Efficacy of first-line treatments for multiple myeloma patients not eligible for stem cell transplantation: a network meta-analysis
Efficacy of first-line treatments for multiple myeloma patients not eligible for stem cell transplantation: a network meta-analysis
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DOI：
10.3324/haematol.2018.206912
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发表时间：
2019-04-30
期刊：
影响因子：
10.1
通讯作者：
Zweegman, Sonja
中科院分区：
文献类型：
--
作者：
Blommestein, Hedwig M.;van Beurden-Tan, Chrissy H. Y.;Zweegman, Sonja
对于不符合移植条件的多发性骨髓瘤（MM）患者，由于缺乏对治疗标准的正面比较，治疗方式选择的增加，以及从新方案研究中迅速发展的有希望的结果，使得决策变得复杂。为了支持循证决策，我们对NTE MM患者进行了网络荟萃分析，综合了直接和间接证据，并对所有治疗方法进行了比较。通过对1999年1月至2016年3月的EMBASE (R)、MEDLINE (R)、MEDLINE (R)-in-Process和Cochrane Central Register of Controlled trials进行系统文献综述，确定相关的随机临床试验。疗效结局[即无进展生存期的风险比（HR）和95%置信区间（95% CI）]被提取并在随机效应网络meta分析中合成。总共确定了24项研究，包括21种治疗方法。根据网络meta分析，与地塞米松相比，所有NTE MM治疗的无进展生存比（HR: 0.19-0.90）都有利。达拉图单抗-硼替佐米-美法仑-强的松和硼替佐米-美法仑-强的松-沙利度胺联合硼替佐米-沙利度胺维持是最有效的治疗方法（HR: 0.19, 95% CI: 0.08-0.45和HR: 0.22, 95% CI: 0.10-0.51）。与地塞米松相比，目前推荐的治疗方案——硼替佐米-来那度胺-地塞米松、硼替佐米-美法兰-强的松和来那度胺-地塞米松的HR和95% CI分别为0.31（0.16-0.59）、0.39（0.20-0.75）和0.44（0.29-0.65）。除了确定最有效的治疗方案外，我们还说明了网络荟萃分析在临床实践中的附加价值和证据。在目前的治疗领域，网络荟萃分析的结果可能支持循证决策，并最终有助于优化NTE MM患者的治疗和预后。
Decision making for patients with multiple myeloma (MM) not transplant eligible (NTE) is complicated by a lack of head-to-head comparisons of standards of care, the increase in the choice of treatment modalities, and the promising results that are rapidly evolving from studies with novel regimens. To support evidence-based decision making, we performed a network meta-analysis for NTE MM patients that synthesizes direct and indirect evidence and enables a comparison of all treatments. Relevant randomized clinical trials were identified by a systematic literature review in EMBASE (R), MEDLINE (R), MEDLINE (R)-in-Process and the Cochrane Central Register of Controlled Trials for January 1999 to March 2016. Efficacy outcomes [i.e. the hazard ratio (HR) and 95% confidence interval (95% CI) for progression-free survival] were extracted and synthesized in a random effects network-meta analysis. In total, 24 studies were identified including 21 treatments. According to the network-meta analysis, the HR for progression-free survival was favorable for all NTE MM treatments compared to dexamethasone (HR: 0.19-0.90). Daratumumab-bortezomib-melphalan-prednisone and bortezomib-melphalan-prednisone-thalidomide with bortezomib-thalidomide maintenance were identified as the most effective treatments (HR: 0.19, 95% CI: 0.08-0.45 and HR: 0.22, 95% CI: 0.10-0.51, respectively). HR and 95% CI for currently recommended treatments, bortezomib-lenalidomide-dexamethasone, bortezomib-melphalan-prednisone, and lenalidomide-dexamethasone compared to dexamethasone, were 0.31 (0.16-0.59), 0.39 (0.20-0.75), and 0.44 (0.29-0.65), respectively. In addition to identifying the most effective treatment options, we illustrate the additional value and evidence of network meta-analysis in clinical practice. In the current treatment landscape, the results of net-work meta-analysis may support evidence-based decisions and ultimately help to optimize treatment and outcomes of NTE MM patients.