This retrospective study found significant treatment attrition across the disease course and early mortality in myeloma patients in Finland, especially in the non-SCT cohort, resulting primarily from progressive MM or infections, underscoring the need for more tolerable and effective anti-myeloma treatments earlier in the disease course.
A large proportion of non-SCT myeloma patients died before starting second-line treatment, compared with few SCT patients.
Early attrition in the non-SCT cohort was associated with older age, higher comorbidity burden, and higher ISS and (R)-ISS scores.
Non-SCT patients were more likely to receive less intensive therapy in first line.
Causes of death differed by timing: MM was the most common immediate cause in the first 6 months, and infections were linked mainly to deaths before 2L.
In later disease stages, MM was responsible for the majority of deaths in both cohorts.
Treatment attrition is significant across the disease course, with early mortality especially in non-SCT patients.
This study looked at 1,733 adults with multiple myeloma treated in four Finnish hospital districts between 2013 and 2022. It examined how many patients died before they could start their next line of treatment, a problem called treatment attrition. Myeloma commonly relapses and requires several treatment lines, but many patients never reach later treatments. Among patients who did not receive a stem cell transplant, 31% died before starting second-line treatment, compared with 5% of those who had a transplant. Those who died early were more often over 75, had more other illnesses, and had more advanced myeloma by staging scores, and they tended to receive less intensive first treatment. Early deaths were mostly due to the myeloma itself or infections, while later deaths were mostly due to myeloma. This research suggests that many patients, especially those not eligible for transplant, may not benefit from later treatments because they die earlier. The authors conclude that treatments that are both more tolerable and more effective early in the disease could help improve survival. As a retrospective study, it shows associations rather than proving cause.
Putkonen M, Närhi K, Vikkula J, Mattila R, Waltari M, Eeva J, et al.. (2026). Treatment attrition and outcomes of myeloma patients in Finland: a real-world study.. Acta oncologica (Stockholm, Sweden). https://doi.org/10.2340/1651-226X.2026.46473