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Post‐transplant consolidation plus lenalidomide maintenance vs lenalidomide maintenance alone in multiple myeloma: A systematic review
Author(s) -
AlAni Fatimah,
Louzada Martha
Publication year - 2017
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.12961
Subject(s) - lenalidomide , multiple myeloma , medicine , autologous stem cell transplantation , adverse effect , maintenance therapy , transplantation , oncology , surgery , chemotherapy
Background In newly diagnosed multiple myeloma ( NDMM ), autologous stem cell transplantation ( ASCT ) remains the standard approach for transplant‐eligible patients. To control the inevitable relapse, post‐transplant consolidation/maintenance strategies are commonly used. However, the benefit of post‐transplant consolidation is still uncertain Method We conducted a systematic review of phase II / III studies to compare the efficacy of post‐ ASCT consolidation plus lenalidomide maintenance ( CON + LEN ) vs lenalidomide maintenance alone ( LEN alone) in NDMM . A meta‐analysis using fixed and random effects models was performed. Results Fourteen studies were included with 2275 participants with NDMM treated with ASCT and lenalidomide maintenance. Two groups were identified: CON + LEN group (n = 1102) and LEN alone group (n = 1173). There was no statistically significant difference in the complete response rate between the two groups [ RR  = 1.1; 95% CI : 0.83‐1.44; P  = .490]. Interestingly, we found that very good partial response or better rate is around 1.5‐fold significantly higher in the CON + LEN group compared to LEN alone group [ RR : 1.46; 95% CI : 1.25‐1.70; P  < .0001]. However, there was no significant difference between the two groups regarding PFS [ RR : 1.0; 95% CI : 0.92‐1.08, P  =   .929] and OS [ RR : 0.9; 95% CI : 0.92‐1.01; P  =   .148] at 3‐4 years follow‐up. The risk of secondary primary malignancy ( SPM ) was also similar between the two groups ( RR : 1.2; 95% CI : 0.84‐1.92; P  =   .2). Data on adverse events were limited. Conclusion Our data suggest that, in NDMM patients treated with upfront ASCT , post‐transplant consolidation may improve depth of response, but does not add to OS or PFS , compared to lenalidomide maintenance alone. However, data in this context are still immature.

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