Meta-analysis of the efficacy of treatments for newly diagnosed and relapsed/refractory multiple myeloma with del(17p)
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Jinghua Liu1,*, Hui Yang1,*, Xiaochan Liang2, Yuxin Wang1, Jian Hou3, Yanqin Liu1, Jigang Wang1 and Fan Zhou1
1Department of Hematology, The General Hospital of Shenyang Military, Shenyang, China
2Department of Clinical Medicine, Shenyang Pharmaceutical University, Shenyang, China
3Department of Hematology, The Myeloma and Lymphoma Center, Chang Zheng Hospital, The Second Military Medical University, Shanghai, China
*These authors have contributed equally to this work
Fan Zhou, email: [email protected]
Keywords: multiple myeloma del(17p), carfilzomib, pomalidomide, lenalidomide, bortezomib
Received: February 17, 2017 Accepted: May 06, 2017 Published: June 27, 2017
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).
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