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Comparing efficacy and survivals of initial treatments for elderly patients with newly diagnosed multiple myeloma: a network meta-analysis of randomized controlled trials

Authors Liu X, Chen J, He YA, Meng X, Li K, He CK, Liu S

Received 1 October 2016

Accepted for publication 17 November 2016

Published 22 December 2016 Volume 2017:10 Pages 121—128

DOI https://doi.org/10.2147/OTT.S123680

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 3

Editor who approved publication: Dr Chiung-Kuei Huang

Xiaoping Liu,1,* Jiarui Chen,2,* Yuncen A He,3 Xiangyu Meng,1 Kaili Li,4 Colin K He,5 Shangqin Liu4

1Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, 2School of Basic Medical Science, Wuhan University, Wuhan, Hubei, People’s Republic of China; 3School of Medicine, Case Western Reserve University, Cleveland, OH, USA; 4Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China; 5Orient Healthcare, New York, NY, USA

*These authors contributed equally to this work

Objective: The aim of this study was to evaluate the efficacy and clinical outcome of initial therapies for elderly patients with multiple myeloma (MM).
Methods: Randomized controlled trials (RCTs) were obtained through a comprehensive search. Response rate, progression-free survival (PFS) and overall survival (OS) were the interested outcome measures. Network meta-analysis (NMA) using graph theory methodology to construct an NMA model, and sensitivity analysis were performed.
Results: Nineteen RCTs containing 7,235 participants and 17 treatments were included in the NMA. As compared to the classic melphalan plus prednisone (MP) regimen, the majority of other initial regimens showed higher rates of complete response/near complete response, overall response rate (ORR) and better PFS as well as OS. These four outcomes favored the two lenalidomide plus dexamethasone regimens (continuous lenalidomide and 18 cycles of lenalidomide plus dexamethasone), especially continuous lenalidomide plus dexamethasone regimen, over the majority of other regimens including the two established standard treatments (MP plus thalidomide or bortezomib) for elderly patients with newly diagnosed MM.
Conclusion: Continuous lenalidomide plus dexamethasone ranked as the best regimen in terms of ORR and OS for the treatment of elderly patients with newly diagnosed MM.

Keywords:
multiple myeloma, previously untreated, elderly patients, initial therapies, network meta-analysis

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