First line therapy for patients with newly diagnosed multiple myeloma ineligible for autologous stem cell transplantation: a systematic review and meta-analysis (hemo-oncolgroup study)
Appl. cancer res
; 32(4): 122-141, 2012. tab
Artigo
em Inglês
| LILACS, Inca
| ID: lil-706011
Biblioteca responsável:
BR30.1
ABSTRACT
Background:
Patients not eligible for stem cell transplantation (SCT) have been treated with melphalan (M) plus prednisone (P); however, the standard of care has shifted to MP plus thalidomide(T) due to a greater survival benefit. Bortezomib (B) and lenalidomide have also emerged as effective agents.Methods:
Randomized clinical trials (RCTs) that compared MP to any otherregimen were identified from the databases of Cochrane Library, PubMed, LILACS, EMBASE and Scirus.Results:
Twenty-two trials were included from 2159 potential eligible references. MP vs.M plus dexamethasone (MD) (3 RCTs) MD was superior in partial response (PR) rate and non-hematological toxicity. MP vs. T-based regimens (4 RCTs) significant differences favoring T-basedregimens in complete response (CR) rate, partial response (PR) rate, and progression-free survival (PFS). MP vs. B based regimens (1 RCT) significant differences in overall survival (OS) , time to progression (TTP), CR and PR rate favored B-based regimens according to the European Group for Blood and Marrow Transplantation (EBMT) criteria. MP vs. chemotherapy regimens withoutM (3 RCTs) A significantly higher number of patients treated with BP achieved a CR. TTP was alsosignificantly longer in BP-treated patients (p < 0.02). MP vs. other polychemotherapy regimens(13 RCTs) No significant differences in PR, OS, hematological or other type of toxicity were observed between MP and the other chemotherapy regimens.Conclusions:
Symptomatic multiplemyeloma patients ineligible for SCT should receive as first-line treatment a combination of MP plus B or T; these regimens are associated with improved outcome but greater toxicity comparedto MP alone. More homogeneous clinical trials using a cytogenetic risk approach are required
Texto completo:
Disponível
Coleções:
Bases de dados internacionais
Base de dados:
LILACS
/
Inca
Assunto principal:
Transplante Autólogo
/
Metanálise como Assunto
/
Tratamento Farmacológico
/
Mieloma Múltiplo
Tipo de estudo:
Ensaio clínico controlado
/
Estudo diagnóstico
/
Estudo prognóstico
/
Revisão sistemática
Limite:
Humanos
Idioma:
Inglês
Revista:
Appl. cancer res
Assunto da revista:
Neoplasias
Ano de publicação:
2012
Tipo de documento:
Artigo
País de afiliação:
Colômbia
/
Venezuela
Instituição/País de afiliação:
Fundação Sante Fé de Bogotá/CO
/
Hospital Pablo Tobón Uribe/CO
/
Instituto Nacional de Cancerologia/CO
/
Rede Cochrane Ibero-americana/VE
/
Universidade Nacional da Colômbia/CO