The Efficacy And Safety Of CAR-T For Relapsed Or Refractory Multiple Myeloma: A Systematic Review And Meta-analysis

Objective: To systematically evaluate the effectiveness and safety of chimeric antigen receptor T cell(CAR-T)therapy in the treatment of multiple myeloma.Methods: Pub Med,The Cochrane Library,Embase,CNKI,Wanfang and other databases were searched to collect clinical trial literatures on CAR-T treatment of multiple myeloma.The literature search time is set from the date of databases inception to December 2020.Two researchers independently screened the literature according to the literature inclusion and exclusion criteria set in this study,evaluated the quality of the included literature and extracted data.Meta-analysis of the effectiveness and safety of CAR-T in the treatmentof multiple myeloma was carriedout using Stata ver.12.0 software.Results: Through literature screening,a total of 6 literatures met the inclusion criteria of this study,all of which were articles about CAR-T treatment of relapsed or refractory multiple myeloma.In terms of effectiveness,CAR-T therapy in the treatment of relapsed or refractory multiple myeloma showed that ORR(including PR,VGPR,CR,SCR)was 89%(95%CI: 84%-94%),response rate above PR(Including VGPR,CR,SCR)was 78%(95% CI: 72%-84%),CR + SCR was 54%(95% CI: 34%-74%);MRD negative rate was 69%(95% CI : 56%-83%).Interms of safety,the incidence of CRS was 89%(95%CI: 82%-97%),andthe incidence of CRS of grade 1-2was 74%(95% CI:64%-84%);The incidence of CRS of grade 3 or higher was12%(95% CI: 4%-21%).The incidence of grade 3 or higher neutropenia was66%(95% CI:43%-89%),and the incidence of grade 3 or higher anemia was47%(95% CI:22%-73%),the incidence of grade 3 or higher thrombocytopenia was 41%(95% CI:25%-57%).Conclusions:1.For patients with relapsed or refractory multiple myeloma,CAR-T cell therapy is an effective treatment plan.2.CAR-T therapy in the treatment of relapsed or refractory multiple myeloma has a high quality of remission,CR+SCR is better than other traditional treatments.3.The patients are well tolerated to CAR-T cell therapy relatively.The main adverse reaction is CRS,but it is concentrated in grade 1-2,and the outcome is good after treatment.Some serious adverse reactions exist,and they can even be life-threatening.They need to be carefully prevented and dealt with early.