Tratamiento de primera línea para pacientes con mieloma múltiple no elegibles para trasplante autólogo de células progenitoras : revisión sistemática y meta-análisis (estudio del Hemo-ONCOLGroup).

First line therapy for patients with newly diagnosed multiple myeloma ineligible for autologous stem cell transplantation : a systematic review and meta-analysis (Hemo-ONCOLGroup study).

Contenido principal del artículo

Myriam Rodríguez
Juan Felipe Combariza
Claudia Patricia Casas
Ludovic Reveiz
Jefferson Buendía
Arturo Martí Carvajal
Henry Becerra
Andrés Acevedo
Andrés Felipe Cardona

Resumen

Antecedentes: Los pacientes con mieloma múltiple (MM) que no son elegibles para Trasplante de Médula Ósea han sido tratados con melfalán (M) más prednisona (P); sin embargo, el estándar de tratamiento ha cambiado a MP mas talidomida (T) debido a un beneficio en supervivencia. Bortezomib (B) y lenalidomida también han surgido como tratamientos efectivos. Métodos: Se identificaron los ensayos clínicos aleatorizados y controlados (RCT) obtenidos en la Librería Cochrane, PUBMED, LILACS, EMBASE y Scirus. Sólo se consideraron los estudios que compararon melfalán-prednisolona (MP) con cualquier otro régimen. Resultados: Se analizaron 22 RCTs, de 2.159 referencias. MP vs. M mas dexametasona (MD): 3 RCT. No hubo diferencias respecto de la supervivencia global (SG), la tasa de respuesta completa (TRC) y la toxicidad hematológica. MD fue superior en respuesta parcial (RR 1.54;1.32-1.80) y toxicidad no hematológica RR 2.15;1.36-3.41. MP vs. regímenes basados en talidomida: 4 RCT. Se encontraron diferencias a favor de la talidomida respecto de la TRC RR 3.44;1.86-6.39 y respuesta parcial (RP) RR 1.67;1.28-2.17. La supervivencia libre de progresión (SLP) fue superior con talidomida (p = 0.02). MP vs. regímenes basados en bortezomib: 1 RCT. Se encontraron diferencias significativas a favor de bortezomib en SG HR 0.61;0.42-0.89, tiempo a la progresión HR 0.48;0.41-0.56, TRC RR 8.35;4.68-14.89 y RP RR 1.30;1.06-1.59. MP vs. quimioterapia sin M: 3 RCT. Los esquemas con bendamustina lograron una mayor respuesta completa RR 2.55;1.22-5.30. MP vs. otros: 13 RCT. No se encontraron diferencias en la RP, SG ni en los efectos adversos. Conclusiones: Los pacientes sintomáticos con MM no elegibles para trasplante de médula ósea deben recibir como primera línea una combinación de MP con bortezomib o talidomida. Se necesitan más estudios que permitan determinar el beneficio terapéutico basado en el fenotipo y la citogenética.

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Biografía del autor/a (VER)

Myriam Rodríguez, Fundación Santa Fe de Bogotá

Hematology and Bone Marrow Therapy Department, Fundación Santa Fe de Bogotá (Bogotá, Colombia). Associate researcher, Colombian Group for the Clinical and Translational Research of Cancer (ONCOLGroup); haematological malignancies platform (Hemo-ONCOLGroup)

Juan Felipe Combariza, Hospital Pablo Tobón Uribe

Associate researcher, Colombian Group for the Clinical and Translational Research of Cancer (ONCOLGroup); haematological malignancies platform (Hemo-ONCOLGroup).  Hematology and Bone Marrow Transplantation Department, Hospital Pablo Tobón Uribe (Medellín, Colombia).

Claudia Patricia Casas, Hospital de San José

Associate researcher, Colombian Group for the Clinical and Translational Research of Cancer (ONCOLGroup); haematological malignancies platform (Hemo-ONCOLGroup). Hematology Department, Hospital de San José (Bogotá, Colombia).

Ludovic Reveiz, Universidad Nacional de Colombia

Associate researcher, Colombian Group for the Clinical and Translational Research of Cancer (ONCOLGroup); haematological malignancies platform (Hemo-ONCOLGroup). Clinical Research Institute, Clinical Epidemiology and Health Technology Assessment Unit, National University of Colombia (Bogotá, Colombia).

Jefferson Buendía, Universidad Nacional de Colombia

Clinical Research Institute, Clinical Epidemiology and Health Technology Assessment Unit, National University of Colombia (Bogotá, Colombia).

Arturo Martí Carvajal

Iberoamerican Cochrane Network (Valencia, Venezuela).

Henry Becerra, Fundación Santa Fe de Bogotá

Clinical and Translational Oncology Group, Fundación Santa Fe de Bogotá (Bogotá, Colombia).

Andrés Acevedo

Hematology and Bone Marrow Therapy Department, Fundación Santa Fe de Bogotá (Bogotá, Colombia).

Andrés Felipe Cardona, Fundación Santa Fe de Bogotá

Associate researcher, Colombian Group for the Clinical and Translational Research of Cancer (ONCOLGroup); haematological malignancies platform (Hemo-ONCOLGroup). Clinical and Translational Oncology Group, Fundación Santa Fe de Bogotá (Bogotá, Colombia)

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