Abstract
BackgroundAlthough high-dose therapy (HDT) with autologous stem cell transplantation (ASCT) has been confirmed to result in longer remission time than conventional chemotherapy, multiple myeloma (MM) remains incurable. Post-ASCT maintenance is considered as a strategy for obtaining durable remissions and preventing tumor progression. Randomized controlled trials (RCTs) studying maintenance therapy with immunomodulatory drugs (IMiDs) after ASCT have shown some valuable survival improvements. This meta-analysis of RCTs therefore assesses the effect of post-ASCT IMiDs maintenance on MM patients.MethodsWe performed a meta-analysis to evaluate the impact of IMiDs (thalidomide or lenalidomide) as post-ASCT maintenance therapy on the survival of newly diagnosed MM patients. The outcomes for this meta-analysis were progression-free survival (PFS) and overall survival (OS).ResultsEight RCTs enrolling 3514 patients were included for analysis. An obvious improvement in Os (hazard ratio [HR] 0.75) and a significant PFS advantage (HR 0.58) with post-ASCT IMiDs maintenance was revealed. Thalidomide maintenance after ASCT can result in significant benefit in Os (HR 0.72), particularly combined with corticosteroids (HR 0.66).ConclusionsMM patients after ASCT have a significant overall survival benefit with IMiDs maintenance. IMiDs maintenance was justified for MM patients who received HDT with ASCT.
Highlights
Multiple myeloma (MM) is a plasma cell malignancy that comprises about 1% of malignant tumors and 10% to 15% of hematopoietic neoplasms, and causes 20% of deaths from hematologic malignancy [1]
We reviewed potentially relevant articles in full to ensure that they satisfied the following criteria: (1) study design: Randomized controlled trials (RCTs); (2) study population: newly diagnosed MM patients treated with induction chemotherapies followed by autologous stem cell transplantation (ASCT); (3) intervention: IMiDs-containing maintenance regimens; (4) control: observation or other non-IMiDs maintenance regimens; (5) outcomes reported: progressionfree or event-free survival (PFS/EFS), and overall survival (OS)
Our meta-analysis revealed an obvious improvement of OS (HR 0.75, 95% confidence interval (95% CI): 0.59–0.91, Figure 2A) when post-ASCT IMiDs maintenance was compared with no maintenance or other non-IMiDs maintenance therapies
Summary
Multiple myeloma (MM) is a plasma cell malignancy that comprises about 1% of malignant tumors and 10% to 15% of hematopoietic neoplasms, and causes 20% of deaths from hematologic malignancy [1]. High-dose therapy (HDT) with autologous stem cell transplantation (ASCT) has been confirmed to result in longer remission time than conventional chemotherapy, multiple myeloma (MM) remains incurable. Randomized controlled trials (RCTs) studying maintenance therapy with immunomodulatory drugs (IMiDs) after ASCT have shown some valuable survival improvements. This meta-analysis of RCTs assesses the effect of post-ASCT IMiDs maintenance on MM patients. Methods: We performed a meta-analysis to evaluate the impact of IMiDs (thalidomide or lenalidomide) as postASCT maintenance therapy on the survival of newly diagnosed MM patients The outcomes for this meta-analysis were progression-free survival (PFS) and overall survival (OS). IMiDs maintenance was justified for MM patients who received HDT with ASCT
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