Department of Hematology, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Hematology. 2023 Dec;28(1):2187972. doi: 10.1080/16078454.2023.2187972.
Multiple myeloma (MM) remains an incurable disease despite advances in treatment options. Recently, selinexor has shown promising efficacy for relapsed/refractory multiple myeloma (RRMM), whereas its optimal timing and drug combination remain unclear. In order to assess the various regimens that incorporate selinexor, a systematic review and meta-analysis was conducted.
Clinical trials and real-world studies involving MM patients treated with selinexor were included. Pooled risk ratio (RR) was calculated to compare the rates, along with a 95% confidence interval (CI) and concurrent -value assessment. A random-effects model was employed to provide a more conservative evaluation.
A total of 16 studies enrolling 817 patients were reviewed. The usage of selinexor as the fifth-line or prior therapy achieved a higher objective response rate (ORR) (65.9% versus 23.4%, < 0.01) and longer pooled progression-free survival (PFS) (median: 12.5 months versus 2.9 months, < 0.01) than those after the fifth-line usage. In addition, early usage also resulted in a consistent trend of pooled overall survival (median: 22.7 months versus 8.9 months, = 0.26), compared with post-fifth-line usage. Selinexor and dexamethasone (Xd) plus either protease inhibitors (PIs) or immunomodulatory drugs (IMiDs) achieved better ORRs than the Xd-only regimen for RRMM, with ORRs of 56.1%, 52.5% and 24.6%, respectively (< 0.01).
In conclusion, using selinexor as the fifth-line or prior therapy had a beneficial impact on RRMM. The regimen of Xd plus PIs or IMiDs was recommended.
尽管治疗选择有所进步，但多发性骨髓瘤（MM）仍然是一种无法治愈的疾病。最近，塞利尼索在复发/难治性多发性骨髓瘤（RRMM）方面显示出了有希望的疗效，但其最佳时机和药物组合尚不清楚。为了评估包含塞利尼索的各种方案，进行了系统评价和荟萃分析。
纳入了接受塞利尼索治疗的 MM 患者的临床试验和真实世界研究。计算了汇总风险比（RR），以比较比率，以及 95%置信区间（CI）和并发 -值评估。采用随机效应模型提供更保守的评估。
共综述了 16 项纳入 817 例患者的研究。与第五线或之前治疗相比，塞利尼索的使用率作为第五线或之前治疗可获得更高的客观缓解率（ORR）（65.9%比 23.4%，<0.01）和更长的无进展生存期（PFS）（中位数：12.5 个月比 2.9 个月，<0.01）。此外，早期使用也导致汇总总生存期（中位数：22.7 个月比 8.9 个月，=0.26）呈现出一致的趋势，与第五线后使用相比。与 Xd 单药方案相比，塞利尼索联合地塞米松（Xd）加蛋白酶抑制剂（PIs）或免疫调节药物（IMiDs）治疗 RRMM 可获得更好的 ORR，ORR 分别为 56.1%、52.5%和 24.6%（<0.01）。
总之，将塞利尼索作为第五线或之前的治疗对 RRMM 有有益的影响。建议采用 Xd 联合 PIs 或 IMiDs 的方案。
