Comprehensive meta analysis single subject

a control group given either a bortezomib-free regimen or no consolidation/maintenance therapy (4) studies reporting PFS and/or OS and (5) studies published in English. Studies eligible for inclusion met all the following criteria: (1) RCTs (2) participants with MM (3) studies with an intervention group given a bortezomib-containing regimen for consolidation/maintenance vs. The references of relevant articles were manually searched to identify any additional eligible clinical trials. The keywords used for the literature search were вЂњmyeloma,вЂќ вЂњbortezomib,вЂќ and вЂњconsolidation OR maintenance OR continuous therapy.вЂќ We also searched for abstracts presented at the American Society of Clinical Oncology or American Society of Hematology annual conferences. PubMed, Web of Science, and Embase databases were searched for RCTs of bortezomib-based regimens (either single-agent or combination) as consolidation or maintenance therapy for MM through 31 August 2019. Bortezomib-based regimens were compared with regimens without bortezomib or observation. Therefore, we conducted this meta-analysis of randomized controlled trials (RCTs) to examine the efficacy and safety of bortezomib-based regimens as consolidation or maintenance therapy in MM following induction therapy with or without ASCT. Unlike lenalidomide, the role of bortezomib in the consolidation or maintenance setting is less clear. Bortezomib has been used off label for consolidation or maintenance therapy after the initial treatment of MM, particularly for those with high-risk disease 10. Bortezomib-based regimens are widely used as induction therapy for MM 7, 8, 9. Bortezomib is a first-in-class proteasome inhibitor that can lead to cell-cycle arrest and apoptosis 6. Although generally well-tolerated, lenalidomide is associated with increased risk for neutropenia, thrombocytopenia, anemia, infections, thromboembolism, and second primary cancers 4, 5. Maintenance therapy aims to extend the period of disease quiescence with a longer course of a less-intensive regimen 3.ДЄt the time of analysis, lenalidomide was the only Food and Drug Administration (FDA)-approved drug in the United States (US) for maintenance therapy after ASCT in MM. Consolidation therapy is a short course of treatment to deepen the response to the initial therapy. Therefore, a large portion of patients are given consolidation or maintenance therapy with the intent to prolong progression-free survival (PFS) and overall survival (OS). Despite therapeutic advancements and the availability of novel drugs, disease relapse is inevitable for the majority of patients after the initial treatment. For transplant-ineligible patients, triplet or doublet drug combinations are typically recommended for induction therapy 2. The initial treatment of newly diagnosed MM patients who are transplant-eligible is induction chemotherapy with a triple-drug regimen followed by high-dose chemotherapy and autologous stem cell transplantation (ASCT). Better understanding of the diseaseвЂ™s pathophysiology has led to recent advances in therapy and improved patient outcomes dramatically. It is the second most common hematologic malignancy, accounting for about 1% of all cancers 1. Multiple myeloma (MM) is a clonal plasma cell neoplasm that is associated with significant morbidity and mortality. More research is warranted to further assess the role of bortezomib-based consolidation and maintenance therapy for multiple myeloma. Bortezomib-based consolidation/maintenance therapy led to a trend toward increased risk of gradeвЂ‰в‰ҐвЂ‰3 neurologic symptoms, gastrointestinal symptoms, and fatigue. The meta-analysis suggested that bortezomib-based maintenance therapy improved progression-free survival (PFS hazard ratio вЂ‰=вЂ‰0.72, 95% CI 0.55вЂ“0.95, PвЂ‰=вЂ‰0.02) and overall survival (OS HRвЂ‰=вЂ‰0.71, 95% CI 0.58вЂ“0.87, PвЂ‰=вЂ‰0.001). Ten RCTs enrolling 3147 patients were included in the meta-analysis. PubMed, Web of Science, Embase databases, and major conference proceedings were searched for randomized controlled trials (RCTs) of bortezomib-based regimens as consolidation or maintenance therapy for MM. We performed a meta-analysis to evaluate the impact of bortezomib-based consolidation and maintenance therapy on survival outcomes and adverse events. Unlike lenalidomide, the role of bortezomib in consolidation and maintenance therapy for MM is less clear. Bortezomib-based regimens are widely used as induction therapy for multiple myeloma (MM).

Comprehensive meta analysis single subject