| BACKGROUND AND OBJECTIVE:Nowadays, whether maintenance therapy has beneficial role in the treatment of multiple myeloma (MM) has become a new issue for the researchers. Besides, whether lenalidomide or bortezomib can be the drug of choice for the maintenance therapy has no unification. Many randomized controlled trials (RCTs) have been studying maintenance therapy with bortezomib or lenalidomide after chemotherapy or ASCT, and the results were promising. Herein, we conduct a meta-analysis of RCTs assessing the efficacy and safety of these drugs as maintenance therapy for MM.METHODS:An electronic literature search was performed from the databases using the terms "lenalidomide or revlimid AND bortezomib AND multiple myeloma". Our search was up to January 2015. Data were analyzed by Review Manager 5.1. Meta-analysis was performed with measures including progression free survival (PFS), overall survival (OS), response rate, and adverse effects.RESULTS:Seven studies, enrolling 3618 patients met the inclusion criteria.1. Maintenance therapy can improve both PFS and OS, the corresponding HRs were PFS HR= 0.54,95%CI [0.44,0.66], p<0.00001,I2= 62%, OS HR= 0.83,95%CI [0.72,0.95], p=0.009,I2= 3%. Bortezomib maintenance therapy significantly improved the patient OS, HR=0.81,95%CI [0.66,0.99], p=0.04, I 2= 0%. On the other hand, lenalidomide maintenance therapy had no obvious improvement in OS HR= 0.84,95%CI [0.65,1.08], p=0.18, I2= 40%. As for PFS, both bortezomib and lenalidomide had significant advantage over the controlled groups. The corresponding HRs were lenalidomide HR=0.44,95%CI [0.37,0.53], p＜0.00001,I2= 0%, and bortezomib HR=0.71,95%CI [0.61,0.82], p<0.00001, I2= 0% respectively. Transplant patients had higher OS and PFS corresponding HRs were:PFS:HR= 0.60 (95%CI [0.52,0.68], p＜0.00001, I2 = 74%), OS:HR=0.81(95%CI [0.69,0.96],p=0.01,I2= 39%). Non transplant patients had only higher PFS, but no improvement in OS, corresponding HRs were PFS:HR= 0.57 (95%CI [0.45,0.71], p＜0.00001, I2= 39%), OS:HR= 0.88 (95%CI [0.68,1.13], p=0.31, I2=0%)2. Lenalidomide therapy had no advantage over CR, PR, VGPR. Corresponding RRs were CR (RR= 1.10,95%CI [0.74,1.65]; p=0.64, I2= 71%), VGPR (RR=0.84,95%CI [0.61,1.14];p=0.26, I2= 69%), PR (RR= 1.04, 95%CI [0.89,1.22]; p=0.60, I2= 41%) respectively. Bortezomib therapy only had advantage in CR and PR. Corresponding RRs were CR (RR=1.47,95%CI [1.30,1.67]; p< 0.00001, I2= 0%), PR (RR= 1.08,95%CI [1.04,1.12]; p< 0.00001,I2= 0%), VGPR (RR= 1.18,95%CI[1.00,1.41]; p=0.06,I2= 80%).3. For the adverse effects, there were increased in events such as neutropenia grade 3&4 (RR=3.24,95%CI[2.22,4.73], p<0.00001,I2=44%), thromboembolism (RR=2.39,95%CI [1.10,5.19], p=0.03, I2= 0%), infections (RR=2.39,95%CI [1.59,3.58], p＜0.00001, I2= 0%) in lenalidomide group, and peripheral neuropathy (RR=2.13,95%CI [1.08,4.17], p=0.03, I2= 82%) in bortezomib group. There were also increased incidences of second primary cancers, leukemogenic risk (RR= 3.64,95%CI [1.58,8.41], p=0.002,12= 0%), solid tumors (RR= 2.07,95%CI [1.05,4.09], p=0.04, I2= 0%) in patients treating with lenalidomide.CONCLUSION:l.As our results, continuous maintenance therapy with lenalidomide and bortezomib has been shown to have improvement in PFS consistently, and bortezomib may prolong the overall survival for the MM patients.2. Transplant patients may have survival benefit form maintenance therapy.3. Lenalidomide has higher risk of hematological toxicity and second’ primary cancers, bortezomib has higher risk of peripheral neuropathy.4. Both drugs can be used in maintenance therapy of multiple myeloma. |
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