- (1) a Division of Haematology/Oncology, University Hospital Tubingen, University of Tübingen , Tübingen , Germany.
- (2) b CHU UcL Namur , Yvoir , Belgium.
- (3) National and Kapodistrian University of Athens, grid.5216.0
- (4) BC Cancer Agency, grid.248762.d
- (5) Hospital Universitario 12 De Octubre, grid.144756.5
- (6) f EVIDERA , Lexington , MA , USA.
- (7) g Redwood Outcomes , Vancouver , Canada.
- (8) Odense University Hospital, grid.7143.1, Southern Denmark Region
- (9) i Peking University Institute of Hematology, People's Hospital , Beijing , China.
- (10) j AZ Sint-Jan AV Brugge , Brugge , Belgium.
- (11) Hospitais da Universidade de Coimbra, grid.28911.33
- (12) l Chiara Dip. Oncologia , A.O. Universitaria Ospedale S , Pisa , Italy.
- (13) m Centre Hospitalier William Morey , Chalon , France.
- (14) Centre Jean Bernard, grid.477089.5
- (15) Hôpital Claude Huriez, grid.413875.c
In newly diagnosed multiple myeloma (MM), patients ineligible for front-line autologous stem cell transplantation (ASCT), melphalan and prednisone (MP) with thalidomide (MPT) or bortezomib (VMP) are standard first-line therapeutic options. Despite new treatment regimens incorporating bortezomib or lenalidomide, MM remains incurable. The FIRST study demonstrated significant improvement in progression-free survival (PFS) and overall survival (OS) for the combination of lenalidomide and low-dose dexamethasone (Rd) until progression vs. MPT in transplant-ineligible ndMM patients. However, to date no head-to-head randomized controlled trials (RCTs) have compared Rd or MPT versus VMP. We conducted a network meta-analysis using RCTs identified through a systematic literature review to evaluate the relative efficacy of Rd versus other regimens on survival endpoints in previously untreated MM patients ineligible for ASCT. In this analysis, Rd was associated with a significant PFS and survival advantage versus other first-line treatments (VMP, MPT, MP), challenging the role of alkylators in this setting.