Post‐transplant consolidation plus lenalidomide maintenance vs lenalidomide maintenance alone in multiple myeloma: A systematic review

다국어 초록 (Multilingual Abstract)

In newly diagnosed multiple myeloma (NDMM), autologous stem cell transplantation (ASCT) remains the standard approach for transplant‐eligible patients. To control the inevitable relapse, post‐transplant consolidation/maintenance strategies are commonly used. However, the benefit of post‐transplant consolidation is still uncertain
We conducted a systematic review of phase II/III studies to compare the efficacy of post‐ASCT consolidation plus lenalidomide maintenance (CON+LEN) vs lenalidomide maintenance alone (LEN alone) in NDMM. A meta‐analysis using fixed and random effects models was performed.
Fourteen studies were included with 2275 participants with NDMM treated with ASCT and lenalidomide maintenance. Two groups were identified: CON+LEN group (n = 1102) and LEN alone group (n = 1173). There was no statistically significant difference in the complete response rate between the two groups [RR = 1.1; 95% CI: 0.83‐1.44; P = .490]. Interestingly, we found that very good partial response or better rate is around 1.5‐fold significantly higher in the CON+LEN group compared to LEN alone group [RR: 1.46; 95% CI: 1.25‐1.70; P < .0001]. However, there was no significant difference between the two groups regarding PFS [RR: 1.0; 95% CI: 0.92‐1.08, P = .929] and OS [RR: 0.9; 95% CI: 0.92‐1.01; P = .148] at 3‐4 years follow‐up. The risk of secondary primary malignancy (SPM) was also similar between the two groups (RR: 1.2; 95% CI: 0.84‐1.92; P = .2). Data on adverse events were limited.
Our data suggest that, in NDMM patients treated with upfront ASCT, post‐transplant consolidation may improve depth of response, but does not add to OS or PFS, compared to lenalidomide maintenance alone. However, data in this context are still immature.