{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T08:31:23Z","timestamp":1765960283362,"version":"3.40.5"},"reference-count":36,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T00:00:00Z","timestamp":1687996800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Haematology"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Patients with multiple myeloma (MM) enrolled in randomized control trials (RCTs) discontinue treatment for various reasons; however, no prior study has analyzed reasons for discontinuation. We performed a systematic review of MM RCTs to investigate reasons for treatment discontinuation, imbalances between trial cohorts, and reporting practices.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A comprehensive search for RCTs in MM from 2015 to 2021 identified 45 studies meeting inclusion criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 21\u2009236 randomized patients, 10\u2009161 (47.8%) discontinued therapy by primary endpoint ascertainment. Causes of discontinuation included progression (<jats:italic>n<\/jats:italic>\u2009=\u20094790; 22.6% of randomized patients); toxicity (<jats:italic>n<\/jats:italic>\u2009=\u20092569; 12.1%); patient\/physician withdrawal (<jats:italic>n<\/jats:italic>\u2009=\u20091200; 5.7%) and death (<jats:italic>n<\/jats:italic>\u2009=\u2009495; 2.3%). Of randomized patients, 20\u2009914 (98.5%) were included in the RCT analysis. Imbalances of attrition, defined as trials with greater than 5% absolute difference in discontinuation rate for reasons other than death, progression, and toxicity between intervention and control arms, were found in 11 (24.4%) studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although progression is the most common reason for RCT treatment discontinuation in patients with MM, over 10% discontinued due to toxicity. Furthermore, 24.4% of trials showed substantial imbalances between trial cohorts; raising concern for informative censoring and emphasizes the importance of detailed characterization of withdrawal in MM RCTs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ejh.14032","type":"journal-article","created":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T08:43:48Z","timestamp":1688028228000},"page":"491-498","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Attrition and withdrawal in multiple myeloma randomized controlled trials: A systematic review"],"prefix":"10.1111","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8177-6673","authenticated-orcid":false,"given":"Stijn","family":"Hentzen","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Kansas University Medical Center  Kansas City Kansas 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