Efficacy of first-line treatment options in transplant-ineligible multiple myeloma: A network meta-analysis

Szabolcs Kiss; Noémi Gede; Alexandra Soós; Péter Hegyi; Bettina Nagy; Marcell Imrei; Bernadett Czibere; Nelli Farkas; Lilla Hanák; Zsolt Szakács; Bálint Eröss; Hussain Alizadeh

doi:10.1016/j.critrevonc.2021.103504

Efficacy of first-line treatment options in transplant-ineligible multiple myeloma: A network meta-analysis

Crit Rev Oncol Hematol. 2021 Dec:168:103504. doi: 10.1016/j.critrevonc.2021.103504. Epub 2021 Oct 18.

Authors

Affiliations

¹ Doctoral School of Clinical Medicine, University of Szeged, H-6720 Szeged, Korányi fasor 8-10., Szeged, Hungary; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, H-7624 Pécs, Szigeti Street 12. 2nd floor, Hungary.
² Institute for Translational Medicine, Medical School, University of Pécs, Pécs, H-7624 Pécs, Szigeti Street 12. 2nd floor, Hungary.
³ Institute for Translational Medicine, Medical School, University of Pécs, Pécs, H-7624 Pécs, Szigeti Street 12. 2nd floor, Hungary; János Szentágothai Research Centre, University of Pécs, Pécs, H-7624 Pécs, Ifjúság Street 20., Hungary; First Department of Medicine, Medical School, University of Pécs, Pécs, H-7624 Pécs, Ifjúság Street 13., Hungary.
⁴ Institute for Translational Medicine, Medical School, University of Pécs, Pécs, H-7624 Pécs, Szigeti Street 12. 2nd floor, Hungary; Institute of Bioanalysis, Medical School, University of Pécs, Pécs, H-7624 Pécs, Szigeti Street 12. 2nd floor, Hungary.
⁵ Institute for Translational Medicine, Medical School, University of Pécs, Pécs, H-7624 Pécs, Szigeti Street 12. 2nd floor, Hungary; First Department of Medicine, Medical School, University of Pécs, Pécs, H-7624 Pécs, Ifjúság Street 13., Hungary.
⁶ Doctoral School of Clinical Medicine, University of Szeged, H-6720 Szeged, Korányi fasor 8-10., Szeged, Hungary; Division of Haematology, First Department of Medicine, Medical School, University of Pécs, Pécs, H-7624 Pécs, Ifjúság Street 13., Hungary. Electronic address: alizadeh.hussain@pte.hu.

PMID: 34673218
DOI: 10.1016/j.critrevonc.2021.103504

Abstract

Background: Despite major therapeutic advances, the rational choice of the most appropriate first-line regimen in newly diagnosed transplant-ineligible multiple myeloma (TIE-MM) is currently undefined.

Aim: We aimed to identify the most effective first-line treatment for TIE-MM patients.

Methods: A total of 37 articles, including 34 treatments and 16,681 patients, were included in this Bayesian network meta-analysis. The outcomes of interest were risk ratios (RR) for progression-free survival (PFS) and overall survival (OS).

Results: Based on surface under cumulative ranking curve values, daratumumab-bortezomib-melphalan-prednisone (Dara-VMP) and daratumumab-lenalidomide-dexamethasone (Dara-Rd28) showed superiority compared to other combinations regarding 12-, 24-, 36-, and 48-month PFS. Dara-VMP also ranked first for 12-, 24-, 36-, and 48-month OS.

Conclusion: Our finding supports the incorporation of daratumumab into first-line regimens. Additionally, these results highlight the relative benefit of incorporating novel agents like monoclonal antibodies, immunomodulatory derivatives, and proteasome inhibitors in combination with the currently existing treatment options.

Keywords: First-line; Meta-analysis; Multiple myeloma; Survival; Transplant-ineligible.

Publication types

Meta-Analysis
Review

MeSH terms

Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Bayes Theorem
Bortezomib / therapeutic use
Dexamethasone / therapeutic use
Humans
Lenalidomide
Multiple Myeloma* / drug therapy
Network Meta-Analysis
Treatment Outcome

Substances

Bortezomib
Dexamethasone
Lenalidomide