Ye Xueshi, Huang Jinwen, Pan Qin, Li Wanli
Department of Hematology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
PLoS One. 2013 Aug 19;8(8):e72635. doi: 10.1371/journal.pone.0072635. eCollection 2013.
Although high-dose therapy (HDT) with autologous stem cell transplantation (ASCT) has been confirmed to result in longer remission time than conventional chemotherapy, multiple myeloma (MM) remains incurable. Post-ASCT maintenance is considered as a strategy for obtaining durable remissions and preventing tumor progression. Randomized controlled trials (RCTs) studying maintenance therapy with immunomodulatory drugs (IMiDs) after ASCT have shown some valuable survival improvements. This meta-analysis of RCTs therefore assesses the effect of post-ASCT IMiDs maintenance on MM patients.
We performed a meta-analysis to evaluate the impact of IMiDs (thalidomide or lenalidomide) as post-ASCT maintenance therapy on the survival of newly diagnosed MM patients. The outcomes for this meta-analysis were progression-free survival (PFS) and overall survival (OS).
Eight RCTs enrolling 3514 patients were included for analysis. An obvious improvement in Os (hazard ratio [HR] 0.75) and a significant PFS advantage (HR 0.58) with post-ASCT IMiDs maintenance was revealed. Thalidomide maintenance after ASCT can result in significant benefit in Os (HR 0.72), particularly combined with corticosteroids (HR 0.66).
MM patients after ASCT have a significant overall survival benefit with IMiDs maintenance. IMiDs maintenance was justified for MM patients who received HDT with ASCT.
尽管高剂量疗法（HDT）联合自体干细胞移植（ASCT）已被证实比传统化疗能带来更长的缓解时间，但多发性骨髓瘤（MM）仍然无法治愈。ASCT后的维持治疗被认为是获得持久缓解和预防肿瘤进展的一种策略。研究ASCT后使用免疫调节药物（IMiDs）进行维持治疗的随机对照试验（RCT）已显示出一些有价值的生存改善。因此，这项RCT的荟萃分析评估了ASCT后IMiDs维持治疗对MM患者的影响。
我们进行了一项荟萃分析，以评估IMiDs（沙利度胺或来那度胺）作为ASCT后维持治疗对新诊断MM患者生存的影响。该荟萃分析的结果是无进展生存期（PFS）和总生存期（OS）。
纳入八项RCT共3514例患者进行分析。结果显示，ASCT后使用IMiDs维持治疗可显著改善OS（风险比[HR]0.75），并具有显著的PFS优势（HR 0.58）。ASCT后使用沙利度胺维持治疗可显著改善OS（HR 0.72），尤其是与皮质类固醇联合使用时（HR 0.66）。
ASCT后的MM患者接受IMiDs维持治疗可显著提高总生存期。对于接受HDT联合ASCT的MM患者，IMiDs维持治疗是合理的。
