Allogeneic Stem Cell Transplantation For Newly Diagnosed Multiple Myeloma: Cochrane Systematic Review

Background：Multiple myeloma (MM) is a malignant proliferative disease which account for about15%of hematological malignancies, and the incidence of MM is just lower than lymphoma.MM is considered an incurable disease. Chemotherapy and autologous hematopoietic stemcell transplantation (ASCT) have played an important role in the management of MM. Ithas made great progress in the treatment of MM with emergence of new drug. Due to thegraft versus myeloma (GVM), allogeneic hematopoietic stem cell transplantation (alloSCT)is considered to have the potential to cure MM. However, it is highly controversial chosenalloSCT as the scheme selection for the treatment of MM due to its high treatment-relatedmortality (TRM). In recent years, some clinical studies compared the effect of alloSCT withautologoushematopoietic stem cell transplantation (ASCT). But the question of whetheralloSCT is better than ASCT is still unknown. This study aim to compare the efficacy andsafety of alloSCT and ASCT in patients with newly diagnosed MM by CochraneMeta-analysis, to provide the evidence of alloSCT in the treatment of MM in clinicalapplication.Objective:To compare the efficacy and safety of alloSCT and ASCT in patients with newlydiagnosed MM by Cochrane Meta-analysis.Methods:We searched The Cochrane Library, Medline, Embase, CBM, CNKI, VIP, WanfangData to collect literatures which compareing alloSCT with ASCT in patients with newlydiagnosed MM and assigned participants according to Mendelian randomization. We adoptoverall survival (OS), progression-free survival (PFS), complete remission (CR) rate,treatment-related mortality (TRM) as result indicators and analyed data with Cochranereview manager software5.1(Rev Man5.1). Results:Six eligible studies including1961cases subjects were included in our study,626cases were assigned to alloSCT group and1335cases were assigned to ASCT group. All theincluded trials aimed to evaluate the efficacy of ASCT followed by non-myeloablativealloSCT (ASCT-alloSCT) versus signle or tandem ASCT in patients with multiple myeloma.So far, we have not found any prospective trials which compare single alloSCT with singleASCT based on the absence or presence of matched sibling donor. Meta-analysis of all ofthese trials showed that there were no statistically significant difference between alloSCTgroup and ASCT group on OS [HR=1.06，95%CI(0.78，1.44)] and PFS [HR=0.92，95%CI(0.76，1.11)]. However, it is showed a statistically significant difference of CR[RR=1.29，95%CI(1.13，1.48)]and TRM [RR=3.40，95%CI(2.27，5.07)] in favor of alloSCTgroup.Conclusions:Our Cochrane Meta-analysis showed that alloSCT did not improve OS and EFS inpatients with MM. AlloSCT group had higher CR than ASCT group, but the TRM is alsohigher in patients who received alloSCT than ASCT at the same time. Onthe basis of available evidence, alloSCT is not considered as the front-line standardtreatment for MM. As substantial heterogeneity and a few studies prevent us from drawinga robust conclusions which need to be validated by further studies.