53.1%), white (ZA: 72.2%, PA: 64.2%), and ≥65 years (ZA: 64.5%, PA: 67.7%). Average time to initiation of therapy from MM diagnosis was 3 months for both ZA and PA. Most of the patients initiated therapy within 3 months (ZA: 76.1%, PA: 75.1%) or 6 months (ZA: 86.3%, PA: 85.6%) of MM diagnosis. Overall the compliance rate was low and declined during follow-up (Table 1). The median time to non-persistence was 16.2 (15.4-17.4) months for ZA and 13.8 (11.5-15.4) months for PA (Fig. 1). Persistence rates declined over the follow-up years, ranging from 86% at 6 months to 34% at 24 months for ZA, and from 77% at 6 months to 30% at 24 months for PA (Fig. 1). Table 1. Compliance with BTA therapy over follow-up years Patients with Minimum 12 Months of Follow-up (N=2,211) Patients with Minimum 24 Months of Follow-up (N=899) Pamidronate Zoledronic Acid Pamidronate Zoledronic Acid N 191 2,020 95 804 Current Users 191 2,020 64 641 Mean Administrations (Standard Deviation) 7.6 (4) 8.3 (3.8) 7.0 (3.7) 7.3 (3.9) Switch (n, %) 28 (14.7) 39 (1.9) 3 (3.2) 9 (1.1) ≥12 Administrations/Year (n, %) 44 (23) 553 (27.4) 10 (15.6) 127 (19.8) Conclusions: The treatment landscape in MM has evolved in recent years with clinical trial data supporting improved survival for patients. In this dynamic landscape, it is increasingly important to understand prescribing patterns and patient compliance with BTAs. This analysis indicates there may be limited compliance to BTA therapy in the real-world setting. Potential reasons for non-compliance may include concerns of medical contraindications, patient burden associated with IV administration, or clinician preference. With emerging therapies being evaluated in MM, BTA treatment patterns warrant investigation in future studies. Figure 1. Figure 1. Disclosures Qian: Amgen Inc.: Employment. Bhowmik:Amgen Inc.: Employment. Kachru:Amgen Inc.: Employment. Hernandez:Amgen Inc.: Employment. Cheng:Amgen Inc.: Employment. Liede:Amgen Inc.: Employment.

Bone Targeting Agent Treatment Patterns Among Patients with Multiple Myeloma Treated at Oncology Clinics Across the United States: Observations from Real-World Data

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2364-2364
Author(s):  
Christopher Kim ◽  
Rohini K. Hernandez ◽  
Paul C Cheng ◽  
Jeremy Smith ◽  
Lori Cyprien ◽  
...  
Keyword(s):  
Zoledronic Acid ◽  
Real World ◽  
The United States ◽  
Treatment Patterns ◽  
First Year ◽  
Real World Data ◽  
Employment Equity ◽  
The Us ◽  
Equity Ownership

Abstract Introduction: Multiple myeloma (MM) is a hematologic malignancy with 30,330 estimated new cases in the US in 2016. The International Myeloma Working Group recommended that intravenous (IV) bisphosphonates be initiated in all patients with active MM administered at 3 to 4-week intervals. However, there are limited data to date on the real-world use of bone target agents (BTA; zoledronic acid and pamidronate disodium) in MM. The primary goal of this study is to describe current real-world BTA treatment patterns. Methods: A database of electronic medical records from >1 million patients treated at approximately 220 cancer centers across the United States, OSCER (Oncology Services Comprehensive Electronic Records, generated by Flatiron Health), was used to identify individuals 18 years or older diagnosed with MM (ICD-9 203.00; ICD-10 C90.00) with at least 1 clinic visit within 1 month of diagnosis date between January 1, 2009 and March 31, 2016. Timing of BTA administrations, frequency, schedule, and changes/discontinuation were calculated, renal function, and BTA treatment relative to anti-MM therapy regimens was also determined. Results: During the study period, 11,099 patients were diagnosed with MM; most were male (55%), white (59%), and 65 and older at diagnosis (66%). Through the end of the follow-up period (median follow-up: 687 days), 64% of patients received ≥1 administration of a BTA (% consistent across study period) and zoledronic acid was the predominant BTA (93% of patients received ≥1 administration). The mean time from MM diagnosis until first BTA was 105.7 days (median: 29, IQR: 11-78). In more recent years, the time to BTA initiation decreased. Initial BTA treatment occurred in first year after MM diagnosis in 58.7% of patients. By calendar year of diagnosis, the percentage of patients that ever received BTA treatment had decreased over time (2009-2010: 72.3%; 2011-2012: 68.0%; 2013-2014: 63.6%). Most BTA administrations were dosed on a Q4W schedule (77%), particularly in the first year of MM diagnosis (84%). A total of 2,350 patients (33.2%) either discontinued or changed BTA dosing scheduling through the end of follow-up. Approximately 54% of patients that received a first line anti-MM therapy received BTA concomitantly; in second line, concomitant BTA was 59%, and in third line, 55%. Conclusions: Real-world data from oncology practices across the US indicate that approximately two-thirds of MM patients received BTA treatment, and the treatment rate did not increase in more recent years. Additionally, few patients continued BTA beyond 2 years. Among BTA treated patients, BTA initiation occurred at approximately 3.5 months after diagnosis, and the majority of administrations followed a Q4W schedule with zoledronic acid. Further work will explore reasons for non-treatment and treatment discontinuation with particular attention given to potential contraindications such as renal impairment, and the added burden of IV therapy in MM. Disclosures Kim: Amgen Inc.: Employment, Equity Ownership. Hernandez:Amgen: Employment, Equity Ownership. Cheng:Amgen: Employment, Equity Ownership. Smith:Amgen: Consultancy. Cyprien:Amgen: Consultancy. Liede:Amgen: Employment, Equity Ownership.

Real-world treatment patterns and outcomes of triple-exposed multiple myeloma patients treated in community oncology practices in the United States.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18727-e18727
Author(s):  
Robert Smith ◽  
Mei Xue ◽  
Natalie Dorrow ◽  
Prateesh Varughese ◽  
Cosima Hogea ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Real World ◽  
Proteasome Inhibitors ◽  
Office Visit ◽  
The United States ◽  
Subsequent Treatment ◽  
Treatment Patterns ◽  
Duration Of Therapy ◽  
The Us

e18727 Background: Treatment for multiple myeloma (MM) over the past decade has significantly improved survival. In particular, 3 drug classes have altered the treatment paradigm for MM patients: proteasome inhibitors (PIs), immunomodulatory drugs (IMiDs), and CD38 monoclonal antibodies (anti-CD38s). Despite these advances, the majority of patients with MM will become refractory to PIs, IMiDs, and anti-CD38s, and limited evidence indicates these patients have poor outcomes. A retrospective study in the US showed that 275 patients treated at 14 academic institutions with prior exposure to a PI, IMiD, and anti-CD38 had median overall survival of 9.2 months. The aim of this study was to evaluate real-world treatment patterns and outcomes (duration of therapy and overall survival) of patients who had been treated with a PI, IMiD, and anti-CD38 in community practices in the US. Methods: This retrospective observational study was conducted using the Integra Connect (IC) database. The IC database includes electronic health data from structured and unstructured fields from 12 community practices on the East and West Coast of the US. Adult patients with ≥2 ICD-9/ICD-10 codes for MM on at least 2 separate dates, who received MM treatment between Jan 1, 2016, and Dec 31, 2019, with treatment history that included at least one PI, one IMiD, and one anti-CD38 (triple exposed), and initiated a subsequent line of therapy (s-LOT) after becoming triple exposed, were included. Duration of length of s-LOT was defined as number of days from start of s-LOT to last-day supply of s-LOT. Overall survival was defined as the length of time from start of s-LOT through death or the date of the last office visit. Results: A total of 501 patients were included in this analysis. The median age of patients was 64.9 years; 50% were male; 50% had commercial insurance. 82.8% of patients had ECOG 0 or 1 at diagnosis and had received a median of 3 prior lines of therapy (LOTs) before initiating s-LOT. Prior to initiating s-LOT, 91% had been exposed to bortezomib, 81% to carfilzomib, 94% to lenalidomide, 82% to pomalidomide, and 100% to daratumumab. In s-LOT, 95% received treatment that included same drug or same drug class (30% received bortezomib, 48% carfilzomib, 31% lenalidomide, 47% pomalidomide, and 31% daratumumab). The median duration of s-LOT was 78 days and median survival was 10.3 months (308 days) from initiation of s-LOT. Conclusions: For triple-class exposed patients, there is a lack of consensus on the most efficacious approach to subsequent treatment. The present study shows a significant amount of retreatment with previously used agents or classes among these patients with short duration of therapy and poor survival. As has been previously noted, new strategies and agents targeting novel aspects of MM are needed to improve outcomes for these patients. Disclosures: This study (213286) was sponsored by GlaxoSmithKline.

scholarly journals Brazilian Real-World Multiple Myeloma (MM) Electronic Platform Register Project

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 4-4
Author(s):  
Edvan De Queiroz Crusoe ◽  
Glaciano Ribeiro ◽  
Karla Richter Zanella ◽  
Leila Martins Perobelli ◽  
Milton A. F. Aranha ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Epidemiological Study ◽  
Healthcare System ◽  
Real World ◽  
Performance Status ◽  
Laboratory Data ◽  
Treatment Patterns ◽  
Public Healthcare ◽  
Research Activities

Introduction: An epidemiological database is an important tool to characterize the population disease distribution, long-term effects of the diseases, impact of evolving treatments, to identify adverse events (AE) and their possible mitigation and to improve the healthcare system. Another important reason to create a database is to rapidly identify, recruit and enroll individuals for research activities. Based on these, the Brazilian Multiple Myeloma Study Group (GBRAM) developed an electronic database platform with the intention of prospectively registering the MM cases diagnosed at Brazilian healthcare services. Methods: This is a prospective, multicenter, open, epidemiological study, based on an electronic system register. Patients diagnosed with MM after January 1, 2018 have been included. The eligibility criteria were: intent-to-treat (ITT) MM patients, aged over 18 years and under care in any healthcare system (private, public and academic). All clinical and laboratory data, prognostic profiling, treatment patterns and responses, AE and survival were compiled. The data were analyzed with the NCSS® 2020 software. This project is registered in the Brazilian study platform control (Plataforma Brasil) linked to federal health authorities by the number CAAE-05340918.3.1001.8098. Results: To date, 1,113 patients at 44 reference centers were included. The median age was 64 (25 -96) years and 578 (52%) were male. According to the ECOG performance status: 0 = 185 (16.5%), 1 = 257 (23.2%), 2 = 144 (13%), 3 = 105 (9.5%), 4 = 62 (5.5%) and the not available data (NA) = 359 (32.3%). The ISS 1, 2, and 3 were 219 (19.7%), 286 (25.7%) and 406 (36.5%), respectively, the NA being 202 (18.1%). MM isotypes were 524 (47.1%) IgG, 202 (18.2%) IgA, 192 (17.2%) free-light chain, 4 (0.5%) IgM, 7 (0.8%) biclonal, 9 (0.7%) non-secretor and 175 (15.5%) NA. Regarding the treatment backbone, 427 (38.4%) patients received immunomodulators (IMID- thalidomide), 277 (20.4%), proteasome inhibitors (PI-bortezomib), 84 (7.6%), the combination of PI + IMID, 72 (6.6%), combinations with anti-CD38 monoclonal antibody (Daratumumab) and 253 (27%), other treatments. Based on the ITT analysis of 1003 cases, 636 (63.4%) patients were planned for bone marrow transplantation (BMT) and 367 (36.6%) were ineligible. After a median follow-up of 14.0 months, 150 (23.6%) of the planned patients had undergone the procedure, 284 (44.7%) had not yet been submitted and 202 (31.7%) had NA data. The overall survival (OS) was 80.9% for the total group at 20 months, 73.5% for ineligible and 95.5% for eligible. There was a significant improvement in eligible patients who had performed BMT, as compared to those who had not, HR 0.15 (0.09 - 0.26), p < 0.0001. A total of 142 deaths (12.8%) occurred, 51 (36%) of them being during the first 180 days. Discussion: Due to the lack of a reliable national register and the undoubtable need for a better understanding of MM for the development of public health and patient support measures, GBRAM has developed and built an electronic platform. This epidemiological study prospectively enrolled patients diagnosed since January 2018 and is of a nationwide scope. To date, 1,113 new cases were included. Despite the short follow-up, this analysis has identified differences in survival, comparing ISS stratifications and whether a BMT was performed or not. Conclusion: This project demonstrates the feasibility and importance of electronic platforms in the compilation of MM populational data for a better understanding of the clinical characteristics, treatment patterns and outcomes in the real world, permitting a clearer perception of local issues and thus, addressing possible improvement in public healthcare policy, such as the improvement of BMT access. Disclosures De Queiroz Crusoe: Janssen: Research Funding. Aranha:Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Ache Pharmaceutics: Honoraria.

scholarly journals Treatment Patterns and Outcomes of 159 Ibrutinib-Treated MCL Patients in the United States: A Retrospective Electronic Medical Record Database and Chart Review Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4163-4163
Author(s):  
Jeff Sharman ◽  
Shaum Kabadi ◽  
Jamyia Clark ◽  
E Susan Amirian ◽  
David J. Andorsky
Keyword(s):  
Real World ◽  
Research Funding ◽  
Chart Review ◽  
Kinase Inhibitor ◽  
Stage Iv ◽  
The United States ◽  
Treatment Patterns ◽  
Discontinuation Rate ◽  
Real World Data

Abstract Introduction Ibrutinib, a Bruton's tyrosine kinase inhibitor, was approved in the U.S. for the treatment of relapsed or refractory mantle cell lymphoma (MCL) in November of 2013. However, real-world data on ibrutinib use for the treatment of MCL is limited. The purpose of this study was to examine ibrutinib use, dosages, and reasons for treatment discontinuation among MCL patients treated in a community oncology practice setting. Methods The study population consisted of adult (≥18 year old) MCL patients treated with ibrutinib between November 1, 2013 and October 31, 2016, who were not enrolled in a clinical trial and had at least 2 visits to a US Oncology Network (USON) clinic. Patients with other primary cancers were excluded. Patient data were sourced from the USON's electronic health records system, iKnowMed (iKM)™. The structured iKM database provided information on demographics and clinical and treatment characteristics. Manual chart review was used to confirm ibrutinib treatment patterns. Duration of ibrutinib therapy (DOT), overall survival (OS), and progression-free survival (PFS) from systemic treatment initiation were estimated using Kaplan-Meier methods. Events were defined as death in the OS analysis, and progression or death in the PFS analysis. Patients were censored if their treatment was ongoing for DOT. Censors for OS and PFS were patients lost to follow up or those who did not experience a failure event within the study period. Results 159 eligible MCL patients were identified through iKM. The majority of patients were Caucasian (n=141, 88.7%), male (n=121, 76.1%), and diagnosed with Stage IV disease (n=117, 73.6%). Median follow-up for the population was 16.1 months. Approximately 7.5% (n=12) of patients received ibrutinib as first-line therapy (1L), compared to 54.1% (n=86) in 2L and 38.4% (n=61) in 3L or beyond. Median ibrutinib dose at initiation was 560mg (range: 140-700). During ibrutinib treatment, 16.4% (n=26) of patients experienced a dose reduction. Dose holds occurred in 30.2% (n=48), 66.7% (n=32) due toxicities. The overall discontinuation rate was 83.6% The primary reason for discontinuation was disease progression (n=46, 34.6%) followed by toxicities (n=34, 25.6%). Median DOT was higher for patients initiating treatment in 3L+ (14.9: 95% CI 8.8-17.1) compared to other lines. Median PFS was 19.6 (95% CI: 16.5-24.3) for the overall population and median OS was 25.8 months (95% CI: 19.9-not reached). Conclusions Our real-world findings on survival are consistent with those from clinical trials on ibrutinib in relapsed/refractory MCL, although our observed discontinuation rate (~84%) was higher than that of the trial (~58%), which had a similar median follow-up time (16.1 months vs. 15.3 months, respectively). Our findings provide additional data on MCL treatment patterns and patient outcomes in clinical practice. Disclosures Sharman: Acerta: Consultancy, Research Funding; Pharmacyclics, an AbbVie Company: Consultancy, Research Funding. Kabadi:AstraZeneca: Employment. Clark:McKesson Specialty Health: Employment, Equity Ownership. Amirian:McKesson Specialty Health: Employment. Andorsky:Celgene: Research Funding; CTI BioPharma: Consultancy, Research Funding; AstraZeneca: Consultancy; Genentech: Consultancy.

An Ongoing Multinational Observational Study in Multiple Myeloma (PREAMBLE): Initial Assessment of Treatment Patterns in Patients with ≥6 Months Follow-up

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1297-1297
Author(s):  
Ravi Vij ◽  
Lieven Annemans ◽  
Catherine Davis ◽  
Trong K. Le ◽  
Blake Bartlett ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
North America ◽  
Disease Progression ◽  
Real World ◽  
Response Rate ◽  
Clinical Effectiveness ◽  
Treatment Patterns ◽  
Initial Assessment ◽  
Prior Therapy

Abstract INTRODUCTION Outcomes for patients with multiple myeloma (MM) have improved in the past decade with the use of immunomodulatory drugs (IMiDs) and proteasome inhibitors (PIs). There are, however, limited data on real-world effectiveness of these agents in the setting of relapsed/refractory MM (RRMM). PREAMBLE (Prospective REsearch Assessment in Multiple Myeloma: an OBservationaL Evaluation; NCT01838512) is an ongoing, prospective, multinational, observational cohort study to evaluate the real-world clinical effectiveness, healthcare resource utilization, and patient-reported outcomes associated with IMiD, PI, and IMiD+PI therapy in patients with RRMM. We present initial treatment patterns and clinical effectiveness in patients with ≥6 months of follow-up in the study. METHODS Patients aged ≥18 years with RRMM, ≥1 prior therapy and initiating treatment with an IMiD, PI, or IMiD+PI within 90 days prior to or 30 days after study enrollment (index therapy) were eligible. Treatment was administered according to standard clinical practice. Data were collected at baseline and every 3 (Year 1) and 6 (Years 2–3) months over 3 years or until study discontinuation. Assessment of clinical effectiveness included response rates and progression-free survival (PFS); response was based on defined criteria (e.g. European Group for Blood and Bone Marrow Transplant and International Myeloma Working Group criteria), or clinical judgment. RESULTS At the time of the data cut-off (8 May 2014), 274 patients were enrolled: 209 (76.3%) were still in the study, 65 (24%) had discontinued; 55 (85%) discontinuations were due to death. Results are reported for 189/274 (69%) patients (Europe n=105 [56%]; North America n=84 [44%]) with ≥6 months (median 11.1 months) follow-up; the majority (165/189; 87%) were alive at the data cut-off. Median time from diagnosis to start of index therapy was 41.0 months. Eighty-nine (49%) patients had 1 prior line of therapy (n=181); 58 patients (32%) had 2 lines of prior therapy (median 95 days between regimens). Most patients received prior regimens containing a PI (53%) or IMiD (46%); 19% received regimens containing both. Of patients receiving IMiD index therapy (n=87), 66% were from Europe and 35% were from North America; 52% and 48% of patients receiving PI index therapy (n=87) were from Europe and North America, respectively. Most patients with combination index therapy (IMiD+PI, n=15) were from North America (80%). Approximately half of patients (102/189; 54%) permanently discontinued or switched index treatment regimen, occurring after (median) 3.8 months, most often due to disease progression (20/102; 20%) or toxicity (20/102; 20%). Patients who switched (29/189; 15%) did so in (median) 21 days. The most common switch was bortezomib to lenalidomide (5/29; 17%); patients receiving lenalidomide most commonly switched to bortezomib (4/8; 50%). Around one fifth of patients (6/29; 21%) switched to a triplet regimen (IMiD+PI). Regional treatment patterns are planned for inclusion in the presentation. Median PFS was 9.0 months, 6-month PFS rate was 77%, and overall response rate was 39%. PFS and response rate by class of index regimen are provided in the table; subset analyses by line of therapy are planned for inclusion in the presentation. TableIMiD-based regimens (n=87)PI-based regimens (n=87)IMiD+PI-based regimens (n=15)PFS, median (95% CI) months9 (7, 12)11 (7, 13)7 (5, NE)6-month PFS rate, % (95% CI)79 (65, 88)76 (62, 85)69 (21, 91)Response rate, %, (95% CI)39 (29, 50)44 (33, 55)7 (0.2, 32) NE, not estimable due to insufficient follow-up time, limited number of patients, and limited number of events among these patients. CONCLUSIONS In this initial assessment of patients with ≥6 months of follow up in PREAMBLE, a greater proportion of patients from Europe received an IMiD as index therapy compared with those from North America. Treatment regimens were discontinued or switched for over half of patients, predominantly due to disease progression or toxicity. Additional follow-up is needed to better understand the implications of treatment patterns observed in real-world clinical practice, and specific reasons for disease progression and toxicity in patient subgroups and regions. Study funded by Bristol-Myers Squibb. Professional medical writing and editorial assistance was provided by Alyson Bexfield, Caudex Medical, funded by Bristol-Myers Squibb. Disclosures Vij: Sanofi: Honoraria; Novartis: Honoraria; Millennium: Honoraria; Janssen: Honoraria; Array: Honoraria; Onyx: Honoraria, Research Funding; Celgene: Honoraria, Research Funding. Annemans:Bristol-Myers Squibb: Consultancy. Davis:Bristol-Myers Squibb: Employment. Le:Bristol-Myers Squibb: Employment. Bartlett:Bristol-Myers Squibb: Employment; Bristol-Myers Squibb: Equity Ownership. Moreau:BMS, Celgene, Novartis, Millenium, Janssen: Honoraria; BMS, Celgene, Novartis, Millenium, Janssen: Membership on an entity's Board of Directors or advisory committees.

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