Аңдатпа
Although significant advances in new treatments have extended the survival of patients with multiple myeloma (MM), proteasome inhibitor (PI) drug therapy, represented by bortezomib (BTZ), remains the cornerstone of MM treatment.However, relapse after treatment is inevitable in MM patients, and there are numerous treatment options available after the first relapse.There is currently no consensus on which treatment should be adopted for the first relapse after BTZ or PI treatment.Based on the cost advantage and cornerstone position of BTZ, whether BTZ can continue to be used has always been a concern for clinical doctors.Therefore, this study aims to examine the benefits of various new treatments for patients with first relapse after BTZ or PI treatment and compare the analysis results with real-world data from West China Hospital.Firstly, a network meta-analysis included 4 studies involving 513 MM patients who had their first relapse after BTZ treatment, and the combination therapy with new drugs showed promising prospects.To further examine the current situation in clinical practice, a retrospective cohort of 187 real-world MM patients with such relapse was included and divided into the BTZ group and the non-BTZ group, with median PFS of 20 and 24 months respectively (p = 0.1031, HR = 0.8333, 95% CI: 0.5691-1.220).In addition, we used the same method to study the choice of second-line treatment for first-time relapse after PI treatment.A network meta-analysis, which included two studies involving 442 MM patients who experienced first-time relapse after PI treatment, revealed no statistically significant difference in PFS between the PI group and the non-PI group.The real-world analysis had the same results, with median PFS of 21 and 24 months, respectively (p = 0.0963, HR = 1.386, 95% CI: 0.9434-2.036).The study concludes that for MM patients with first relapse after BTZ or PI treatment, BTZ re-treatment may not be optimal, and other options need consideration based on additional clinical trial data.