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Leuk Lymphoma. 2017 Jan;58(1):153-161. Epub 2016 Apr 28.

A systematic literature review and network meta-analysis of treatments for patients with untreated multiple myeloma not eligible for stem cell transplantation.

Author information

1
a Division of Haematology/Oncology, University Hospital Tubingen, University of Tübingen , Tübingen , Germany.
2
b CHU UcL Namur , Yvoir , Belgium.
3
c National and Kapodistrian University of Athens , Athens , Greece.
4
d BC Cancer Agency , British Columbia , Canada.
5
e Hospital 12 De Octubre , Madrid , Spain.
6
f EVIDERA , Lexington , MA , USA.
7
g Redwood Outcomes , Vancouver , Canada.
8
h Odense University Hospital , Odense , Denmark.
9
i Peking University Institute of Hematology, People's Hospital , Beijing , China.
10
j AZ Sint-Jan AV Brugge , Brugge , Belgium.
11
k Hospitais Da Universidade De Coimbra , Coimbra , Portugal.
12
l Chiara Dip. Oncologia , A.O. Universitaria Ospedale S , Pisa , Italy.
13
m Centre Hospitalier William Morey , Chalon , France.
14
n Centre Jean Bernard , Le Mans , France.
15
o Hopital Claude Huriez , Lille , France.

Abstract

In newly diagnosed multiple myeloma (MM), patients ineligible for front-line autologous stem cell transplantation (ASCT), melphalan and prednisone (MP) with thalidomide (MPT) or bortezomib (VMP) are standard first-line therapeutic options. Despite new treatment regimens incorporating bortezomib or lenalidomide, MM remains incurable. The FIRST study demonstrated significant improvement in progression-free survival (PFS) and overall survival (OS) for the combination of lenalidomide and low-dose dexamethasone (Rd) until progression vs. MPT in transplant-ineligible ndMM patients. However, to date no head-to-head randomized controlled trials (RCTs) have compared Rd or MPT versus VMP. We conducted a network meta-analysis using RCTs identified through a systematic literature review to evaluate the relative efficacy of Rd versus other regimens on survival endpoints in previously untreated MM patients ineligible for ASCT. In this analysis, Rd was associated with a significant PFS and survival advantage versus other first-line treatments (VMP, MPT, MP), challenging the role of alkylators in this setting.

KEYWORDS:

Lenalidomide; multiple myeloma; network meta-analysis; systematic review

PMID:
27124703
DOI:
10.1080/10428194.2016.1177772
[Indexed for MEDLINE]

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