title: Maintenance therapy with immunomodulatory drugs after autologous stem cell transplantation in patients with multiple myeloma: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Although high-dose therapy (HDT) with autologous stem cell transplantation (ASCT) has been confirmed to result in longer remission time than conventional chemotherapy, multiple myeloma (MM) remains incurable. Post-ASCT maintenance is considered as a strategy for obtaining durable remissions and preventing tumor progression. Randomized controlled trials (RCTs) studying maintenance therapy with immunomodulatory drugs (IMiDs) after ASCT have shown some valuable survival improvements. This meta-analysis of RCTs therefore assesses the effect of post-ASCT IMiDs maintenance on MM patients.
  
  
  METHODS
  We performed a meta-analysis to evaluate the impact of IMiDs (thalidomide or lenalidomide) as post-ASCT maintenance therapy on the survival of newly diagnosed MM patients. The outcomes for this meta-analysis were progression-free survival (PFS) and overall survival (OS).
  
  
  RESULTS
  Eight RCTs enrolling 3514 patients were included for analysis. An obvious improvement in Os (hazard ratio [HR] 0.75) and a significant PFS advantage (HR 0.58) with post-ASCT IMiDs maintenance was revealed. Thalidomide maintenance after ASCT can result in significant benefit in Os (HR 0.72), particularly combined with corticosteroids (HR 0.66).
  
  
  CONCLUSIONS
  MM patients after ASCT have a significant overall survival benefit with IMiDs maintenance. IMiDs maintenance was justified for MM patients who received HDT with ASCT.
authors: Department of Hematology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
authors: Xueshi
authors: X
authors: Ye
authors: Jinwen
authors: J
authors: Huang
authors: Qin
authors: Q
authors: Pan
authors: Wanli
authors: W
authors: Li
mesh_terms: D018572:Disease-Free Survival; D018740:Genetic Heterogeneity; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D060046:Maintenance Chemotherapy; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous
chemical_list: D007155:Immunologic Factors
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