| Background Multiple myeloma(MM) is derived from plasma cells malignant hyperpl astic diseases,It secretes monoclonal immunoglobulin or its fragment(M protein),damages related organs and tissues,and its common clinical symptoms are anemia, renal insufficien cy, infection and bone destruction, etc.The morbidity of MM can be accounted for 10% of blood cancer,especially in the old.In China,the median onset age was 56 years old,and the natural course for MM is 6~12 months. Once acceptted the traditional chemotherapy,the median survival time is only 2.5~3 years.The end of last century, hematopoietic stem cell transplantation is recommended by a lot of guidelines as a kind of first-line approac h for MM treatment.The Allo-geneic hematopoietic stem cell transplantation has possiblely t o cure this disease.However,allo-HSCT is only suitable for age<55 patients with HLA ma tching, and has a high transplant related mortality and graft-versus-host disease.It may li mits the clinical application widely.The autologous hematopoietic stem cell transplantation also can increase the response rate, complete response rate, no event survival and overall surv ival, but it can not avoid long-term recurrence after transplantation.In recent years, with the immunomodulator and proteasome inhibitor,such as thalidomide, lenalidomide an d bortezomib has applied to teratment,the response rate and complete response rate has i ncreased.At the same time, ASCT also faced a challenge.So far,several clinical randomized controlled studies on the efficacy and security amo ng ASCT,traditional chemotherapy and new drugs has compared both at home and abroa d.ASCT curative effect is significantly higher than traditional chemotherapy has been con firmed,but new drugs with induction and maintenance therapy has been a kind of tenden cy.So whether needing ASCT and the transplanted period have become a focus of contr o versy.Considering a single research has a small sample size and large clinical heterogen ei ty,it lack of effective statistical efficiency.Therefore, we use Meta analysis method.Readi n g and screening of ASCT and new drugs for the treatment of multiple myeloma relate d with 7 references.The cumulative cases of ASCT(transplantation group) and targeted dru g s of treatment group are 183 and 208 respectively.Objective To explore the efficacy and safety between autologous hematopoietic stem cell transplantation and targeted new drugs on the treatment of multiple myeloma by perf orming a meta-analysis based on published articles.Methods Systematic electronic searches of Pub Med,EMBase,Chinese Biomedical Data base, web of science,CNKI,VIP and Wan-Fang Data until December 2013 were performe d to idetify the published epidemiological studies on ASCT on the treatment of multiple myeloma.Strict inclusion and exclusion criteria were determined before data analse-s.Using the key words: Multiple myeloma,Autologous hematopoietic stem cell transplantation,ASC T,proteasome inhibitor,protease inhibitor,immunomodulator,immunorugular,immunomodifier, Bortezomib,Tha Kdomide,Lenalidomide,clinical trials.Finally,there were 7 literatures Include d.Themeta-analysis was conducted using Rev Man5.0 software.Software was used for meta analysis. The quantitative analysis indexes include complete response/very good partial re sponse(CR/VGPR),1 year progression free survival(PFS) rate,1 year overall survival(OS) r ate,Bone marrow toxicity reaction rate,Level III ~ IV infection rate,gastrointestinal reactio n rate and peripheral neuropathy rate. Firstly,statistical heterogeneity analysis was conduct ed to examine the effect size with Chi-square test to determine I2.I2 measures the share o f heterogeneity in the effect size, if I2<50%,it means that there was no heterogeneity,a fix e d effect model should be chosen infollowing analysis;otherwise,when I2>50%, it means t h at there is heterogenei-ty, a random effects model should be chosed.The publication biasis evaluated by funnel plot, relative risk is described by odds ratio(OR) and 95% conf i dence interval(95%CI).Results 1.The comparisons between two groups of complete response rate/very good partial response:significant differences were found[OR=2.30,95%CI(1.47,3.53),P=0.0002]and CR/VGPR rate for the treatment of MM to ASCT group was obviously highe r than that of new drugs treatment;2.The comparisons between two groups of 1 year PF S rate:no differences were found[OR=2.00,95%CI(1.10,3.65),P=0.02];3.The co mparisons between two groups of 1 year OS rate:no differences were found[OR=2.24,95%CI(1.07,4.69),P=0.03];4.The comparisons between two groups of safety:significa nt differences were found in Bone marrow toxicity reaction rate[OR=3.02,95%CI(1.97,4.62),P<0.00001]and ASCT group was higher than that of new drugs treatment;there are significant differences were found in Level III ~ IV infection rate[OR=2.04,95%CI(1.24,3.35),P=0.005]and ASCT group was higher than that of new drugs treatment; there are significant differences were found in gastrointestinal reaction rate[OR=0.40,95%CI(0.22,0.72),P=0.002]and new drugs treatment was higher than that of ASCT gro up;there are significant differences were found in peripheral neuropathy rate[OR=0.14,9 5%CI(0.07,0.29),P<0.00001]and new drugs treatment was higher than that of ASC T group.Conclusion 1.The CR/VGPR rate for the treatment of MM to ASCT group was obviously higher than that of new drugs treatment by meta-analysis;2.The 1 year PFS rate for the treatment of MM to ASCT group was no significantly improvement compared with that of new drugs treat ment by meta-analysis;3.The 1 year OS rate for the treatment of MM to ASCT group was no significantly improvement compared with that of new drugs treatment by meta-analysis; 4.By meta-analysis,ASCT group was higher than that of new drugs treatment in Bone marrow toxicity reaction rate and Level III ~ IV infection rate,but was lower in gastrointestinal reaction rate and peripheral neuropathy rate;5.The curative effect of autologous hematopoietic stem cell transplan tation in the treatment of multiple myeloma and is higher than that of new drugs therapy,but ther e was no difference in safety. |
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