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Bortezomib‐containing induction regimens in transplant‐eligible myeloma patients
Author(s) -
Nooka Ajay K.,
Kaufman Jonathan L.,
Behera Madhusmita,
Langston Amelia,
Waller Edmund K.,
Flowers Christopher R.,
Gleason Charise,
Boise Lawrence H.,
Lonial Sagar
Publication year - 2013
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.28325
Subject(s) - medicine , bortezomib , hazard ratio , multiple myeloma , odds ratio , regimen , confidence interval , meta analysis , oncology , randomized controlled trial , induction chemotherapy , surgery , radiation therapy
BACKGROUND The objective of this meta‐analysis in patients with myeloma was to test the hypothesis that the addition of bortezomib to induction therapy not only improves the depth of response but also improves post‐transplant progression‐free survival (PFS) and overall survival (OS) outcomes. METHODS Phase 3 trials that randomized newly diagnosed, transplant‐eligible patients with myeloma to receive either a bortezomib‐containing induction regimen (BCIR) or a nonbortezomib‐containing induction regimen (NBCIR) were identified. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were adapted for data synthesis, and comprehensive meta‐analysis software was used to report pooled data as hazard ratios or odds ratios under a random‐effects model. RESULTS Four published phase 3 trials that included 2169 patients were analyzed. The postinduction and post‐transplant pooled odds ratio for achieving a complete response/near complete response or a very good partial response or better and the overall response rate were higher with BCIR. The pooled hazard ratios for 3‐year PFS and OS were 0.71 (95% confidence interval, 0.60‐0.83; P < .00,001) and 0.79 (95% confidence interval, 0.66‐0.96; P = .014), respectively, favoring BCIR. The odds of developing selected grade ≥3 toxicities (peripheral neuropathy and varicella‐zoster virus reactivation) also were higher with BCIR. CONCLUSIONS The current meta‐analysis demonstrated that BCIR results in an improved depth of response, which translates into improved post‐transplant PFS and OS outcomes despite a higher incidence of toxicity. This analysis supports the concept that the choice of induction regimen can influence post‐transplant outcomes such as PFS and OS. Cancer 2013 ;119:4119–4128. © 2013 American Cancer Society .