COMBINATION CHEMOTHERAPY VERSUS MELPHALAN AND PREDNISOLONE IN THE TREATMENT OF MULTIPLE-MYELOMA - AN OVERVIEW OF PUBLISHED TRIALS

Purpose: A meta-analysis was performed to compare survival after treatment with melphalan and prednisolone (M+P) with that after combination chemotherapy (CCT) in patients with multiple myeloma. Methods: Meta-analysis was performed on 18 published trials comprising 3,814 patients comparing M+P with CCT. Two-year survival percentages with observed and expected deaths at 2 years were calculated for each trial, and the overview methodology was applied to these figures. Results: Overall results from the 18 trials suggest that there is no difference in efficacy between the two treatments. This finding, however, masks a highly significant correlation between 2-year survival rates for M+P-treated patients in individual studies and the difference between the M+P and CCT 2-year survival rates for that study (r = .69; P = .0008). In separate overviews, those studies with a high M+P 2-year survival rate showed a survival difference in favor of M+P (P = .02), whereas those with a low rate suggested a difference in favor of CCT (P = .07). Comparison of the 2-year survival rates in the M+P treatment arms of each of the studies with available data showed an inverse correlation between survival and the proportion of patients with either poor performance status (P < .001) or immunoglobulin A (IgA) M band (P = .02). Conclusions: These results imply that M+P is superior for patients with an intrinsically good prognosis and inferior for those patients with a poor prognosis. If reliable prognostic factors can be established for this disease, they could be used to select therapy for individual patients.