Attrition rates and treatment outcomes in multiple myeloma: real-world data over a 40-year period

IF 12.9 1区 医学 Q1 HEMATOLOGY
Luis Gerardo Rodríguez-Lobato, Anna de Daniel, Arturo Pereira, Carlos Fernández de Larrea, Natalia Tovar, M. Teresa Cibeira, David F. Moreno, Jose Miguel Mateos, Noemí Llobet, Esther Carcelero, Daniel Munárriz, Joan Bladé, Laura Rosiñol
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Abstract

The treatment landscape of multiple myeloma (MM) has evolved significantly over four decades, driven by novel therapies and optimized supportive care. However, the attrition rate (AR), defined as the proportion of patients who die without advancing to the next line of therapy (LOT) after treatment failure, remains a major challenge. To assess how treatment patterns and outcomes have evolved, we analyzed 1,297 MM patients treated between 1980 and 2020, stratified by diagnosis period and age. ARs declined from 38–55% in the 1980s to 15–20% in 2010–2020, but remained high in older patients, with 46.9% of those over 80 unable to proceed beyond first LOT. While progression-free survival gains were primarily observed in the first LOT (15.8 to 24.1 months, p = 0.001), overall survival (OS) improved across all LOTs and age groups, likely due to more effective salvage therapies and supportive care. Achieving a complete response in first-line therapy was associated with a significant OS benefit (4.5 vs. 1.6 years, p < 0.001), underscoring its importance, as many patients, particularly older ones, are less likely to reach subsequent LOTs. Despite advances in MM treatment, patient loss to attrition remains a challenge, highlighting the need for more effective therapies early in the disease course.

Abstract Image

多发性骨髓瘤的损失率和治疗结果:超过40年的真实世界数据
在新的治疗方法和优化的支持性护理的推动下,多发性骨髓瘤(MM)的治疗前景在过去四十年中发生了重大变化。然而,流失率(AR),即在治疗失败后未进入下一条治疗线(LOT)而死亡的患者比例,仍然是一个主要挑战。为了评估治疗模式和结果的演变,我们分析了1980年至2020年间治疗的1297例MM患者,按诊断期和年龄分层。ARs从1980年代的38-55%下降到2010-2020年的15-20%,但在老年患者中仍然很高,80岁以上患者中有46.9%无法进行第一次LOT后的治疗。虽然无进展生存期主要在第一个LOT(15.8至24.1个月,p = 0.001)中观察到,但所有LOT和年龄组的总生存期(OS)都有所改善,这可能是由于更有效的挽救性治疗和支持性护理。在一线治疗中获得完全缓解与显著的OS获益相关(4.5年vs. 1.6年,p < 0.001),强调了其重要性,因为许多患者,特别是老年患者,不太可能达到后续的批次。尽管多发性骨髓瘤的治疗取得了进展,但患者的损耗仍然是一个挑战,这突出表明需要在病程早期进行更有效的治疗。
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来源期刊
CiteScore
16.70
自引率
2.30%
发文量
153
审稿时长
>12 weeks
期刊介绍: Blood Cancer Journal is dedicated to publishing high-quality articles related to hematologic malignancies and related disorders. The journal welcomes submissions of original research, reviews, guidelines, and letters that are deemed to have a significant impact in the field. While the journal covers a wide range of topics, it particularly focuses on areas such as: Preclinical studies of new compounds, especially those that provide mechanistic insights Clinical trials and observations Reviews related to new drugs and current management of hematologic malignancies Novel observations related to new mutations, molecular pathways, and tumor genomics Blood Cancer Journal offers a forum for expedited publication of novel observations regarding new mutations or altered pathways.
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