title: A systematic literature review and network meta-analysis of treatments for patients with untreated multiple myeloma not eligible for stem cell transplantation.
abstract: In newly diagnosed multiple myeloma (MM), patients ineligible for front-line autologous stem cell transplantation (ASCT), melphalan and prednisone (MP) with thalidomide (MPT) or bortezomib (VMP) are standard first-line therapeutic options. Despite new treatment regimens incorporating bortezomib or lenalidomide, MM remains incurable. The FIRST study demonstrated significant improvement in progression-free survival (PFS) and overall survival (OS) for the combination of lenalidomide and low-dose dexamethasone (Rd) until progression vs. MPT in transplant-ineligible ndMM patients. However, to date no head-to-head randomized controlled trials (RCTs) have compared Rd or MPT versus VMP. We conducted a network meta-analysis using RCTs identified through a systematic literature review to evaluate the relative efficacy of Rd versus other regimens on survival endpoints in previously untreated MM patients ineligible for ASCT. In this analysis, Rd was associated with a significant PFS and survival advantage versus other first-line treatments (VMP, MPT, MP), challenging the role of alkylators in this setting.
authors.affiliation: a Division of Haematology/Oncology, University Hospital Tubingen, University of Tübingen , Tübingen , Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Weisel
authors.affiliation: b CHU UcL Namur , Yvoir , Belgium.
authors.forename: Chantal
authors.initials: C
authors.lastname: Doyen
authors.affiliation: c National and Kapodistrian University of Athens , Athens , Greece.
authors.forename: Meletios
authors.initials: M
authors.lastname: Dimopoulos
authors.affiliation: d BC Cancer Agency , British Columbia , Canada.
authors.forename: Adrian
authors.initials: A
authors.lastname: Yee
authors.affiliation: e Hospital 12 De Octubre , Madrid , Spain.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Lahuerta
authors.affiliation: f EVIDERA , Lexington , MA , USA.
authors.forename: Amber
authors.initials: A
authors.lastname: Martin
authors.affiliation: f EVIDERA , Lexington , MA , USA.
authors.forename: Karin
authors.initials: K
authors.lastname: Travers
authors.affiliation: g Redwood Outcomes , Vancouver , Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Druyts
authors.affiliation: g Redwood Outcomes , Vancouver , Canada.
authors.forename: Kabirraaj
authors.initials: K
authors.lastname: Toor
authors.affiliation: h Odense University Hospital , Odense , Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Abildgaard
authors.affiliation: i Peking University Institute of Hematology, People's Hospital , Beijing , China.
authors.forename: Jin
authors.initials: J
authors.lastname: Lu
authors.affiliation: j AZ Sint-Jan AV Brugge , Brugge , Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Van Droogenbroeck
authors.affiliation: k Hospitais Da Universidade De Coimbra , Coimbra , Portugal.
authors.forename: Catarina
authors.initials: C
authors.lastname: Geraldes
authors.affiliation: l Chiara Dip. Oncologia , A.O. Universitaria Ospedale S , Pisa , Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Petrini
authors.affiliation: m Centre Hospitalier William Morey , Chalon , France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Voillat
authors.affiliation: n Centre Jean Bernard , Le Mans , France.
authors.forename: Eric
authors.initials: E
authors.lastname: Voog
authors.affiliation: o Hopital Claude Huriez , Lille , France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Facon
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D009101:Multiple Myeloma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D009367:Neoplasm Staging; D017594:Publication Bias; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Lenalidomide; multiple myeloma; network meta-analysis; systematic review