Systematic literature review and network meta-analysis of induction treatment for newly diagnosed transplant-eligible multiple myeloma patients

초록

Background: Based on the current guideline, bortezomib-based two or three drug regimens are mainly listed a category 1 primary treatment option for transplant-eligible patients with myeloma. However, to date there are few direct head-to-head randomized controlled trials (RCTs) comparing effects fo these recommended regimens, which makes it different to assess which treatment is most favorable to obtaing high response rates Aims: to determine the ranking of the currently recommended induction regimens and to compare efficacy of all available tretments Methods: We conducted a systematic literature review to identify all eligible RCTs that include at least one currently recommended regimens by searching PubMed, Web of science, ASH, ASCO, EHA, and ESMO databases. A Bayesian network meta-analysis(NMA) with a fixed-effect model was performed to rank the regimens of their very good partial response rates or better(> VGPR) and provide a comparison of treatment options. One of the most commonly utilized regimens, lenalidomide-dexamethasone, was used as reference treatment. Results: Ten RCTs were identibied including nine treatment regimens: VAD, TD, VD, PAD, VTDC, RD and VRD. Summary/Conclusion: Our systematic review and NMA included most of the recommended induction treatments for transplant-eligible myeloma patients and identified VRD as being most effective in achievement of > VGPR. NMAs can provide an overview of the best treatment and each regimen's relative efficacy in case of lacking head-to-head RCTs, thereby supporting clinical decision making