Early or deferred treatment of smoldering multiple myeloma: a meta-analysis on randomized controlled studies

Smoldering multiple myeloma (SMM) is a rare asymptomatic plasma cell disorder. Even with emerging therapeutic approaches and risk stratification, the optimal time to treat SMM remains controversial. This meta-analysis aimed to compare early treatment with deferred treatment of SMM, especially high-r...

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Bibliographic Details
Published in:Cancer management and research 2019-06, Vol.11, p.5599-5611
Main Authors: Zhao, Ai-Lin, Shen, Kai-Ni, Wang, Ji-Nuo, Huo, Lan-Qing, Li, Jian, Cao, Xin-Xin
Format: Article
Language:English
Subjects:
Bias
Cancer therapies
Collaboration
Constipation
Early treatment
Glucocorticoids
Health aspects
Lenalidomide
Leukemia
Medical research
Meta-analysis
Mortality
Multiple myeloma
NMR
Nuclear magnetic resonance
Original Research
Prednisone
Response rates
Siltuximab
Smoldering multiple myeloma
Studies
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Summary:Smoldering multiple myeloma (SMM) is a rare asymptomatic plasma cell disorder. Even with emerging therapeutic approaches and risk stratification, the optimal time to treat SMM remains controversial. This meta-analysis aimed to compare early treatment with deferred treatment of SMM, especially high-risk SMM. Early treatment was defined as treatment immediately after diagnosis. Deferred treatment was initiated after progression. The primary outcome was progression. Secondary outcomes were mortality, response, and safety. PubMed, EMBASE, Medline, Cochrane, and ClinicalTrials.gov databases were searched from January 1990 to March 2019. Randomized controlled trials (RCTs) comparing early treatment with deferred treatment in SMM patients were eligible. Risk ratios (RRs) with 95% confidence interval (CI) were pooled. Eight RCTs covering 885 SMM patients were included. Considering all the different treatment approaches, early treatment significantly decreased progression of SMM (RR=0.53, 95% CI 0.33-0.87, =0.01). In subgroup analysis, melphalan plus prednisone (RR=0.22, 95% CI 0.08-0.64, =0.005) and immuno-modulatory drugs (RR=0.43, 95% CI 0.31-0.59,
ISSN:1179-1322
1179-1322
DOI:10.2147/cmar.s205623