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).

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).

Published 2012-04-01

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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).
Rev. colomb. hematol. oncol. [Internet]. 2012 Apr. 1 [cited 2024 Dec. 22];1(1):12-3. Disponible en: https://doi.org/10.51643/22562915.285
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Myriam Rodríguez
Fundación Santa Fe de Bogotá
    Juan Felipe Combariza
    Hospital Pablo Tobón Uribe
      Claudia Patricia Casas
      Hospital de San José
        Ludovic Reveiz
        Universidad Nacional de Colombia
          Jefferson Buendía
          Universidad Nacional de Colombia
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            Myriam Rodríguez,

            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,

            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,

            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,

            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,

            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,

            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,

            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)

            Background: Patients with multiple myeloma (MM) not eligible for SCT have been treated with melphalan (M) plus prednisone (P); however, the standard of care has shifted to MP plus thalidomide (T) due to a greater survival benefit. Bortezomib (B) and lenalidomide have also emerged as effective agents. Methods: Randomized clinical trials (RCT) were identified from the Cochrane Library, PubMed, Lilacs, Embase and Scirus, that compare MP to any other regimen. Results: Twenty-two trials were included from 2159 potentially eligible references. MP vs. M plus dexamethasone (MD): (3 RCT) MD was superior in partial response (PR) rate and non-hematological toxicity. MP vs. T-based regimens: (4 RCT) significant differences favoring T-based regimens in CR rate, PR rate, and progression-free survival (PFS). MP vs. B based regimens: (1 RCT) Significant differences in OS, TTP, CR rate and PR rate favored B-based regimens according to the EBMT criteria. MP vs. chemotherapy regimens without M: (3 RCT) A significantly higher number of patients treated with BP achieved a CR. TTP was also significantly longer in BP-treated patients (p < 0.02). MP vs. other polychemotherapy regimens: (13 RCT) No significant differences in PR, OS, hemathological or other type of toxicity were observed between MP and the other chemotherapy regimens. Conclusions: Symptomatic MM patients ineligible for SCT should receive as first-line treatment a combination of MP plus B or T; these regimens are associated with improved outcome but greater toxicity compared to MP alone. More homogeneous clinical trials using a cytogenetic risk approach are required.

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