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Deng J, Liu L, Sun J, Ma Y, Li L. Effectiveness and safety of chemotherapy combined with immunomodulatory therapies for multiple myeloma: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29093. [PMID: 35421063 PMCID: PMC9276082 DOI: 10.1097/md.0000000000029093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 02/26/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Multiple myeloma (MM) is considered one of the prevalent malignant plasma cell diseases affecting people. In essence, maintenance treatment is valuable for prolonging the survival time of patients experiencing MM. The majority of the currently used treatment protocols for MM are founded on a combination of chemotherapy and immunomodulatory drugs, of which immunomodulatory drugs seems to be one of the most active drugs. However, in the literature, chemotherapy combined with immunomodulatory therapies have not been unambiguously proven. To systematically appraise and synthesize these results, the present investigation will evaluate whether combining chemotherapy with immunomodulatory therapies an effective and safe approach to treating patients with MM. METHODS Two authors relied in 7 different databases: PubMed, EMBASE, Cochrane Library, Web of Science, WanFang Database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure and for studies on chemotherapy's effectiveness when combined with immunomodulatory therapies. The authors only considered studies published up to December 16, 2021 and only those written in English or Chinese. They will also carry out selection of studies, extraction of data, along with assessing risk of bias. Besides, they will also use RevMan V.5.3 to conduct data synthesis. They will establish heterogeneity using the I2 test. At the same time, the authors will evaluate publication bias by making a funnel plot and conducting the Begg as well as Egger tests. ETHICS AND DISSEMINATION The present study will not necessitate ethics approval since it will be funded on already published works. OSF REGISTRATION NUMBER 10.17605/OSF.IO/X7DE4.
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Chen H, Wang Y, Shao C, Sun C, Zheng C. Efficacy and safety of ixazomib maintenance therapy for patients with multiple myeloma: a meta-analysis. Hematology 2021; 26:1031-1039. [PMID: 34895096 DOI: 10.1080/16078454.2021.2009648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES Multiple myeloma(MM) is a malignant plasma cell disease. Maintenance treatment is beneficial to prolong survival time in patients with MM. Ixazomib was approved for the treatment of relapsed or refractory MM in combination with lenalidomide and dexamethasone. Here, we carried out a meta-analysis to determine the efficacy and safety of ixazomib maintenance therapy. METHODS Several databases were searched including PubMed, Web of Science, Embase, the Cochrane Library, etc. The last search dated back to July, 2020. Three clinical trials with a total of 1440 participants with newly diagnosed MM were included. RESULTS AND CONCLUSION The pooled HR of progression-free survival (PFS) was 0.69 (95% CI = 0.59-0.79), which suggested ixazomib maintenance therapy could prolong PFS remarkably. In addition, ixazomib was effective in deepening remission (RR = 1.57, 95% CI = 1.26-1.96). But it could not significantly prolong PFS in cytogenetic high-risk patients (HR = 0.74, 95% CI = 0.47-1.00). In terms of adverse reactions, our analysis revealed higher incidences of grade 3-4 thrombocytopenia (RR = 7.47, 95% CI = 2.06-27.06), neuropathy (RR = 1.48, 95% CI = 1.14-1.92), grade 3-4 infections (RR = 1.77, 95% CI = 1.21-2.59) and gastrointestinal disorders (RR = 1.48, 95% CI = 1.32-1.66). There was no significant correlation between the use of ixazomib and grade 3-4 neutropenia (RR = 1.46, 95% CI = 0.77-2.78, p = 0.25) or the occurrence of new primary malignant tumor (RR = 0.88, 95% CI = 0.53-1.46, p = 0.62). Additionally, more RCTs are needed for better choice of treatment regimen.
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Affiliation(s)
- Huixian Chen
- Department of Hematology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Yongjing Wang
- Department of Hematology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China.,Shandong University-Karolinska Institute Collaboration Laboratory for Stem Cell Research, Jinan, People's Republic of China.,Institute of Biotherapy for Hematological Malignancies, Shandong University, Jinan, People's Republic of China
| | - Chunchun Shao
- Center of Evidence-Based Medicine, Institute of Medical Sciences, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Chenxi Sun
- Department of Hematology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Chengyun Zheng
- Department of Hematology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China.,Shandong University-Karolinska Institute Collaboration Laboratory for Stem Cell Research, Jinan, People's Republic of China.,Institute of Biotherapy for Hematological Malignancies, Shandong University, Jinan, People's Republic of China
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Salwender H, Bertsch U, Weisel K, Duerig J, Kunz C, Benner A, Blau IW, Raab MS, Hillengass J, Hose D, Huhn S, Hundemer M, Andrulis M, Jauch A, Seidel-Glaetzer A, Lindemann HW, Hensel M, Fronhoffs S, Martens U, Hansen T, Wattad M, Graeven U, Munder M, Fenk R, Haenel M, Scheid C, Goldschmidt H. Rationale and design of the German-speaking myeloma multicenter group (GMMG) trial HD6: a randomized phase III trial on the effect of elotuzumab in VRD induction/consolidation and lenalidomide maintenance in patients with newly diagnosed myeloma. BMC Cancer 2019; 19:504. [PMID: 31138244 PMCID: PMC6537200 DOI: 10.1186/s12885-019-5600-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/12/2019] [Indexed: 12/03/2022] Open
Abstract
Background Despite major advances in therapy, multiple myeloma is still an incurable malignancy in the majority of patients. To increase survival, deeper remissions (i.e. CR) translating into longer PFS need to be achieved. Incorporation of new drugs (i.e. bortezomib and lenalidomide) as induction and maintenance treatment in an intensified treatment concept, including high dose melphalan (200 mg/m2), has resulted in increased CR rates, and is considered the standard of care for younger patients. Elotuzumab in combination with lenalidomide and dexamethasone has given better results as lenalidomide and dexamethasone alone in a phase III trial. The GMMG-HD6 trial will be the first phase III trial investigating the role of elotuzumab in combination with bortezomib, lenalidomide and dexamethasone (VRD) induction/consolidation and lenalidomide maintenance within a high dose concept. Methods GMMG-HD6 is a randomized, open, multicenter phase III trial. The planned recruitment number is 564 NDMM patients. All patients will receive 4 VRD cycles as induction and undergo peripheral blood stem cell mobilization and harvesting. Thereafter they will be treated with high dose melphalan therapy plus autologous stem cell transplantation followed by 2 cycles of VRD consolidation and lenalidomide maintenance. Patients in arm B1 + B2 will additionally receive elotuzumab in the induction phase, whereas patients in A2 + B2 will be treated with elotuzumab added to consolidation and maintenance. The primary endpoint of the trial is PFS. Secondary objectives and endpoints are OS, CR rates after induction therapy comparing the two arms VRD (A1 + A2) vs VRD + elotuzumab (B1 + B2), CR rates after consolidation treatment, best response to treatment during the study, time to progression (TTP), duration of response (DOR), toxicity and quality of life. Results Since this is the publication of a study protocol of an ongoing study, no results can be presented. Discussion This phase III trial is designed to evaluate whether the addition of elotuzumab to an intensified treatment concept with high dose melphalan chemotherapy plus autologous stem cell transplantation and induction, consolidation and maintenance treatment with bortezomib and lenalidomide is able to improve PFS compared to the same concept without elotuzumab. Trial registration NCT02495922 on June 24th, 2015.
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Affiliation(s)
- Hans Salwender
- Asklepios Hospital Hamburg, Altona, Hematology, Oncology and Palliative Care, 22763, Hamburg, Germany.
| | - Uta Bertsch
- University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases Heidelberg, Heidelberg, Germany
| | - Katja Weisel
- University Hospital Tuebingen, Tuebingen, Germany.,University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Jan Duerig
- University Hospital Essen, Essen, Germany
| | - Christina Kunz
- German Cancer Research Center Heidelberg, Heidelberg, Germany
| | - Axel Benner
- German Cancer Research Center Heidelberg, Heidelberg, Germany
| | - Igor W Blau
- Charité Universitaetsmedizin Berlin, Berlin, Germany
| | | | | | - Dirk Hose
- University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases Heidelberg, Heidelberg, Germany
| | | | | | - Mindaugas Andrulis
- Institute of Pathology, Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Anna Jauch
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - Andrea Seidel-Glaetzer
- Cordination Center for Clinical Trials, University of Heidelberg (KKS), Heidelberg, Germany
| | | | | | - Stefan Fronhoffs
- Zentrum fuer ambulante Haematologie und Onkologie Siegburg, Siegburg, Germany
| | | | - Timon Hansen
- University Hospital Hamburg Eppendorf, Hamburg, Germany
| | | | - Ullrich Graeven
- Krankenhaus Maria Hilf Moenchengladbach, Moenchengladbach, Germany
| | | | - Roland Fenk
- University Hospital Duesseldorf, Dusseldorf, Germany
| | | | | | - Hartmut Goldschmidt
- University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases Heidelberg, Heidelberg, Germany
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