TL16: Comparing efficacy and survivals of initial treatments for elderly patients with newly diagnosed multiple myeloma: A Bayesian network meta-analysis of randomized controlled trials
*Colin K He, Orient Health Care 

Keywords: multiple myeloma, newly diagnosed, elderly patients, initial therapies, Bayesian network meta-analysis.

The efficacy and clinical outcome of initial therapies for elderly patients with multiple myeloma (MM) were evaluated by Bayesian network meta-analysis (NMA) using R package and OpenBugs. Randomized controlled trials (RCTs) were obtained through a comprehensive search. Response rate (RR), progression-free survival (PFS) and overall survival (OS) were the interested outcomes. The series of Bayesian network meta-analysis models were constructed. The consistency, sensitivity, rank probability and surface under the cumulative ranking curve (SUCRA) plot were carried out. Seventeen randomized controlled trials containing 7402 participants and 15 treatments were included in the network meta-analysis. As compared to the classical melphalan plus prednisone (MP) regimen, the majority of other initial regimens showed higher rates of complete response/near complete response (CR/nCR), overall response rate (ORR) and better progression-free survival as well as overall survival. These four outcomes favored the two lenalidomide plus dexamethasone regimens (continuous lenalidomide and 18 cycles of lenalidomide plus dexamethasone), especially continuous lenalidomide plus dexamethasone regimen, over the majority of other regimens including the two established standard treatments (MP plus thalidomide or bortezomib) for elderly patients with newly multiple myeloma diagnosed. Our indirect comparisons suggested that continuous lenalidomide plus dexamethasone showed superiority compared with MPT (melphalan plus prednisone and thalidomide) (RRCR/nCR=1.55, 95% CI:1.31-1.82; RRORR=1.21, 95% CI: 1.11-1.31; HROS=0.78, 95% CI: 0.64-0.96) and bortezomib plus melphalan and prednisone (RRORR=0.79, 95% CI: 0.61-1.01; HROS=1.41, 95% CI: 0.95-2.09). The similar trend could be found when comparing Ld 18 cycles with melphalan plus prednisone and thalidomide(MPT) (RRCR/nCR=0.66, 95% CI: 0.56-0.78; RRORR=0.85, 95% CI: 0.58-0.72; HROS=1.14, 95% CI: 0.94-1.39) and bortezomib plus melphalan and prednisone ((RRCR/nCR=1.39, 95% CI: 0.74-2.58; RRORR=1.27, 95% CI: 0.99-1.63; HROS=0.71, 95% CI: 0.48-1.05). For the outcomes CR/nCR, ORR, and OS, no significant difference could be found between Ld 18 cycles and 18 continuous, whereas Ld continuous had better PFS than Ld 18 cycles (HR=0.70, 95% CI:0.48-1.08) , which was confirmed by a previous clinical trial. Continuous lenalidomde plus dexamethasone ranked as the best regimen in terms of CR/nCR, ORR and OS for the treatment of elderly patients with newly diagnosed multiple myeloma.