■即使取得了重大进展,多发性骨髓瘤(MM)的治疗仍然困难。目前,主要治疗方法包括干细胞移植联合治疗,药物治疗,等。随着MM分子生物学机制的阐明,以及对骨髓瘤细胞内部信号和MM患者微环境的深入研究,越来越多的针对骨髓瘤和微环境的新药逐渐用于临床维持治疗,如抑制蛋白体:ixazomib,硼替佐米和卡非佐米,免疫调节剂:沙利度胺和来那度胺,单克隆抗体,等。在MM保养处理方面取得了很大的进步。随着蛋白酶体抑制剂维持治疗在MM中的不断发展,该疾病的预后得到了明显改善。我们的目的是评估蛋白酶体抑制剂在多发性骨髓瘤维持治疗中的有效性和不良反应。为临床用药提供新思路。
■计算机检索了四个数据库,其中包含有关蛋白酶体抑制剂在多发性骨髓瘤维持治疗中的有效性和安全性的随机对照研究。一旦对文献质量进行了全面评估,通过RevMan5.3软件运行数据。
■最终,本系统综述增加了8项研究。与安慰剂组相比,蛋白酶体抑制剂在多发性骨髓瘤患者的维持治疗中具有延长的生存期而无进展和整体存在。5项研究报道了治疗组与安慰剂组相比多发性骨髓瘤的周围神经病变,显著高于安慰剂组(OR:1.98;95%Cl:1.35,2.92;P<0.001),严重不良事件(OR:1.60;95%Cl:1.19,2.14;P<0.01),皮疹(OR:2.23;95%Cl:1.62,3.05;P<0.001)和呕吐(OR:5.12;95%Cl:3.36,7.80;P<0.001)。治疗组的严重不良事件明显高于未治疗组(OR:1.60;95%Cl:1.19,2.14;P<0.01)。
■研究结果表明,与安慰剂组相比,蛋白酶体抑制剂在多发性骨髓瘤维持治疗中有效。硼替佐米在延长PFS方面具有一定的优势,在疗效方面依次为艾沙佐米和卡非佐米。硼替佐姆在扩展OS方面可能优于卡菲佐姆。然而,蛋白酶体抑制剂引起的不良反应,如周围神经病变,严重不良事件,皮疹,呕吐,等。,应该给予足够的重视。
UNASSIGNED: Even with significant advancements, treating multiple myeloma (MM) remains difficult. At present, the main treatment methods include combined treatment of stem cell transplantation, drug treatment, etc. With the clarification of the molecular biological mechanism of MM, as well as the in-depth study of the internal signal of myeloma cells and the microenvironment of MM patients, more and more new drugs targeting myeloma and microenvironment are gradually used in clinical maintenance treatment, such as inhibit the proteosome: ixazomib, bortezomib and carfilzomib, immune - modulators: thalidomide and lenalidomide, monoclonal antibodies, etc. have made great progress in MM maintenance treatment. With the continuous development of proteasome inhibitor maintenance treatment in MM, the prognosis of the disease has been significantly improved. Our aim is to evaluate the effectiveness and adverse reactions of proteasome inhibitors in maintenance therapy for multiple myeloma, providing new ideas for clinical medication.
UNASSIGNED: Four databases containing randomized controlled studies on the effectiveness and safety of proteasome inhibitors in the maintenance therapy of multiple myeloma are retrieved by the computer. Once the quality of the literature has been thoroughly evaluated, run the data via the RevMan 5.3 software.
UNASSIGNED: Eventually 8 studies were added in this systematic review. Compared with the placebo group, proteasome inhibitor in maintenance treatment of multiple myeloma patients with prolonged the survival without progression and overall existence. 5 studies reported the peripheral neuropathy of multiple myeloma in the treatment group compared to placebo group, which was remarkably greater (OR: 1.98; 95 % Cl: 1.35, 2.92; P < 0.001) compared to placebo group, Serious adverse events (OR: 1.60; 95 % Cl: 1.19, 2.14; P < 0.01), Rash (OR: 2.23; 95 % Cl: 1.62, 3.05; P < 0.001) and Vomiting (OR: 5.12; 95 % Cl: 3.36, 7.80; P < 0.001). The Serious adverse events of the treatment group were remarkably greater compared with the untreated group (OR: 1.60; 95 % Cl: 1.19, 2.14; P < 0.01).
UNASSIGNED: The study results proposed that proteasome inhibitors are effective in the multiple myeloma maintenance treatment compared with the placebo group. Bortezomib has certain advantages in prolonging PFS, followed by ixazomib and carfilzomib in terms of efficacy. Bortezombib may be superior to carfilzombib in extending OS. However, the adverse reactions caused by proteasome inhibitors, such as Peripheral neuropathy, Serious adverse events, Rash, Vomiting, etc., should be paid enough attention.