Triplet Regimen Found Most Effective for Relapsed/Refractory Multiple Myeloma

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Multiple Myeloma
Multiple Myeloma

A network meta-analysis (NMA) found the combination of daratumumab, lenalidomide, and dexamethasone may be the most effective regimen for patients with relapsed/refractory multiple myeloma (RRMM), a report in Cancer Management and Researchhas shown.

Outcomes for patients with multiple myeloma have improved significantly over the last almost 2 decades, mostly fueled by new agents. However, the complexity of refractory/relapsed multiple myeloma (RRMM) continues to challenge clinical management of the disease. Many randomized controlled trials (RCTs) have been conducted worldwide in an effort to meet this challenge. The results of the trials have been summarized into network meta-analysis (NMA) by 2 research groups; however, both NMAs have certain limitations.

In this study, researchers sought to perform an update NMA focusing on various efficacy outcome measures: nonresponse rate (NRR), time to progression (TTP), progression-free survival (PFS), and overall survival (OS). The researchers searched PubMed database, extended the literature search strategy of a previous NMA to June 30, 2017, and included additional primary RCTs. 

Regimens were ranked by calculating the surface under the cumulative ranking curve (SUCRA). The researchers applied a weighted averaging strategy to rank the regimens for overall efficacy. “The OS is the ‘gold standard' outcome measure for the evaluation of long-term anticancer efficacy, the PFS and TTP are widely acknowledged surrogates of OS, and the treatment response associated with early efficacy may differ from long-term outcomes,” the researchers reported. 

The updated NMA included 24 RCTs. It showed that the combination of daratumumab, lenalidomide, and dexamethasone had better NRR, TTP, and PFS than other regimens, but OS was better with the combination of ixazomib, lenalidomide, and dexamethasone. However, the former regimen ranked first in overall efficacy (weighted average of SUCRAs = 0.920).

In their conclusion, the researchers stated that triplet regimens consisting of daratumumab, ixazomib, carfilzomib, or elotumumab plus lenalidomide and dexamethasone can be recommended as first-line therapies for RRMM.


Luo XW, Du XQ, Li JL, L XP, Meng XY. Treatment options for refractory/relapsed multiple myeloma: an updated evidence synthesis by network meta-analysisCancer Manag Res.2018;10:2817-2823.

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