Bortezomib-containing induction regimens in transplant-eligible myeloma patients: A meta-analysis of phase 3 randomized clinical trials

Ajay K. Nooka, Jonathan L. Kaufman, Madhusmita Behera, Amelia Langston, Edmund K. Waller, Christopher R. Flowers, Charise Gleason, Lawrence H. Boise, Sagar Lonial

Research output: Contribution to journalArticle

31 Scopus citations

Abstract

BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

Original languageEnglish (US)
Pages (from-to)4119-4128
Number of pages10
JournalCancer
Volume119
Issue number23
DOIs
StatePublished - Dec 1 2013

Keywords

  • bortezomib-containing induction regimen
  • induction therapy
  • multiple myeloma
  • nonbortezomib-containing induction regimen
  • transplant-eligible

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Nooka, A. K., Kaufman, J. L., Behera, M., Langston, A., Waller, E. K., Flowers, C. R., Gleason, C., Boise, L. H., & Lonial, S. (2013). Bortezomib-containing induction regimens in transplant-eligible myeloma patients: A meta-analysis of phase 3 randomized clinical trials. Cancer, 119(23), 4119-4128. https://doi.org/10.1002/cncr.28325