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Association of minimal residual disease with superior survival outcomes in patients with multiple myeloma: a meta-analysis

Phase meta-analysisN = 1,273

Population
Patients with multiple myeloma in 21 pooled studies; the authors' objective concerned newly diagnosed myeloma, and 13 of the 21 articles are reported as involving newly diagnosed patients. MRD-negative versus MRD-positive status after treatment
Design
Meta-analysis of 21 eligible studies (reporting MRD status and PFS or OS in 20 or more patients after treatment) identified from a Medline search of English-language articles from January 1990 to January 2016. 14 studies (n = 1273) provided data on PFS and 12 studies (n = 1100) on OS; data were pooled with the Peto method and adjusted for different proportions of MRD-negative patients.
Arms
  • MRD-negative after treatment (experimental): Observational grouping by MRD status; no treatment assigned
  • MRD-positive after treatment (control): Observational grouping by MRD status; no treatment assigned
People
Munshi NC
PFSHR 0.41 (95% CI 0.36–0.48)PFSHR 0.44 (95% CI 0.34–0.56)OSHR 0.57 (95% CI 0.46–0.71)OSHR 0.47 (95% CI 0.33–0.67)
Show the numbers
Results reported for Association of minimal residual disease with superior survival outcomes in patients with multiple myeloma: a meta-analysis
EndpointAnalysisMRD-negative after treatmentMRD-positive after treatmentEffect
PFS14 studies (n = 1273) with PFS dataprimaryMunshi 2017——HR 0.41 (95% CI 0.36–0.48)P<.001Hazard ratio for MRD-negative versus MRD-positive status; an association in observational groupings, not a treatment effect.
PFSStudies in patients with conventional complete response: 5 studies (n = 574)primaryMunshi 2017——HR 0.44 (95% CI 0.34–0.56)P<.001Hazard ratio for MRD-negative versus MRD-positive status within patients in conventional complete response.
OS12 studies (n = 1100) with OS dataprimaryMunshi 2017——HR 0.57 (95% CI 0.46–0.71)P<.001Hazard ratio for MRD-negative versus MRD-positive status.
OSStudies in patients with conventional complete response: 6 studies (n = 616)primaryMunshi 2017——HR 0.47 (95% CI 0.33–0.67)P<.001Hazard ratio for MRD-negative versus MRD-positive status within patients in conventional complete response.
Results reported for Association of minimal residual disease with superior survival outcomes in patients with multiple myeloma: a meta-analysis
EndpointAnalysisMRD-negative after treatmentMRD-positive after treatmentEffect
PFS14 studies (n = 1273) with PFS dataprimaryMunshi 2017——HR 0.41 (95% CI 0.36–0.48)P<.001Hazard ratio for MRD-negative versus MRD-positive status; an association in observational groupings, not a treatment effect.
PFSStudies in patients with conventional complete response: 5 studies (n = 574)primaryMunshi 2017——HR 0.44 (95% CI 0.34–0.56)P<.001Hazard ratio for MRD-negative versus MRD-positive status within patients in conventional complete response.
OS12 studies (n = 1100) with OS dataprimaryMunshi 2017——HR 0.57 (95% CI 0.46–0.71)P<.001Hazard ratio for MRD-negative versus MRD-positive status.
OSStudies in patients with conventional complete response: 6 studies (n = 616)primaryMunshi 2017——HR 0.47 (95% CI 0.33–0.67)P<.001Hazard ratio for MRD-negative versus MRD-positive status within patients in conventional complete response.
Hazard ratio (95% CI) by endpoint. Values below 1 favour the experimental arm.
PFSPFSOSOS0.512◀ experimentalcontrol ▶
Data table
EndpointHR95% CI
PFS0.410.36–0.48
PFS0.440.34–0.56
OS0.570.46–0.71
OS0.470.33–0.67
Primary publication: Munshi NC, Avet-Loiseau H, Rawstron AC, Owen RG, Child JA, Thakurta A, et al. Association of Minimal Residual Disease With Superior Survival Outcomes in Patients With Multiple Myeloma: A Meta-analysis. JAMA Oncol. 2017;3(1):28-35. PubMedDOI

Appears in

Sources

  1. Munshi NC, Avet-Loiseau H, Rawstron AC, Owen RG, Child JA, Thakurta A, et al. Association of Minimal Residual Disease With Superior Survival Outcomes in Patients With Multiple Myeloma: A Meta-analysis. JAMA Oncol. 2017;3(1):28-35.

    PubMedDOI