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Thalidomide-based Regimens for Elderly and/or Transplant Ineligible Patients with
Multiple Myeloma: A Meta-analysis
#MMPMID26831235
Lyu WW
; Zhao QC
; Song DH
; Zhang JJ
; Ding ZX
; Li BY
; Wei CM
Chin Med J (Engl)
2016[Feb]; 129
(3
): 320-5
PMID26831235
show ga
BACKGROUND: Thalidomide is an immunomodulatory and anti-angiogenic drug that has
shown promise in patients with myeloma. Trials comparing efficacy of standard
melphalan and prednisone (MP) therapy with MP plus thalidomide (MPT) in
transplant-ineligible or elderly patients with multiple myeloma (MM) have
provided conflicting evidence. This meta-analysis aimed to determine the efficacy
and toxicity of thalidomide in previously untreated elderly patients with
myeloma. METHODS: Medline, the Cochrane Controlled Trials register, conference
proceedings of the American Society of Hematology (1995-2014), the American
Society of Clinical Oncology (1995-2014), and CBM, VIP, and CNKI databases were
searched for randomized control trials with the use of the medical subject
headings "MM " and "thalidomide ". Trials were assessed by two reviewers for
eligibility. Meta-analysis was conducted using a fixed effects model. Sensitivity
analysis was performed to test the robustness of the findings. RESULTS: Overall,
seven trials were identified, covering a total of 1821 subjects. The summary
hazard ratio (thalidomide vs. control) was 0.82 (95% confidence interval [CI]:
0.72-0.94) for overall survival (OS), and 0.65 (95% CI: 0.58-0.73) for
progression-free survival, in favor of thalidomide treated group. The risk ratio
of complete response with induction thalidomide was 3.48 (95% CI: 2.24-5.41). A
higher rate of III/IV adverse events were observed in MPT arm compared with the
MP arm. However, analysis of sub-groups administering anticoagulation as venous
thromboembolism prophylaxis suggested no difference in relative risk of
thrombotic events between two arms (RR = 1.47, 95% CI: 0.43-5.07, P = 0.54).
Further analysis of trials on the treatment effects of MPT versus MP on adverse
events-related mortality showed no statistical difference between two arms (RR =
1.24, 95% CI: [0.95-1.63], P = 0.120). CONCLUSION: Thalidomide appears to improve
the OS of elderly and/or transplant-ineligible patients with MM when it is added
to standard MP therapy.
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