The treatment landscape for transplant-eligible patients with newly diagnosed multiple myeloma (TE-NDMM) has evolved with the introduction of daratumumab-based quadruplet regimens. Adding daratumumab to traditional triplet regimens has demonstrated improved response rates and progression-free survival (PFS). However, the impact on long-term outcomes, particularly overall survival (OS), remains uncertain. This systematic review and meta-analysis aimed to compare the survival outcomes of these quadruplet regimens with triplets. Conducted in adherence to Cochrane Collaboration and PRISMA guidelines and registered on PROSPERO (CRD42024571946), the study involved searching PubMed, Embase, and Cochrane databases, from inception to June 2024. We included randomized clinical trials (RCT) and non-randomized controlled studies (NRCS) that compared daratumumab-based quadruplet regimens to triplets, focusing on OS and PFS, with a minimum follow-up of 18 months. The meta-analysis included 3327 TE-NDMM patients from four studies, comprising three RCT and one NRCS. Daratumumab-based regimens were administered to 1328 (40%) patients. The analysis revealed that daratumumab-based quadruplet regimens significantly improved both OS (pooled HR 0.60; 95% CI 0.48–0.75; P < 0.00001; I² = 0%) and PFS (pooled HR 0.49; 95% CI 0.37–0.65; P < 0.00001; I² = 52%). A per-protocol subgroup analysis comparing D-VRD to VRD further confirmed these benefits, with significant improvements in both OS (pooled HR 0.68; 95% CI 0.48–0.97; P = 0.03; I² = 0%) and PFS (pooled HR 0.41; 95% CI 0.31–0.54; P < 0.00001; I² = 0%). This meta-analysis consolidates evidence that daratumumab-based quadruplet regimens significantly improve OS, compared to triplet regimens for TE-NDMM patients.
适合移植的新诊断多发性骨髓瘤（TE-NDMM）患者的治疗格局随着基于达雷妥尤单抗的四药联合方案的应用而不断发展。在传统三药方案基础上加用达雷妥尤单抗已被证明可提高缓解率并延长无进展生存期（PFS），但其对长期结局尤其是总生存期（OS）的影响仍不确定。本系统综述和荟萃分析旨在比较这些四药方案与三药方案的生存结局。研究遵循Cochrane协作网和PRISMA指南，并在PROSPERO注册（CRD42024571946），检索了自建库至2024年6月的PubMed、Embase和Cochrane数据库。我们纳入了比较基于达雷妥尤单抗的四药方案与三药方案的随机临床试验（RCT）和非随机对照研究（NRCS），主要关注OS和PFS，且随访时间至少18个月。荟萃分析共纳入4项研究的3327例TE-NDMM患者，包括3项RCT和1项NRCS。其中1328例（40%）患者接受了基于达雷妥尤单抗的方案。分析显示，基于达雷妥尤单抗的四药方案显著改善了OS（汇总HR 0.60；95% CI 0.48–0.75；P < 0.00001；I² = 0%）和PFS（汇总HR 0.49；95% CI 0.37–0.65；P < 0.00001；I² = 52%）。一项比较D-VRD与VRD的方案集亚组分析进一步证实了这些获益，OS（汇总HR 0.68；95% CI 0.48–0.97；P = 0.03；I² = 0%）和PFS（汇总HR 0.41；95% CI 0.31–0.54；P < 0.00001；I² = 0%）均有显著改善。本荟萃分析证实，对于TE-NDMM患者，基于达雷妥尤单抗的四药方案相较于三药方案能显著改善总生存期。
肿瘤(癌症)患者之家