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Multiple myeloma gammopathies

Response to the Commentary on “Is posttransplant lenalidomide the standard-of-care after an autotransplant for plasma cell myeloma”

Leukemia volume 33, pages 1301–1302 (2019)Cite this article

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In our analyses of posttransplant lenalidomide in plasma cell myeloma (PCM) published in the issue of January 28, we envisioned ourselves as clinical epidemiologists compiling a summary of evidence including benefits and risks to be presented to an idealized expert panel asked to produce practice recommendations. To do so, we used the GRADE criteria followed by the DECIDE framework for how to use results of a critical appraisal of evidence in decision reasoning.

Holstein and colleagues [1] challenge our analyses of bias in the design of the trials we reviewed. They claim using survival hazard ratio (HR) to quantify the benefit of an anti-cancer therapy is wrong [2], mostly because the survival HR for solid cancers is measured in months whereas for posttransplant lenalidomide it is measured in years. Further, they reference a new meta-analysis resulting in a survival HR of 0.72 favoring posttransplant lenalidomide [3].

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References

  1. Holstein SA, Suman VJ, McCarthy PL. Commentary on Is posttransplant lenalidomide the standard-of-care after an autotransplant for plasma cell myeloma. Leukemia 2019 (this issue).

  2. Sobrero AF, Pastorino A, Sargent DJ, Bruzzi P. Raising the bar for antineoplastic agents: how to choose threshold values for superiority trials in advanced solid tumors. Clin Cancer Res. 2015;21:1036–43.

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  3. Gay F, Jackson G, Rosinol L, Holstein SA, Moreau P, et al. Maintenance treatment and survival in patients with myeloma: a systematic review and network meta-analysis. JAMA Oncol. 2018;4:1389–97.

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  4. Palumbo A, Cavallo F, Gay F, Di Raimondo F, Ben Yehuda D, Petrucci MT, et al. Autologous transplantation and maintenance therapy in multiple myeloma. N Engl J Med. 2014;371:895–905.

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Authors and Affiliations

  1. Center for the Study of Myelofibrosis, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy

    Giovanni Barosi

  2. Haematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College, London, London, UK

    Robert Peter Gale

Authors
  1. Giovanni Barosi
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  2. Robert Peter Gale
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Correspondence to Giovanni Barosi.

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GB received advisory board funds from Novartis. RPG is a part-time employee of Celgene Corp.

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Barosi, G., Gale, R.P. Response to the Commentary on “Is posttransplant lenalidomide the standard-of-care after an autotransplant for plasma cell myeloma”. Leukemia 33, 1301–1302 (2019). https://doi.org/10.1038/s41375-019-0432-x

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