Presented in abstract form at the 53rd Annual Meeting of the American Society of Hematology; December 10-13, 2011; San Diego, California.
Bortezomib-containing induction regimens in transplant-eligible myeloma patients
A meta-analysis of phase 3 randomized clinical trials
Article first published online: 4 SEP 2013
© 2013 American Cancer Society
Volume 119, Issue 23, pages 4119–4128, 1 December 2013
How to Cite
Nooka, A. K., Kaufman, J. L., Behera, M., Langston, A., Waller, E. K., Flowers, C. R., Gleason, C., Boise, L. H. and Lonial, S. (2013), Bortezomib-containing induction regimens in transplant-eligible myeloma patients. Cancer, 119: 4119–4128. doi: 10.1002/cncr.28325
- Issue published online: 18 NOV 2013
- Article first published online: 4 SEP 2013
- Manuscript Accepted: 22 MAY 2013
- Manuscript Revised: 1 MAY 2013
- Manuscript Received: 26 FEB 2013
- induction therapy;
- bortezomib-containing induction regimen;
- nonbortezomib-containing induction regimen;
- multiple myeloma
The objective of this meta-analysis in patients with myeloma was to test the hypothesis that the addition of bortezomib to induction therapy not only improves the depth of response but also improves post-transplant progression-free survival (PFS) and overall survival (OS) outcomes.
Phase 3 trials that randomized newly diagnosed, transplant-eligible patients with myeloma to receive either a bortezomib-containing induction regimen (BCIR) or a nonbortezomib-containing induction regimen (NBCIR) were identified. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adapted for data synthesis, and comprehensive meta-analysis software was used to report pooled data as hazard ratios or odds ratios under a random-effects model.
Four published phase 3 trials that included 2169 patients were analyzed. The postinduction and post-transplant pooled odds ratio for achieving a complete response/near complete response or a very good partial response or better and the overall response rate were higher with BCIR. The pooled hazard ratios for 3-year PFS and OS were 0.71 (95% confidence interval, 0.60-0.83; P < .00,001) and 0.79 (95% confidence interval, 0.66-0.96; P = .014), respectively, favoring BCIR. The odds of developing selected grade ≥3 toxicities (peripheral neuropathy and varicella-zoster virus reactivation) also were higher with BCIR.
The current meta-analysis demonstrated that BCIR results in an improved depth of response, which translates into improved post-transplant PFS and OS outcomes despite a higher incidence of toxicity. This analysis supports the concept that the choice of induction regimen can influence post-transplant outcomes such as PFS and OS. Cancer 2013;119:4119–4128. © 2013 American Cancer Society.