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. 2025 May 26;15(1):103.
doi: 10.1038/s41408-025-01311-y.

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

Luis Gerardo Rodríguez-Lobato #  1   2 , Anna de Daniel #  3   4 , Arturo Pereira  3   4 , Carlos Fernández de Larrea  3   4 , Natalia Tovar  3   4 , M Teresa Cibeira  3   4 , David F Moreno  3   4 , Jose Miguel Mateos  3   4 , Noemí Llobet  3 , Esther Carcelero  5 , Daniel Munárriz  3   4 , Joan Bladé  3   4 , Laura Rosiñol  6   7
Affiliations

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

Luis Gerardo Rodríguez-Lobato et al. Blood Cancer J. .

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.

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Conflict of interest statement

Competing interests: LGRL: Honoraria and travel grants from Janssen, Amgen, GSK, BMS, Sanofi, and Menarini Stemline; AD: Honoraria from Janssen, travel grants from Sanofi, Janssen, Binding Side; DFM: Honoraria and travel grants from Janssen; MTC: Honoraria from Janssen, Sanofi, GSA, Amgen, and Pfizer, LR: Honoraria from BMS, Celgene, Amgen, Takeda, Sanofi, Janssen, GSK; JB: Honoraria from Janssen, Celgene, BMS, Amgen, Takeda, Oncopeptides; CFL: Consultancy: BeiGene, Sanofi, GSK, BMS, Janssen; Honoraria: BeiGene, Pfizer, Sanofi, GSK, Takeda, BMS, Janssen; Research Funding: Takeda, Amgen, BMS, Janssen. The rest of the authors declare no competing interests. Ethics approval and consent to participate: All methods were performed in accordance with the relevant guidelines and regulations, including the Declaration of Helsinki. The study was approved by the Ethics Committee of the Hospital Clínic de Barcelona. Informed consent was obtained from all participants, authorizing the use of their anonymized clinical data for research purposes.

Figures

Fig. 1
Fig. 1. Treatment patterns by line of treatment and period.
LoT line of treatment, Chemo chemotherapy, Bor bortezomib, T thalidomide, R lenalidomide, B bortezomib, K carfilzomib, Pom pomalidomide.
Fig. 2
Fig. 2. Attrition rate across successive lines of therapy.
A Attrition rate by line of treatment and period. B Attrition rate by line of treatment and age.
Fig. 3
Fig. 3. Response rate across successive lines of therapy.
A Overall response rate by line of treatment and period. B Overall response rate by line of treatment and age. NR not reached.
Fig. 4
Fig. 4. Survival analysis across successive lines of therapy.
A Progression-free survival by line of treatment and period. B Overall survival by line of treatment and period. NR not reached.
Fig. 5
Fig. 5. Survival analysis according to treatment regimen.
A Progression-free survival after first and second line of treatment by treatment regimen between 2010–20. B Overall survival after first and second line of treatment by treatment regimen between 2010–20. QMT Chemotherapy, Bor bortezomib, T thalidomide, R lenalidomide, B bortezomib, K carfilzomib, Pom pomalidomide.
See this image and copyright information in PMC

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