Table 3.
Summary of the evidence for key questions in the management of multiple myeloma.
| Question | Conclusion | Evidence | References |
|---|---|---|---|
| Is chemotherapy an ideal treatment modality? | High-dose chemotherapy followed by ASCT is helpful in tumour management. Bortezomib-based chemotherapy and vincristine–cyclophosphamide–melphalan or mitoxantrone–prednisone is beneficial in MM patients with RI. A combination of partial tumour excision and chemotherapy appears to be a viable treatment for MM spinal cord compression. |
Based on four studies from India (two studies) and China (two studies) | [1,25,62,63] |
| Is there a successful salvage therapy once the first-line therapy has failed? | A viable alternative for people with multiple myeloma who have significant concomitant conditions or a history of recurring infections linked to traditional chemotherapy is low-dose cyclophosphamide and prednisone. In transplant-eligible patients, a staged approach using VTD is a good salvage option |
Based on two studies from Hong Kong and China | [47,64] |
| Is ASCT beneficial in R/RMM? | Patients with pre-transplant treatment and frontline use of bortezomib-based induction before ASCT had better prognoses after ASCT | Based on two studies from Hong Kong and Taiwan | [35,55] |
| Are allogenic (BCMA)-CAR-T-cells are better than autologous CAR-T cells in R/RMM? | Patients who received autologous CAR-T cells had better PFS and OS rates than those who received allogeneic CAR-T cells. | Based on a Chinese study | [57] |
| Is thalidomide an option after transplant failure for R/RMM patients? | Thalidomide is safe, efficient, and practical for long-term use. Large-scale studies are required to support its use as a maintenance treatment. Patients with R/RMM who took thalidomide alone also found it to be effective and well-tolerated. When taken with dexamethasone, thalidomide was more thrombogenic than other medications. | Based on six studies from India, Taiwan, and China | [24,33,54,[65], [66], [67]] |
ASCT: Autologous stem cell transplantation; BCMA: B-cell maturation antigen; CAR-T cell: Chimeric antigen receptor T cell; MM: Multiple myeloma; OS: Overall survival; PFS: Progression-free survival; RI: Renal impairment; R/RMM: Relapsed or refractory multiple myeloma; VTD: Bortezomib–thalidomide–dexamethasone.