Association between response rates and survival outcomes in patients with newly diagnosed multiple myeloma. A systematic review and meta-regression analysis.
OBJECTIVE
We performed a systematic review and meta-regression analysis of randomized control trials to investigate the association between response to initial treatment and survival outcomes in patients with newly diagnosed multiple myeloma (MM).


METHODS
Response outcomes included complete response (CR) and the combined outcome of CR or very good partial response (VGPR), while survival outcomes were overall survival (OS) and progression-free survival (PFS). We used random-effect meta-regression models and conducted sensitivity analyses based on definition of CR and study quality.


RESULTS
Seventy-two trials were included in the systematic review, 63 of which contributed data in meta-regression analyses. There was no association between OS and CR in patients without autologous stem cell transplant (ASCT) (regression coefficient: .02, 95% confidence interval [CI] -0.06, 0.10), in patients undergoing ASCT (-.11, 95% CI -0.44, 0.22) and in trials comparing ASCT with non-ASCT patients (.04, 95% CI -0.29, 0.38). Similarly, OS did not correlate with the combined metric of CR or VGPR, and no association was evident between response outcomes and PFS. Sensitivity analyses yielded similar results.


CONCLUSIONS
This meta-regression analysis suggests that there is no association between conventional response outcomes and survival in patients with newly diagnosed MM.
Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece.|Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Maria
http://orcid.org/0000-0002-5775-2241
M
Mainou
Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Anastasia-Vasiliki
AV
Madenidou
Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece.|Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Aris
A
Liakos
Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Paschalis
P
Paschos
Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece.|Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Thomas
T
Karagiannis
Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece.|Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Eleni
E
Bekiari
Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Efthymia
E
Vlachaki
Evidence-Based Practice Center, Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA.
Zhen
Z
Wang
Evidence-Based Practice Center, Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA.
Mohammad Hassan
MH
Murad
Division of Hematology, Mayo Clinic, Rochester, MN, USA.
Shaji
S
Kumar
Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece.|Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.|Harris Manchester College, University of Oxford, Oxford, UK.
Apostolos
A
Tsapas
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D009101:Multiple Myeloma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012074:Remission Induction; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome
complete response; meta-regression analysis; multiple myeloma; survival; systematic review