LAUSR

Simple Summary Reports of attrition rates in the treatment of multiple myeloma vary widely, indicating that despite all innovations in multiple myeloma treatment, many patients do not reach their full treatment potential. In this retrospective study, the attrition rate in the Austrian Myeloma Registry (AMR) was analysed. A total of 571 patients diagnosed between January 2009 and August 2021 were included. The result of attrition in the AMR is very encouraging compared to previous data, with 22% +/− 5% per line of treatment (LoT). Attrition is higher in the elderly and lower in patients with optimal frontline treatment, including stem cell transplantation and maintenance. The importance of achieving an optimal response is highlighted, not only in terms of attrition, but also in terms of the achievable treatment-free intervals. These promising results support the putative key role of liberal universal drug access and reimbursement. Abstract Multiple myeloma (MM) is characterized by serial relapses, necessitating the application of sequential lines of therapy (LoT). Reports on attrition rates (ARs) vary widely. The present study analysed ARs from the Austrian Myeloma Registry. Attrition was defined as being either deceased, progressive without having received another LoT, or lack of follow-up for ≥5 years. A total of 571 patients diagnosed between January 2009 and August 2021 were included (median age: 72 years; median follow-up: 50.8 months). Some 507 patients received at least one LoT. Of the total, 43.6% underwent autologous stem cell transplantation (SCT, transplant eligible = TE)) with primarily VRd (Bortezomib/Lenalidomide/Dexamethasone) given as induction (26.5%), followed by lenalidomide maintenance in 55.7% of cases. Transplant-ineligible (NTE) patients were predominantly treated with Vd (Bortezomib/Dexamethasone, 21.6%), receiving maintenance in 27.1%. A total of 37.5% received a second LoT. ARs across one to five LoTs were 16.7–27%. Frontline induction/ SCT followed by maintenance reduced ARs associated with age and achievement of deep remission in the frontline. Deep remission prolongs follow-up and time-to-next-treatment (TTNT), while high-risk-cyctogenetics negatively affected these outcomes. Our results demonstrate considerably lower ARs for MM patients within the AMR data versus other healthcare systems. Young age and the achievement of significant remissions after optimal frontline therapy resulted in particularly low ARs. These promising results support a key role for the ease of drug access and reimbursement policies in governing long-term MM patient outcomes.