Early versus deferred treatment for early stage multiple myeloma

Early treatment of early stage multiple myeloma appears to inhibit disease progression and reduce vertebral compression. However, early treatment may increase the risk of acute leukemia.

A Cochrane review (abstract , review ) included 3 studies with a total of 131 subjects. Early MM was asymptomatic stage I in these trials. All trials used standard Melphalan treatment but not stem cell transplantation. Beneficial effects of early treatment were seen in delay of myeloma progression (Peto's OR = 0.16, 95% CI: 0.09-0.29), and reduced vertebral compression (OR = 0.18, 95%CI: 0.02-1.59, NNT = 23, 95% CI: an NNT of 11, via infinity, to an NNH of 50). No significant effects on mortality and response rate were seen (Peto's OR = 1.11, 95% CI: 0.67-1.84, and OR = 0.63, 95% CI: 0.33-1.23, respectively). Early treatment may increase the risk of acute leukemia (Peto's OR = 3.20, 95% CI: 0.55-18.73, NNH = 44, 95% CI: an NNT of 63, via infinity, to an NNH of 15).

Comment: The quality of evidence is downgraded by imprecise results; few patients and wide confidence intervals.

Ədəbiyyat

1. He Y, Wheatley K, Clark O, Glasmacher A, Ross H, Djulbegovic B. Early versus deferred treatment for early stage multiple myeloma. Cochrane Database Syst Rev 2003;(1):CD004023.