Efficacy of maintenance or consolidation therapy for multiple myeloma based on proteasome inhibitors: a meta-analysis

This study assessed the efficacy of proteasome inhibitors (PIs) in both maintenance and consolidation therapies for MM patients.

A comprehensive search across multiple databases was conducted, including PubMed, Science Direct, Google Scholar, CNKI, EMBASE, Web of Science, MEDLINE, Cochrane Library, and others, to identify randomized controlled trials published in both Chinese and English languages that examined the use of PIs in either consolidation or maintenance therapy for multiple myeloma. The effectiveness outcomes assessed included complete response (CR), very good partial response or better (≥ VGPR), partial response (PR), progression-free survival (PFS), and overall survival (OS).

Our analysis comprised four (4) randomized controlled trials investigating maintenance therapy and six (6) randomized controlled trials assessing consolidation therapy, including data from 4711 patients. PIS-based treatments significantly improved PFS and OS compared to the control group. PI-based consolidation therapy significantly prolonged PFS. In maintenance therapy, both PIs improved PFS and OS relative to the observation group. PIs significantly improved the achievements of CR in patients compared to the control group. CR attainment in maintenance therapy appeared slightly less effective than in consolidation therapy. PIs significantly improved ≥ VGPR in patients compared to the control group. Consolidation therapy demonstrated a greater improvement in ≥ VGPR compared to maintenance therapy.

Treatment with PI-based maintenance or consolidation therapy showed improvements in CR,  ≥ VGPR, PFS, and OS in patients with MM. However, it is noteworthy that PIs-based maintenance and consolidation therapy were associated with an increased risk of  ≥ grade 3 adverse events.