The Efficacy And Safety Of Lenalidomide In The Maintenance Treatment Of Newly Diagnosed Multiple Myeloma Meta Analysis

BACKGROUND AND OBJECTIVE:Multiple myeloma is a malignant tumor of clonal proliferation of plasma cells.Pernicious anemia,infection,impaired renal function,and extensive bone pathological changes throughout the body are common clinical manifestations.The main treatments include induction therapy,consolidation,and maintenance therapy.There is evidence that long-term maintenance therapy may help suppress residual disease after treatment,prolong remission time,and delay relapse.Therefore,post-transplantation and post-transplantation maintenance therapy are very important in the treatment of multiple myeloma.PURPOSE:Whether lenalidomide as a maintenance therapy drug can improve PFS and OS has not been unified.In this paper,meta-analysis was used to assess the efficacy and safety of lenalidomide in the treatment of multiple myeloma maintenance therapy.METHODS:Electronic retrieval Pubmed,Embase,Cochrane,Web of Science,Chinese Medical Database,China Knowledge Network and other Chinese and foreign databases to obtain information on the treatment of multiple myeloma with lenalido-mide.The search time limit is from the time of database construction to 2018.month.For eligible studies,screening,extraction,and evaluation of quality were performed according to the inclusion and exclusion criteria.Review Manager version 5.3 was used for progression-free survival(PFS)and overall survival(OS).Meta-analysis was performed on end-point indicators such as objective efficacy and adverse events.RESULTS:Six trials that met the inclusion criteria were included.Statistical analysis results show:1,The subgroup analysis suggested that lenalidomide maintenance therapy was divided into transplantation group and non-transplantation group.The HR of median PFS and OS in the transplantation group was HR=0.47(95%CI[0.41,0.55],p<0.00001 12=43%),OS HR=0.72(95%CI[0.51,1.03],p=0.07,1~2=67%).Non-transplanted group had median PFS HR=0.61(95%CI[0.53,0.71],p<0.000011~2=44%),and non-transplanted group had OS HR=0.86(95%CI[0.74,1.00],p=0.06,1~2=0%).According to statistical analysis of the results,lenalidomide maintenance therapy,whether transplanted or non-transplanted patients,can effectively improve the patient's progression-free survival and can not improve overall survival.2.Lenalidomide maintenance therapy was performed again from the data of complete response CR,very good partial response VGPR,partial response PR and other meta-analyses:during lenalidomide maintenance treatment The overall response rate(RR=1.09(95%CI[0.97,1.21],p=0.14,1~2=79%)showed that lenalidomide maintenance therapy failed to increase objective efficacy.3.Adverse reactions included hematologic toxicity and non-hematological toxicity.Hematological toxicity is divided into:Grade 3 and 4 neutropenia(RR=3.15,95%CI[2.56,3.87],p<0.00001,1~2=0%);Grade 3 or 4 anemia(RR=2.2795%CI[1.21,4.29],p=0.01,1~2=2%);Grade 3,4 thrombocytopenia(RR=2.49,95%CI[1.73,3.59],p<0.00001,1~2=0%).Non-hematological toxicity:Infections(including bacteria,fungi,viruses)(RR=2.80,95%CI[1.95,4.02],p<0.00010,1~2=0%);Thrombosis(including deep vein thrombosis and pulmonary embolism)(RR=2.89,95%CI[1.45,5.76],p=0.003,1~2=0%);peripheral neuropathy(RR=1.24,95%CI[0.49,3.12],p=0.65,1~2=0%).Myeloma lenalidomide maintenance therapy for secondary tumors(including hematologic tumors,solid tumors)compared with controls(RR=2.39,95%CI[1.58,3.79],p<0.0001,1~2=0%),hematologic tumors(RR=3.78,95%CI[1.90,7.53],p=0.0002,1~2=0%),Incidence of solid tumors(RR=1.92,95%CI[1.04,3.55],p=0.04,1~2=0%).CONCLUSION:1.This study showed that patients diagnosed with untreated or untreated multiple myeloma,regardless of transplantation or non-transplantation,lenalidomide maintenance treatment can significantly improve the patient's progression-free survival,but can not increase the total number of patients Lifetime.2.This study showed that lenalidomide maintenance therapy failed to increase the overall response rate.3.The severe toxic side effects of lenalidomide are mainly hematological toxicity,infection,thrombosis and the occurrence of secondary tumors,lower peripheral neuropathy.4.In a comprehensive analysis,lenalidomide may be used as a maintenance treatment option for multiple myeloma.