Sun Chun-Yan, Li Jun-Ying, Chu Zhang-Bo, Zhang Lu, Chen Lei, Hu Yu
Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
Biosci Rep. 2017 Jul 27;37(4). doi: 10.1042/BSR20170304. Print 2017 Aug 31.
Multiple myeloma (MM) is a B-cell neoplasm with a high incidence of relapse. Bortezomib has been extensively studied for the maintenance treatment of MM. Here, we carried out a meta-analysis to determine the efficacy and safety of maintenance therapy with bortezomib. We searched for clinical trials in PubMed (Medline), Embase (OVID), and the Cochrane Library. Two randomized controlled trials (RCTs) enrolling a total of 1338 patients were included. Bortezomib maintenance statistically significantly improved both progression-free survival (PFS) (hazard ratio (HR) 0.67, 95% confidence interval (CI) = 0.51 to 0.87, =0.003) and overall survival (OS) (HR = 0.75 therapy, 95% CI = 0.63 to 0.89, =0.001) more than did non-bortezomib maintenance therapy. Our analysis revealed higher incidence of neutropenia (risks ratios (RR) = 1.39; 95% CI = 1.08 to 1.79), peripheral neuropathy (PN) (RR = 2.23; 95% CI = 1.38 to 3.61, =0.001), and cardiologic events (RR = 1.91; 95% CI = 1.12 to 3.28, =0.02) in patients with bortezomib maintenance therapy. Our meta-analysis demonstrates OS and PFS benefits of bortezomib maintenance therapy in patients with newly diagnosed MM. However, the therapy is associated with increased risk of adverse events. Additionally, more RCTs are needed for better understanding and determination of optimal bortezomib maintenance therapy in MM.
多发性骨髓瘤（MM）是一种复发率很高的B细胞肿瘤。硼替佐米已被广泛研究用于MM的维持治疗。在此，我们进行了一项荟萃分析，以确定硼替佐米维持治疗的疗效和安全性。我们在PubMed（医学索引）、Embase（OVID）和Cochrane图书馆中检索临床试验。纳入了两项共招募1338例患者的随机对照试验（RCT）。与非硼替佐米维持治疗相比，硼替佐米维持治疗在统计学上显著改善了无进展生存期（PFS）（风险比（HR）0.67，95%置信区间（CI）=0.51至0.87，P =0.003）和总生存期（OS）（HR =0.75，95%CI =0.63至0.89，P =0.001）。我们的分析显示，接受硼替佐米维持治疗的患者中性粒细胞减少症（风险比（RR）=1.39；95%CI =1.08至1.79）、周围神经病变（PN）（RR =2.23；95%CI =1.38至3.61，P =0.001）和心脏事件（RR =1.91；95%CI =1.12至3.28，P =0.02）的发生率更高。我们的荟萃分析表明，硼替佐米维持治疗对新诊断的MM患者有OS和PFS益处。然而，该治疗与不良事件风险增加相关。此外，还需要更多的RCT来更好地理解和确定MM中最佳的硼替佐米维持治疗方案。
