Reporting of Postprotocol Therapies and Attrition in Multiple Myeloma Randomized Clinical Trials

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Abstract
Advances in the treatment of multiple myeloma (MM) have led to improved survival.1 Triplet therapy is recommended at diagnosis and relapse, because multiple randomized clinical trials (RCTs) have demonstrated the superiority of triplet over doublet therapy with respect to efficacy outcomes, such as progression-free survival (PFS) and overall survival (OS).2-4 To our knowledge, there has not been a systematic review of reporting on postprotocol therapies of patients in these trials. An understanding of the rate and quality of postprotocol therapies is necessary to assess whether combined use of multiple agents is superior to the sequential use of these agents in accordance with the best available standard of care before the study.5 Some contend that, in the absence of improvements in OS or quality of life, gains in PFS alone do not justify the use of drugs in combination that were previously used in sequence.6,7

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