Non-myeloablative Stem Cell Transplantation in the Treatment of Multiple Myeloma after First Autologous Stem Cell Transplantation: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 TANYa , XUShuang-nian , LIXi ,  CHENJie-ping

Center for Hematology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China;

Corresponding author：

CHENJie-ping, Email: chenjpxn@163.com

Keywords：

Non-myeloablative stem cell transplantation; Allogeneic stem cell transplantation; Multiple myeloma; Meta-analysis; Systematic review

DOI：

10.7507/1672-2531.20140053

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the efficacy and safety of non-myeloablative stem cell transplantation (NST) for the treatment of multiple myeloma (MM) after first autologous stem cell transplantation. Methods Such databases as The Cochrane Library (Issue 5, 2013), PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were electronically searched to collect studies investigated the efficacy and safety of NST and non-NST for the treatment of MM after first autologous stem cell transplantation from the date of their establishment to June 13^th 2013. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.1 software. Results Seven studies involving 1 961 participants were included, of which 626 cases were in the NST group and 1 335 cases were in the non-NST group. The results of meta-analysis showed that no significant difference was found between both groups in the overall survival rate (HR=1.06, 95%CI 0.78 to 1.44, P=0.69) and progress-free survival rate (HR=0.92, 95%CI 0.76 to 1.11, P=0.39). However, there were significant differences in the complete remission rate (RR=1.29, 95%CI 1.13 to 1.48, P=0.000 2) and treatment-related mortality rate (RR=3.40, 95%CI 2.27 to 5.07, P < 0.000 01). Conclusion The efficacy of NST is not superior to non-NST for patients with MM which has received first autologous stem cell transplantation. It is not sufficient to recommend NST as the first-line treatment of MM based on the currently available evidence.

Citation： TANYa, XUShuang-nian, LIXi, CHENJie-ping. Non-myeloablative Stem Cell Transplantation in the Treatment of Multiple Myeloma after First Autologous Stem Cell Transplantation: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2014, 14(3): 306-311. doi: 10.7507/1672-2531.20140053 Copy

1.	Palumbo A, Anderson K. Multiple myeloma. N Engl J Med, 2011, 364(11):1046-1060.
2.	Rajkumar SV. Multiple myeloma:2012 update on diagnosis, riskstratification, and management. Am J Hematol, 2012, 87(1):78-88.
3.	Rajkumar SV, Gahrton G, Bergsagel PL. Approach to the treatment of multiple myeloma:A clash of philosophies. Blood, 2011, 118(12):3205-3211.
4.	Kyle RA, Gertz MA, Witzig TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clinic Proc, 2003, 78(1):21-33.
5.	王欢, 哈力达·亚森, 吴泰相.来那度胺联合地塞米松治疗复发难治性多发性骨髓瘤的系统评价.中国循证医学杂志, 2011, 11(2):187-194.
6.	Arora M, McGlave PB, Burns LJ, et al. Results of autologous and allogeneic hematopoietic cell transplant therapy for multiple myeloma. Bone Marrow Transpl, 2005, 35(12):1133-1140.
7.	Kuruvilla J, Shepherd JD, Sutherland HJ, et al. Long-term outcome of myeloablative allogeneic stem cell transplantation for multiple myeloma. Biol Blood Marrow Tr, 2007, 13(8):925-931.
8.	Nishihori T, Alsina M. Advances in the autologous and allogeneic transplantation strategies for multiple myeloma. Cancer Control, 2011, 18(4):258-267.
9.	Wheatley K, Gray R. Commentary:Mendelian randomization——an update on its use to evaluate allogeneic stem cell transplantation in leukaemia. Int J Epidemiol, 2004, 33(1):15-17.
10.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
11.	Tierney JF, Stewart LA, Ghersi D, et al. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials, 2007, 8(7):1-16.
12.	Krishnan A, Pasquini MC, Logan B, et al. Autologous haemopoietic stem-cell transplantation followed by allogeneic or autologous haemopoietic stem-cell transplantation in patients with multiple myeloma(BMT CTN 0102):A phase 3 biological assignment trial. Lancet Oncol, 2011, 12(13):1195-1203.
13.	Lokhorst HM, Holt B, Cornelissen JJ, et al. Donor versus no-donor comparison of newly diagnosed myeloma patients included in the HOVON-50 multiple myeloma study. Blood, 2012, 119(26):6219-6225.
14.	Garban F, Attal M, Michallet M, et al. Prospective comparison of autologous stem cell transplantation followed by dose-reduced allograft(IFM99-03 trial) with tandem autologous stem cell transplantation(IFM99-04 trial) in high-risk de novo multiple myeloma. Blood, 2006, 107(9):3474-3480.
15.	Giaccone L, Storer B, Patriarca F, et al. Long-term follow-up of a comparison of nonmyeloablative allografting with autografting for newly diagnosed myeloma. Blood, 2011, 117(24):6721-6727.
16.	Bjorkstrand B, Iacobelli S, Hegenbart U, et al. Tandem autologous/reduced-intensity conditioning allogeneic stem-cell transplantation versus autologous transplantation in myeloma:Long-term followup. J Clin Oncol, 2011, 29(22):3016-3022.
17.	Rosinol L, Perez-Simon JA, Sureda A, et al. A prospective PETHEMA study of tandem autologous transplantation versus autograft followed by reduced-intensity conditioning allogeneic transplantation in newly diagnosed multiple myeloma. Blood, 2008, 112(9):3591-3593.
18.	Blade J, Rosinol L, Cibeira MT, et al. Hematopoietic stem cell transplantation for multiple myeloma beyond 2010. Blood, 2010, 115(18):3655-3663.
19.	Schots, R. Recent advances in myeloma treatment. Transfus Apher Sci, 2011, 44(2):223-229.
20.	Servais S, Baron F, Beguin Y. Allogeneic hematopoietic stem cell transplantation(HSCT) after reduced intensity conditioning. Transfus Apher Sci, 2011, 44(2):205-210.
21.	Nivison SI, Dodds AJ, Doocey R. Allogeneic hematopoietic cell transplant for multiple myeloma using reduced intensity conditioning therapy, 1998-2006:factors associated with improved survival outcome. Leukemia Lymphoma, 2011, 52(9):1727-1735.
22.	Salit RB, Bishop MR. Reduced-intensity allogeneic hematopoietic stem cell transplantation for multiple myeloma:a concise review. Clin Lymphoma Myelom, 2011, 11(3):247-252.
23.	单志桂, 杨新玲, 姚亚妮.如何运用系统评价结果进行临床实践.中国循证医学杂志, 2012, 12(3):357-359.

1. Palumbo A, Anderson K. Multiple myeloma. N Engl J Med, 2011, 364(11):1046-1060.
2. Rajkumar SV. Multiple myeloma:2012 update on diagnosis, riskstratification, and management. Am J Hematol, 2012, 87(1):78-88.
3. Rajkumar SV, Gahrton G, Bergsagel PL. Approach to the treatment of multiple myeloma:A clash of philosophies. Blood, 2011, 118(12):3205-3211.
4. Kyle RA, Gertz MA, Witzig TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clinic Proc, 2003, 78(1):21-33.
5. 王欢, 哈力达·亚森, 吴泰相.来那度胺联合地塞米松治疗复发难治性多发性骨髓瘤的系统评价.中国循证医学杂志, 2011, 11(2):187-194.
6. Arora M, McGlave PB, Burns LJ, et al. Results of autologous and allogeneic hematopoietic cell transplant therapy for multiple myeloma. Bone Marrow Transpl, 2005, 35(12):1133-1140.
7. Kuruvilla J, Shepherd JD, Sutherland HJ, et al. Long-term outcome of myeloablative allogeneic stem cell transplantation for multiple myeloma. Biol Blood Marrow Tr, 2007, 13(8):925-931.
8. Nishihori T, Alsina M. Advances in the autologous and allogeneic transplantation strategies for multiple myeloma. Cancer Control, 2011, 18(4):258-267.
9. Wheatley K, Gray R. Commentary:Mendelian randomization——an update on its use to evaluate allogeneic stem cell transplantation in leukaemia. Int J Epidemiol, 2004, 33(1):15-17.
10. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
11. Tierney JF, Stewart LA, Ghersi D, et al. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials, 2007, 8(7):1-16.
12. Krishnan A, Pasquini MC, Logan B, et al. Autologous haemopoietic stem-cell transplantation followed by allogeneic or autologous haemopoietic stem-cell transplantation in patients with multiple myeloma(BMT CTN 0102):A phase 3 biological assignment trial. Lancet Oncol, 2011, 12(13):1195-1203.
13. Lokhorst HM, Holt B, Cornelissen JJ, et al. Donor versus no-donor comparison of newly diagnosed myeloma patients included in the HOVON-50 multiple myeloma study. Blood, 2012, 119(26):6219-6225.
14. Garban F, Attal M, Michallet M, et al. Prospective comparison of autologous stem cell transplantation followed by dose-reduced allograft(IFM99-03 trial) with tandem autologous stem cell transplantation(IFM99-04 trial) in high-risk de novo multiple myeloma. Blood, 2006, 107(9):3474-3480.
15. Giaccone L, Storer B, Patriarca F, et al. Long-term follow-up of a comparison of nonmyeloablative allografting with autografting for newly diagnosed myeloma. Blood, 2011, 117(24):6721-6727.
16. Bjorkstrand B, Iacobelli S, Hegenbart U, et al. Tandem autologous/reduced-intensity conditioning allogeneic stem-cell transplantation versus autologous transplantation in myeloma:Long-term followup. J Clin Oncol, 2011, 29(22):3016-3022.
17. Rosinol L, Perez-Simon JA, Sureda A, et al. A prospective PETHEMA study of tandem autologous transplantation versus autograft followed by reduced-intensity conditioning allogeneic transplantation in newly diagnosed multiple myeloma. Blood, 2008, 112(9):3591-3593.
18. Blade J, Rosinol L, Cibeira MT, et al. Hematopoietic stem cell transplantation for multiple myeloma beyond 2010. Blood, 2010, 115(18):3655-3663.
19. Schots, R. Recent advances in myeloma treatment. Transfus Apher Sci, 2011, 44(2):223-229.
20. Servais S, Baron F, Beguin Y. Allogeneic hematopoietic stem cell transplantation(HSCT) after reduced intensity conditioning. Transfus Apher Sci, 2011, 44(2):205-210.
21. Nivison SI, Dodds AJ, Doocey R. Allogeneic hematopoietic cell transplant for multiple myeloma using reduced intensity conditioning therapy, 1998-2006:factors associated with improved survival outcome. Leukemia Lymphoma, 2011, 52(9):1727-1735.
22. Salit RB, Bishop MR. Reduced-intensity allogeneic hematopoietic stem cell transplantation for multiple myeloma:a concise review. Clin Lymphoma Myelom, 2011, 11(3):247-252.
23. 单志桂, 杨新玲, 姚亚妮.如何运用系统评价结果进行临床实践.中国循证医学杂志, 2012, 12(3):357-359.

Chinese Journal of Evidence-Based Medicine

Non-myeloablative Stem Cell Transplantation in the Treatment of Multiple Myeloma after First Autologous Stem Cell Transplantation: A Systematic Review

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content