Weisel Katja, Doyen Chantal, Dimopoulos Meletios, Yee Adrian, Lahuerta Juan José, Martin Amber, Travers Karin, Druyts Eric, Toor Kabirraaj, Abildgaard Niels, Lu Jin, Van Droogenbroeck Jan, Geraldes Catarina, Petrini Mario, Voillat Laurent, Voog Eric, Facon Thierry
a Division of Haematology/Oncology, University Hospital Tubingen, University of Tübingen , Tübingen , Germany.
b CHU UcL Namur , Yvoir , Belgium.
Leuk Lymphoma. 2017 Jan;58(1):153-161. doi: 10.1080/10428194.2016.1177772. Epub 2016 Apr 28.
In newly diagnosed multiple myeloma (MM), patients ineligible for front-line autologous stem cell transplantation (ASCT), melphalan and prednisone (MP) with thalidomide (MPT) or bortezomib (VMP) are standard first-line therapeutic options. Despite new treatment regimens incorporating bortezomib or lenalidomide, MM remains incurable. The FIRST study demonstrated significant improvement in progression-free survival (PFS) and overall survival (OS) for the combination of lenalidomide and low-dose dexamethasone (Rd) until progression vs. MPT in transplant-ineligible ndMM patients. However, to date no head-to-head randomized controlled trials (RCTs) have compared Rd or MPT versus VMP. We conducted a network meta-analysis using RCTs identified through a systematic literature review to evaluate the relative efficacy of Rd versus other regimens on survival endpoints in previously untreated MM patients ineligible for ASCT. In this analysis, Rd was associated with a significant PFS and survival advantage versus other first-line treatments (VMP, MPT, MP), challenging the role of alkylators in this setting.
在新诊断的多发性骨髓瘤（MM）中，不符合一线自体干细胞移植（ASCT）条件的患者，美法仑和泼尼松（MP）联合沙利度胺（MPT）或硼替佐米（VMP）是标准的一线治疗方案。尽管有包含硼替佐米或来那度胺的新治疗方案，但MM仍然无法治愈。FIRST研究表明，对于不符合移植条件的新诊断MM患者，来那度胺与低剂量地塞米松联合用药（Rd）直至病情进展，与MPT相比，无进展生存期（PFS）和总生存期（OS）有显著改善。然而，迄今为止，尚无直接比较Rd或MPT与VMP的头对头随机对照试验（RCT）。我们通过系统文献综述确定的RCT进行了一项网络荟萃分析，以评估Rd与其他方案在不符合ASCT条件的初治MM患者生存终点方面的相对疗效。在该分析中，与其他一线治疗（VMP、MPT、MP）相比，Rd具有显著的PFS和生存优势，这对烷化剂在这种情况下的作用提出了挑战。
