Meta-analysis of the efficacy of treatments for newly diagnosed and relapsed/refractory multiple myeloma with del(17p)

Abstract

We analyzed the treatment of newly diagnosed and relapsed/refractory multiple myeloma (NDMM/RRMM) patients with del(17p). Thirteen prospective studies that evaluated 3,187 MM patients, including 685with del(17p), were included in our meta-analysis. The incidence of del(17p) in NDMM and RRMM patients was similar (13% vs. 14%, respectively, P = 0.64, I² = 94%). The overall response rate (ORR) to new agents was 40.5% and 67.1%, respectively, in RRMM patients with or without del(17p) (P = 0.1, I² = 63.9%). NDMM patients with del(17p) treated with PAD (bortezomib, adriamycin, and dexamethasone) induction therapy followed by bortezomib maintenance therapy had higher progression-free survival (PFS) (25.7 vs. 12-14.6 months) and overall survival (OS) (62% vs. 8% at 36 months) than those treated with PD (bortezomib and dexamethasone) or VAD (vincristine, adriamycin, and dexamethasone). PFS among RRMM patients with del(17p) treated with D (single-agent dexamethasone), Rd/VRd (lenalidomide and dexamethasone/bortezomib and Rd), KRd (carfilzomib and Rd), IRd (ixazomib and Rd), ERd (elotuzumab and Rd), or P+D (pomalidomide and dexamethasone) was 1.1, 2-14.9, 24.5, 15.7, 21.2, and 4.6-7.3 months, respectively. The OS of patients treated with D or K (single-agent carfilzomib), Rd/VRd, ERd, or P+D was 7.7, 7, 4.7–36.4, > 42.3, and 12–12.6 months, respectively. PFS among RRMM patients without del(17p) treated with D, Rd/VRd, ERd, or P+D was 2.3, 8.2-14.8, 18.5, and 4.2 months, while OS was 9, 23-40.8, 42.3, and 14 months, respectively. Thus bortezomib maintenance therapy improves the prognosis of NDMM patients with del(17p). Combined treatment with carfilzomib or elotuzumab and Rd, or pomalidomide with low-dose dexamethasone, improves the outcomes of RRMM patients with del(17p).