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.
多发性骨髓瘤的治疗格局在过去四十年间因新型疗法和优化支持治疗的推动而显著演变。然而，治疗后失败阶段无法进入下一线治疗的患者比例（即流失率）仍是主要挑战。为评估治疗模式与结局的演变，我们分析了1980至2020年间治疗的1,297例多发性骨髓瘤患者，按诊断时期和年龄分层。流失率从1980年代的38–55%下降至2010–2020年间的15–20%，但在老年患者中仍居高不下，80岁以上患者中46.9%无法进入一线以上治疗。虽然无进展生存期的改善主要见于一线治疗（从15.8个月增至24.1个月，p=0.001），但总生存期在所有治疗线和年龄组中均有提升，这可能得益于更有效的挽救性治疗和支持治疗。一线治疗中获得完全缓解与显著的总生存期获益相关（4.5年 vs 1.6年，p<0.001），这凸显了其重要性，因为许多患者（尤其是老年患者）可能无法接受后续治疗。尽管多发性骨髓瘤治疗取得进展，患者流失问题仍然存在，这提示我们需要在疾病早期阶段提供更有效的治疗方案。
Attrition rates and treatment outcomes in multiple myeloma: real-world data over a 40-year period
肿瘤(癌症)患者之家