Comparing efficacy and survivals of initial treatments for elderly patients with newly diagnosed multiple myeloma: a network meta-analysis of randomized controlled trials

Abstract

ObjectiveThe aim of this study was to evaluate the efficacy and clinical outcome of initial therapies for elderly patients with multiple myeloma (MM).MethodsRandomized controlled trials (RCTs) were obtained through a comprehensive search. Response rate, progression-free survival (PFS) and overall survival (OS) were the interested outcome measures. Network meta-analysis (NMA) using graph theory methodology to construct an NMA model, and sensitivity analysis were performed.ResultsNineteen RCTs containing 7,235 participants and 17 treatments were included in the NMA. As compared to the classic melphalan plus prednisone (MP) regimen, the majority of other initial regimens showed higher rates of complete response/near complete response, overall response rate (ORR) and better PFS as well as OS. These four outcomes favored the two lenalidomide plus dexamethasone regimens (continuous lenalidomide and 18 cycles of lenalidomide plus dexamethasone), especially continuous lenalidomide plus dexamethasone regimen, over the majority of other regimens including the two established standard treatments (MP plus thalidomide or bortezomib) for elderly patients with newly diagnosed MM.ConclusionContinuous lenalidomide plus dexamethasone ranked as the best regimen in terms of ORR and OS for the treatment of elderly patients with newly diagnosed MM.

Maintenance Treatment and Survival in Patients With Myeloma

“…We excluded from this NMA trials that evaluated continuous therapy upfront but administered 2 different maintenance treatments after different and noncomparable premaintenance therapies because in such trials the final outcome was probably related to the combined effect of both induction and maintenance, rather than the maintenance therapy itself. The impact of some of these continuous approaches has been evaluated in 2 NMAs, which reported a PFS and OS advantage of lenalidomide-dexamethasone (Rd) over the other therapies, including MPT and VMP (fixed duration) in elderly patients . More recently, Bort-Rd for 8 cycles, followed by continuous Rd showed better PFS and OS vs continuous Rd alone in patients without an immediate intent to undergo ASCT .…”

Relative efficacy of treatment options in transplant-ineligible newly diagnosed multiple myeloma: results from a systematic literature review and network meta-analysis

“…Two other NMAs have addressed the relative efficacy of treatment options for NDMM. An NMA comparing Rd with regimens investigated in RCTs that included patients with NDMM who were aged >65 years reported improved outcomes for response rate, OS, and PFS for Rd, however RVd, VMP + D, and D þ Rd were not included in this analysis [48]. A recently published NMA of treatments for patients with TNE NDMM [49] used a random-effects model with a wide evidence network similar to our extended network.…”

Development and Validation of a 9-Gene Prognostic Signature in Patients With Multiple Myeloma

“…The clinical symptoms of MM range from asymptomatic forms to manifestations of anemia, bone pain, and eventually spontaneous of fractures, renal failure, and frequent infections (6–8). Thanks to the introduction of novel agents (proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies), the management strategies for MM have been improved considerably in the past decade (9–12). Accordingly, the clinical outcomes of patients with MM have been significantly improved, however, MM remains an incurable disease and the prognosis of patients with MM remains poor (with a median survival of approximately 3–4 years) (13).…”