Association of Minimal Residual Disease With Superior Survival Outcomes in Patients With Multiple Myeloma: A Meta-analysis.
Association of Minimal Residual Disease With Superior Survival Outcomes in Patients With Multiple Myeloma: A Meta-analysis.
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DOI：
10.1001/jamaoncol.2016.3160
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发表时间：
2017-01-01
期刊：
影响因子：
28.4
通讯作者：
Gregory WM
中科院分区：
文献类型：
--
作者：
Munshi NC;Avet-Loiseau H;Rawstron AC;Owen RG;Child JA;Thakurta A;Sherrington P;Samur MK;Georgieva A;Anderson KC;Gregory WM
许多研究评估了微小残留病(MRD)在多发性骨髓瘤(MM)中的预后价值。大多数研究都是小规模的，在患者群体、治疗和MRD评估方法方面各不相同。为了评价MRD检测在新诊断MM患者中的实用性，应用Medline检索1990年1月至2016年1月期间发表的英文文章。符合条件的研究报告了≥20名患者在治疗后的MRD状态和无进展生存期(PFS)或总生存期(OS)。在确定的405篇文章中，有21篇符合初步资格标准，并被纳入分析。使用标准表格提取有关患者特征、治疗、MRD评估和结果的信息。通过汇集相关试验的数据来评估MRD状态对PFS和OS的影响。对数据进行了调整，以考虑不同研究中不同比例的MRD患者，并使用Peto方法进行分析。以Cox模型分析为基础，建立森林样地。其他预先指定的研究问题也被定性地解决了。14项研究(n=1,273)提供了MRD对PFS的影响的数据，12项研究(n=1,100)提供了关于OS的数据。在PFS的5项研究(n=574)和OS的6项研究(n=616)中，特别报道了在获得常规完全缓解(CR)的患者中的结果。MRD阴性状态与PFS总体(危险比[HR]0.41；95%可信区间[CI]0.36-0.48；P<；.0001)和专门研究CR患者的研究(HR(HR)0.44；95%CI 0.34-0.56；P<；.0001)显著相关。在MRD阴性患者和CR患者中，OS总体上也是有利的(HR 0.57；95%CI 0.46-0.71；P<；0.0001)和CR患者(HR 0.47；95%CI 0.33-0.67；P<；0.0001)。异质性测试发现，在PFS和OS的研究中没有显著差异。新诊断的多发性骨髓瘤治疗后MRD阴性状态与长期存活率相关。这些发现提供了量化证据，支持将MRD评估整合为MM临床试验的终点。
Numerous studies have evaluated the prognostic value of minimal residual disease (MRD) in multiple myeloma (MM). Most studies were small and varied in terms of patient population, treatment, and MRD assessment methods. To evaluate the utility of MRD detection in patients with newly diagnosed MM. A Medline search was conducted for articles published in English between January 1990 and January 2016. Eligible studies reported MRD status and progression-free survival (PFS) or overall survival (OS) in ≥ 20 patients following treatment. Among 405 articles identified, 21 met the initial eligibility criteria and were included in the analysis. Information on patient characteristics, treatment, MRD assessment, and outcomes were extracted using a standard form. The impact of MRD status on PFS and OS was assessed by pooling data from relevant trials. Data were adjusted to allow for different proportions of patients with MRD in different studies, and analyzed using the Peto method. Forest plots were created based on Cox model analysis. Other pre-specified research questions were addressed qualitatively. Fourteen studies (n = 1,273) provided data on the impact of MRD on PFS, and 12 studies (n = 1,100) on OS. Results were reported specifically in patients who had achieved conventional complete response (CR) in 5 studies for PFS (n = 574) and 6 studies for OS (n = 616). MRD-negative status was associated with significantly better PFS overall (Hazard ratio [HR] 0.41; 95% confidence interval [CI] 0.36–0.48; P < .0001) and in studies specifically looking at CR patients (HR 0.44; 95% CI 0.34–0.56; P < .0001). OS was also favorable in MRD-negative patients overall (HR 0.57; 95% CI 0.46–0.71; P < .0001) and in CR patients (HR 0.47; 95% CI 0.33–0.67; P < .0001). Tests of heterogeneity found no significant differences among the studies for PFS and OS. MRD-negative status after treatment for newly diagnosed MM is associated with long-term survival. These findings provide quantitative evidence to support the integration of MRD assessment as an endpoint in clinical trials of MM.
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影响因子：
6.5
作者：
Davies, FE;Forsyth, PD;Morgan, GJ
通讯作者：
Morgan, GJ
DOI：
10.1038/nrclinonc.2014.239
发表时间：
2015-05
期刊：
Nature reviews. Clinical oncology
影响因子：
--
作者：
Mailankody S;Korde N;Lesokhin AM;Lendvai N;Hassoun H;Stetler-Stevenson M;Landgren O
通讯作者：
Landgren O
影响因子：
2.9
作者：
Biran, Noa;Ely, Scott;Chari, Ajai
通讯作者：
Chari, Ajai
影响因子：
4.3
作者：
Korthals, Mark;Sehnke, Nina;Fenk, Roland
通讯作者：
Fenk, Roland
影响因子：
6.5
作者：
Ludwig, Heinz;Greil, Richard;Viterbo, Luisa
通讯作者：
Viterbo, Luisa