Early versus deferred treatment for smoldering multiple myeloma: a meta-analysis of randomized, controlled trials.
Whether patients with smoldering multiple myeloma (SMM) needed to receive early interventional treatment remains controversial. Herein, we conducted a meta-analysis comparing the efficacy and safety of early treatment over deferred treatment for patients with SMM.MEDLINE and Cochrane Library were se...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2014-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC4184905?pdf=render |
| _version_ | 1818280775486799872 |
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| author | Minjie Gao Guang Yang Van S Tompkins Lu Gao Xiaosong Wu Yi Tao Xiaojing Hu Jun Hou Ying Han Hongwei Xu Fenghuang Zhan Jumei Shi |
| author_facet | Minjie Gao Guang Yang Van S Tompkins Lu Gao Xiaosong Wu Yi Tao Xiaojing Hu Jun Hou Ying Han Hongwei Xu Fenghuang Zhan Jumei Shi |
| author_sort | Minjie Gao |
| collection | DOAJ |
| description | Whether patients with smoldering multiple myeloma (SMM) needed to receive early interventional treatment remains controversial. Herein, we conducted a meta-analysis comparing the efficacy and safety of early treatment over deferred treatment for patients with SMM.MEDLINE and Cochrane Library were searched to May 2014 for randomized controlled trials (RCTs) that assessed the effect of early treatment over deferred treatment. Primary outcome measure was mortality, and secondary outcome measures were progression, response rate, and adverse events.Overall, 5 trials including 449 patients were identified. There was a markedly reduced risk of disease progression with early treatment (Odds Ratio [OR] = 0.13, 95% confidence interval [CI] = 0.07 to 0.24). There were no significant differences in mortality and response rate (OR = 0.85, 95% CI = 0.45 to 1.60, and OR = 0.63, 95% CI = 0.32 to 1.23, respectively). More patients in the early treatment arm experienced gastrointestinal toxicities (OR = 10.02, 95%CI = 4.32 to 23.23), constipation (OR = 8.58, 95%CI = 3.20 to 23.00) and fatigue or asthenia (OR = 2.72, 95%CI = 1.30 to 5.67). No significant differences were seen with the development of acute leukemia (OR = 2.80, 95%CI = 0.42 to 18.81), hematologic cancer (OR = 2.07, 95%CI = 0.43 to 10.01), second primary tumors (OR = 3.45, 95%CI = 0.81 to 14.68), nor vertebral compression (OR = 0.18, 95%CI = 0.02 to 1.59).Early treatment delayed disease progression but increased the risk of gastrointestinal toxicities, constipation and fatigue or asthenia. The differences on vertebral compression, acute leukemia, hematological cancer and second primary tumors were not statistically significant. Based on the current evidence, early treatment didn't significantly affect mortality and response rate. However, further much larger trials were needed to provide more evidence. |
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| format | Article |
| id | doaj.art-18011cf11e094fc18035fb239aa45e51 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-12T23:54:35Z |
| publishDate | 2014-01-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj.art-18011cf11e094fc18035fb239aa45e512022-12-22T00:06:36ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-01910e10975810.1371/journal.pone.0109758Early versus deferred treatment for smoldering multiple myeloma: a meta-analysis of randomized, controlled trials.Minjie GaoGuang YangVan S TompkinsLu GaoXiaosong WuYi TaoXiaojing HuJun HouYing HanHongwei XuFenghuang ZhanJumei ShiWhether patients with smoldering multiple myeloma (SMM) needed to receive early interventional treatment remains controversial. Herein, we conducted a meta-analysis comparing the efficacy and safety of early treatment over deferred treatment for patients with SMM.MEDLINE and Cochrane Library were searched to May 2014 for randomized controlled trials (RCTs) that assessed the effect of early treatment over deferred treatment. Primary outcome measure was mortality, and secondary outcome measures were progression, response rate, and adverse events.Overall, 5 trials including 449 patients were identified. There was a markedly reduced risk of disease progression with early treatment (Odds Ratio [OR] = 0.13, 95% confidence interval [CI] = 0.07 to 0.24). There were no significant differences in mortality and response rate (OR = 0.85, 95% CI = 0.45 to 1.60, and OR = 0.63, 95% CI = 0.32 to 1.23, respectively). More patients in the early treatment arm experienced gastrointestinal toxicities (OR = 10.02, 95%CI = 4.32 to 23.23), constipation (OR = 8.58, 95%CI = 3.20 to 23.00) and fatigue or asthenia (OR = 2.72, 95%CI = 1.30 to 5.67). No significant differences were seen with the development of acute leukemia (OR = 2.80, 95%CI = 0.42 to 18.81), hematologic cancer (OR = 2.07, 95%CI = 0.43 to 10.01), second primary tumors (OR = 3.45, 95%CI = 0.81 to 14.68), nor vertebral compression (OR = 0.18, 95%CI = 0.02 to 1.59).Early treatment delayed disease progression but increased the risk of gastrointestinal toxicities, constipation and fatigue or asthenia. The differences on vertebral compression, acute leukemia, hematological cancer and second primary tumors were not statistically significant. Based on the current evidence, early treatment didn't significantly affect mortality and response rate. However, further much larger trials were needed to provide more evidence.http://europepmc.org/articles/PMC4184905?pdf=render |
| spellingShingle | Minjie Gao Guang Yang Van S Tompkins Lu Gao Xiaosong Wu Yi Tao Xiaojing Hu Jun Hou Ying Han Hongwei Xu Fenghuang Zhan Jumei Shi Early versus deferred treatment for smoldering multiple myeloma: a meta-analysis of randomized, controlled trials. PLoS ONE |
| title | Early versus deferred treatment for smoldering multiple myeloma: a meta-analysis of randomized, controlled trials. |
| title_full | Early versus deferred treatment for smoldering multiple myeloma: a meta-analysis of randomized, controlled trials. |
| title_fullStr | Early versus deferred treatment for smoldering multiple myeloma: a meta-analysis of randomized, controlled trials. |
| title_full_unstemmed | Early versus deferred treatment for smoldering multiple myeloma: a meta-analysis of randomized, controlled trials. |
| title_short | Early versus deferred treatment for smoldering multiple myeloma: a meta-analysis of randomized, controlled trials. |
| title_sort | early versus deferred treatment for smoldering multiple myeloma a meta analysis of randomized controlled trials |
| url | http://europepmc.org/articles/PMC4184905?pdf=render |
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