Lenalidomide, ixazomib, or daratumumab maintenance therapy in multiple myeloma

Blood Neoplasia Pub Date : 2024-09-16 DOI:10.1016/j.bneo.2024.100042

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Abstract

Lenalidomide, ixazomib, and daratumumab have been proposed as maintenance therapies for patients with newly diagnosed multiple myeloma (MM; NDMM). There are, however, no randomized controlled trials (RCTs) comparing them. We conducted a network meta-analysis (NMA) of RCTs comparing these agents against placebo in NDMM. A Bayesian NMA model was used to assess the relative effects of competing treatments on progression-free survival (PFS) and overall survival (OS) in 9 studies including 4115 patients with transplant-eligible MM (TEMM) and 1689 patients with non–transplant-eligible MM (NTEMM). Lenalidomide and daratumumab but not ixazomib were associated with improved PFS compared with placebo in patients with TEMM (lenalidomide [hazard ratio (HR), 0.46; 95% credible interval (CrI), 0.36-0.56]; daratumumab [HR, 0.49; 95% Crl, 0.32-0.76]; and ixazomib [HR, 0.72; 95% CrI, 0.46-1.12]) and those with NTEMM (lenalidomide [HR, 0.46; 95% CrI, 0.29-0.75] and ixazomib [HR, 0.69; 95% CrI, 0.43-1.18]). The PFS benefit for daratumumab was present regardless of whether daratumumab-based induction therapy was received. None of the agents showed an OS benefit, and PFS benefits were not seen in patients with high-risk cytogenetics. Lenalidomide was associated with second malignancies, ixazomib with thrombocytopenia, and daratumumab with pneumonia. We propose that lenalidomide remains the maintenance therapy of choice for NDMM.

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多发性骨髓瘤的来那度胺、伊沙佐米或达拉曲单抗维持疗法

摘要来那度胺、伊沙佐米和达拉曲单抗已被提议作为新诊断多发性骨髓瘤（MM；NDMM）患者的维持疗法。然而，目前还没有随机对照试验（RCT）对它们进行比较。我们对在 NDMM 中比较这些药物与安慰剂的 RCT 进行了网络荟萃分析（NMA）。我们使用贝叶斯NMA模型评估了9项研究中竞争治疗对无进展生存期（PFS）和总生存期（OS）的相对影响，这些研究包括4115名符合移植条件的MM（TEMM）患者和1689名不符合移植条件的MM（NTEMM）患者。与安慰剂相比，来那度胺和达拉曲单抗改善了TEMM患者的PFS（来那度胺[危险比（HR），0.46；95%可信区间（CrI），0.36-0.56]；daratumumab[HR，0.49；95% Crl，0.32-0.76]；ixazomib[HR，0.72；95% CrI，0.46-1.12]]）和NTEMM患者（来那度胺[HR，0.46；95% CrI，0.29-0.75]和ixazomib[HR，0.69；95% CrI，0.43-1.18]）。无论是否接受了基于达拉土单抗的诱导治疗，达拉土单抗的PFS获益都是存在的。没有一种药物显示出OS获益，高危细胞遗传学患者也没有PFS获益。来那度胺与二次恶性肿瘤有关，伊沙佐米与血小板减少有关，达拉土单抗与肺炎有关。我们建议来那度胺仍是NDMM的首选维持疗法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Blood Neoplasia

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