Efficacy of first-line treatment options in transplant-ineligible multiple myeloma: A network meta-analysis. (December 2021)

• Record Type: Journal Article
• Authors: Kiss, Szabolcs; Gede, Noémi; Soós, Alexandra; Hegyi, Péter; Nagy, Bettina; Imrei, Marcell; Czibere, Bernadett; Farkas, Nelli; Hanák, Lilla; Szakács, Zsolt; Eröss, Bálint; Alizadeh, Hussain
• Is Part Of: Critical reviews in oncology/hematology. Volume 168(2021)
• Publication Date: 2021-12
• Subjects: ASCT autologous stem-cell transplantation -- BP bendamustine-prednisone -- ClRd clarithromycin-lenalidomide-dexamethasone -- CPR cyclophosphamide-prednisone-lenalidomide -- CRD cyclophosphamide-lenalidomide-dexamethasone -- CrI credible interval -- CTD cyclophosphamide-thalidomide-dexamethasone -- D dexamethasone -- D-D dexamethasone → dexamethasone -- D-IFN dexamethasone-IFN alfa-2b -- Dara-Rd28 daratumumab-lenalidomide-dexamethasone -- Dara-VMP daratumumab-bortezomib-melphalan-prednisone -- ERd elotuzumab-lenalidomide-dexamethasone -- HDT-ASCT high-dose therapy and autologous stem cell transplantation -- ITD ixazomib-thalidomide-dexamethasone -- ITD-I ixazomib-thalidomide-dexamethasone → ixazomib -- I300CD-I ixazomib-300 mg cyclophosphamide-dexamethasone → ixazomib -- I400CD-I ixazomib-300 mg cyclophosphamide-dexamethasone → ixazomib -- IMiD immunomodulatory derivative -- KRd carfilzomib-lenalidomide-dexamethasone -- KMP carfilzomib-melphalan-prednisone -- MD melphalan-dexamethasone -- MM multiple myeloma -- MP melphalan-prednisone -- MPR melphalan-prednisone-lenalinomide -- MPR-R melphalan-prednisone-lenalinomide → lenalidomide -- MPT melphalan-prednisone-thalidomide -- MPT-T melphalan-prednisone-thalidomide → thalidomide -- NCCN National Comprehensive Cancer Network -- NMA network meta-analysis -- OS overall survival -- Pemb-Rd28 pembrolizumab-lenalidomide-dexamethasone -- PFS progression-free survival -- PI proteasome inhibitor -- RCT randomized controlled trial -- Rd28 lenalidomide-dexamethasone 28-day cycles -- Rd28−18 lenalidomide-dexamethasone 28-day cycles n = 18 -- SMVP siltuximab-bortezomib-melphalan-prednisone -- SUCRA surface under cumulative ranking -- TD thalidomide-dexamethasone -- TIE transplant-ineligible -- TIE-MM transplant- ineligible -- VAD vincristine doxorubicin, dexamethasone -- VD bortezomib-dexamethasone -- VMP bortezomib-melphalan-prednisone -- VMPT-VT bortezomib-melphalan-prednisone-thalidomide → bortezomib-thalidomide -- VTD bortezomib-thalidomide-dexamethasone; Multiple myeloma -- Transplant-ineligible -- Meta-analysis -- Survival -- First-line; Oncology -- Periodicals; Hematology -- Periodicals; 616.994
• DOI: 10.1016/j.critrevonc.2021.103504
• Languages: English
• ISSNs: 1040-8428

Abstract

Graphical abstract: Highlights: The outcome of transplant-ineligible multiple myeloma improved in the last decades. Choosing the best treatment is difficult due to the ever-growing arsenal of regimens. Continuous update of the standard of care regimens is essential. Our study incorporates 34 regimens and data of 16, 681 patients. Daratumumab containing regimens could be the first preference in first-line treatment. Abstract: Background: Despite major therapeutic advances, the rational choice of the most appropriate first-line regimen in newly diagnosed transplant-ineligible multiple myeloma (TIE-MM) is currently undefined. Aim: We aimed to identify the most effective first-line treatment for TIE-MM patients. Methods: A total of 37 articles, including 34 treatments and 16, 681 patients, were included in this Bayesian network meta-analysis. The outcomes of interest were risk ratios (RR) for progression-free survival (PFS) and overall survival (OS). Results: Based on surface under cumulative ranking curve values, daratumumab-bortezomib-melphalan-prednisone (Dara-VMP) and daratumumab-lenalidomide-dexamethasone (Dara-Rd28) showed superiority compared to other combinations regarding 12-, 24-, 36-, and 48-month PFS. Dara-VMP also ranked first for 12-, 24-, 36-, and 48-month OS. Conclusion: Our finding supports the incorporation of daratumumab into first-line regimens. Additionally, these results highlight the relative benefit of incorporating novel agents like monoclonal antibodies, immunomodulatory derivatives, and proteasome inhibitors in combination with the currently existing treatment options.