Survival Following Quadruplet and Triple Therapy in Transplant in-Eligible Multiple Myeloma - a Meta-Analysis of Recent Clinical Trials
Notice bibliographique
Résumé
INTRODUCTION In the management of transplant-ineligible multiple myeloma (TIMM), therapeutic strategies are crucial for improving patient outcomes. Recent clinical trials have explored the efficacy of Quadruplet therapy and Triplet therapy in this context. Quadruplet therapy, involving an additional drug, has been proposed to offer enhanced benefits in overall survival and progression-free survival. AIM This meta-analysis aimed to evaluate the comparative effectiveness (overall survival [OS] and progression-free survival [PFS]) of Quadruplet vs Triplet therapy in TIMM regimens to inform clinical decision-making and optimize patient care. METHODS Type of Study: Meta-analysis of Phase 3 clinical trials Endpoint: Evaluate OS and PFS in Quadruplet vs Triplet therapy Search strategy: PRISMA protocol using keywords ((“multiple myeloma”[Title/Abstract] AND (“quadruple therapy”[Title/Abstract] OR “triple therapy”[Title/Abstract] OR (“bortezomib-lenalidomide-dexamethasone”[All Fields] AND “VRd”[Title/Abstract]) OR (“lenalidomide-dexamethasone”[All Fields] AND “Rd”[Title/Abstract]) OR (“bortezomib-melphalan-prednisone”[All Fields] AND “VMP”[Title/Abstract]) OR (“CD38-targeted”[All Fields] AND “antibody”[Title/Abstract]))) NOT “Transplant-eligible”[All Fields]) AND ((y_10[Filter]) AND (clinicaltrial[Filter] OR clinicaltrialphasei[Filter] OR clinicaltrialphaseii[Filter] OR clinicaltrialphaseiii[Filter] OR clinicaltrialphaseiv[Filter] OR multicenterstudy[Filter] OR observationalstudy[Filter] OR randomizedcontrolledtrial[Filter]) AND (fft[Filter]) AND (humans[Filter]) AND (english[Filter])) to identify clinical trials from last 10 years. Inclusion criteria: Only Clinical trials recruited TIMM patients in the last 10 yearsExclusion criteria: Studies other than clinical trials, non-human, non-English, and non-full text studies were excluded. Study selection & Data extraction: Using eligibility criteria and keywords, we screened the abstracts and evaluated them for their inclusion in our meta-analysis. From screen abstracts, full-length articles were obtained and studied individually for their eligibility in quantitative analysis (meta-analysis). Data on study name, design, country, duration, sample size, population characteristics [country, mean/median age, sex], type of intervention, and outcomes (OS and PFS) were collected. Statistical analysis: Review Manager 5.3 software was used to analyze the data. We performed random effects models to estimate the pooled effect size (pooled odds ratio) and 95% confidence interval (95% CI). Forest plots were obtained. p<0.05 was considered statistically significant. Heterogeneity (I2 values) was identified and I2>75% represented high heterogeneity. Risk of bias analysis was performed using the Newcastle-Ottawa Scale. RESULTS Out of 51 studies, fulfilling the criteria, nine studies had data on the management of TIMM, of which five studies had data on outcomes of Quadruplet vs Triplet therapy. ALCYONE, IMROZ, and OCTANS were the main multicenter, randomized, and open-label clinical trials covering 160+ sites in 25+ countries. We found 607 patients (of 1196) on Quadruplet and 368 patients (of 1142) on Triplet therapy. Quadruplet therapy had 88% higher odds of OS [OR: 1.88, 95%CI: 1.51-2.35, p<0.00001, I2: 0%] and 178% higher odds of PFS [2.78, 0.83-9.33, p=0.1, I2: 92%] in compared to Triplet therapy. [Pooled OR for survival: 2.30, 1.36-3.87, p=0.002, I2: 0%]. Quadruplet therapy had higher odds of MRD negative [4.04, 2.32-7.03, p<0.00001, I2: 52%] and RR [2.25, 1.66-3.05, p<0.00001, I2: 0%] in compared to Triplet therapy. NOS suggested a moderate risk of bias. CONCLUSION In conclusion, our meta-analysis demonstrates that Quadruplet therapy significantly outperforms Triplet therapy in transplant-ineligible multiple myeloma patients, with notable improvements in overall survival and progression-free survival. The Quadruplet regimen also enhances the likelihood of achieving minimal residual disease negativity and a higher response rate. These findings underscore the potential benefits of integrating an additional drug into treatment regimens for better clinical outcomes.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,021 | 0,034 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,001 |
| Méta-épidémiologie (sens large) | 0,017 | 0,061 |
| Bibliométrie | 0,004 | 0,006 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,004 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».