Evaluation of bortezomib and dexamethasone-based treatment in patients with multiple myeloma : a meta-analysis

Multiple myeloma (MM) is the second most frequent hematologic malignancy, and the evaluations of standard therapeutic effects were inconsistent. The study was aimed to provide a comprehensive assessment of bortezomib-cyclophosphamide-dexamethasone (VCD), bortezomib-thalidomide-dexamethasone (VTD) and VTDC (VTD plus cyclophosphamide) regimens for the MM management. Electronic databases such as PubMed, EMBASE and Cochrane were retrieved from their inception to April, 2015. Eligible studies were selected with predefined criteria. Four main outcomes as ORR (overall response rate), CR (complete response), VGPR (very good partial response) and PR (partial response); and the adverse effects were evaluated, basing on the Cochran Q and I2 test. The independent-samples T test was used. Statistical analysis was performed using STATA and SPSS. A set of 11 studies were identified for the meta-analysis. All the regimens achieved a higher response on the newly diagnosed MM than the relapsed MM. VCD and VTD had a comparable efficiency on the ORR, VGPR and PR. However, VTD had a pronounced higher CR than VCD on the newly diagnosed MM patients (P < 0.05). VTDC achieved an increase CR (0.46 vs. 0.082 or 0.326) but a decreased risk of thrombocytopenia (0.06 vs. 0.11 or 0.083) than either VCD or VTD for the newly diagnosed MM. Besides, no difference between VCD and VTD was observed in terms of the toxicity tolerance (P < 0.05). For newly diagnosed MM patients, VTD was comparable with VCD in terms of ORR, VGPR and PR, but superior to VCD in CR.