Pomalidomide combined with dexamethasone for the treatment of relapsed/refractory multiple myeloma: a systematic review and meta-analysis

ABSTRACT

Background

To evaluate the efficacy and safety of pomalidomide in combination treatment of relapsed/refractory multiple myeloma (RRMM).

Methods

Published clinical trials were searched in the Cochrane Library, PubMed, EMBASE to February 2023. The literature was screened and evaluated according to the inclusion criteria, and the data were analyzed by a random effect model. Overall response rate (ORR), overall survival (OS), progression-free survival (PFS) and full grade or ≥ 3 adverse events (AEs) were the outcomes.

Results

This study included 31 clinical trials, which included 4776 patients. The pooled ORR of the doublet regimens was 33.3% (95%CI: 27–39%) and the triplet regimens was 66% (95%CI: 58–74%). Among the 25 included studies, the median PFS was 8.29 months (95%CI: 7.27–9.31), and nine studies reported median OS of 19.43 months (95%CI: 14.56–24.30). In terms of safety, the most common hematologic AEs of grade ≥ 3 were neutropenia (41%) and anemia (20%); Non-hematologic AEs were pneumonia (14%) and infection/febrile neutropenia (14%).

Conclusions

Pomalidomide combined treatment regimens have shown good clinical efficacy, especially in pomalidomide + dexamethasone combined with other drugs. In terms of safety, it’s important to pay attention to the likelihood of hematological adverse events when used clinically.

Systematic Review Registration

PROSPERO: CRD42023420644.

KEYWORDS:

• Relapsed/refractory multiple myeloma
• pomalidomide
• combination regimen
• efficacy
• safety

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Y Luo, C Li and Y Niu performed the literature search, analyzed the data and drafted the manuscript. S Wu, J Tian, Z Hu, J He, Z Zhang and evaluated methodological quality and revised the manuscript. H Liu, Y Li, T Wang and Y Fang designed the study and revised the manuscript. The final version was confirmed by all authors for submission. The authors declare that they have no conflict of interest.

Previous presentations

This article was presented as an abstract at a conference: International Symposium in Quantitative Pharmacology, ISQP 2023.

Data availability statement

The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding authors.

Acknowledgments

We would like to express special gratitude to all the personnel who supported or helped with this meta-analysis.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17474086.2024.2326219.

Additional information

Funding

This manuscript was funded by the Major Project of National Science and Technology ‘Creation of Major New Drugs’ (2020ZX09201026), the Guangzhou Health Science and Technology Project (2021A031005), and the General Guidance Project of Guangzhou Municipal Health Commission (20231A010063).