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.

Background: Treatment of multiple myeloma has advanced tremendously with the approval of anti-CD38 antibodies. Their efficacy is impressive but still controversial in the 1q amplification subgroup (amp1q). This retrospective study aims to provide real-world data. Methods: This trial is analyzing 74 patients with relapsed/refractory multiple myeloma treated with CD38Abs at the Medical University of Innsbruck (2016–2023). High-risk (HR) cytogenetics according to R-ISS (t(4;14), t(14;16), t(14;20), del(17p)), the presence of amp(1q21), the frequency of two HR markers (double hit), and the high-risk criteria agreed at IMS 2024 (HR-IMS24) were considered. Results: The median age of the 74 patients (62.1% male) was 62 years, with a median follow-up of six years. Most patients received third-line therapy (37.8%). R-ISS HR was documented in 39.2% of patients, double hit in 13.5% of patients, and HR-IMS24 in 32.4% of patients, while amp1q was detected in 35.1% of patients. The median OS was 66 months (35–89), and the median PFS was 17 months (6.5–26.9). While neither R-ISS HR nor isolated amp1q had an impact on progression-free survival (e.g., amp1q 7.03: 1.95–22.44; p = 0.347), the occurrence of a double-hit pattern significantly impaired PFS and OS (6.2: 1.4–16.4 months; p = 0.044; OS, 42.8: 25.9–74.6 months; p = 0.035). Patients fulfilling the HR-IMS24 criteria (32.4%, 24 patients) also exhibited an impaired PFS and OS (7: 2.7–18.1 months, p = 0.023; 40.12: 21.1–74.5 months, p = 0.01). Conclusions: This retrospective study highlights the durable effect of daratumumab on cytogenetic abnormalities, particularly amp1q. However, patients who meet the criteria for double-hit myeloma or the high-risk IMS2024 criteria remain a difficult-to-treat patient population who require early access to new treatment approaches.

Background: There is conflicting data about which ventilation strategy is better when performing external chest compressions with mechanical devices. During manual cardiopulmonary resuscitation, continuous ventilation is recommended when the airway is secured and a ventilation rate of 10/min is maintained. However, during mechanical cardiopulmonary resuscitation, some expert groups and various data have raised concerns about ineffective ventilation with continuous ventilation due to the high intrathoracic pressure generated by the devices without pauses for effective ventilation. This study compares the two possible ventilation strategies - continuous ventilation and 30:2 (30 compressions followed by 2 ventilations) - during mechanical cardiopulmonary resuscitation. We analysed the effects of the two resuscitation strategies on ventilatory parameters measured during cardiopulmonary resuscitation and compared mechanical with manual cardiopulmonary resuscitation with both ventilation strategies. Methods: 30 students of human medicine performed cardiopulmonary resuscitation on endotracheally intubated resuscitation training manikins. The chest compressions were performed manually or by using mechanical chest compression devices (LUCAS ^® , EASY PULSE ^® ). Tidal volume, respiratory minute ventilation volume, ventilation frequency, compression frequency, and chest compression depth were recorded by sensors built into the manikins. Cardiopulmonary resuscitation was performed with either continuous ventilation (ventilations every 6 s; 10/min) or 30:2 in two resuscitation runs of 3 min each. Results: Respiratory minute ventilation volume was significantly higher with continuous ventilation than with 30:2 cardiopulmonary resuscitation (4.8 l/min vs. 3.1 l/min, p <.001). Tidal volume was lower with continuous ventilation than with a 30:2 cardiopulmonary resuscitation (521 ml vs. 565 ml; p = .013). There were no significant differences between manual and mechanical cardiopulmonary resuscitation with both ventilation strategies. Conclusion: This study showed that ventilation during mechanical cardiopulmonary resuscitation using mechanical chest compression devices was efficient with both ventilation strategies. Interestingly, the respiratory minute ventilation volume was even higher with continuous ventilation than with 30:2 due to the higher respiratory rate. In addition, there was no significant difference in ventilation outcome between manual and mechanical chest compressions.