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Immunomodulatory drugs and the risk of serious infection in multiple myeloma: systematic review and meta-analysis of randomized and observational studies

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Abstract

The effect of immunomodulatory drugs (IMiDs) on serious infection remains uncertain. We therefore conducted a systematic review and meta-analysis to assess the possible impact of IMiDs on serious infection in patients with multiple myeloma (MM). We searched randomized controlled trials (RCTs) and observational studies from databases that addressed the effect of IMiDs on serious infection in patients with MM. We pooled data from RCTs and observational studies separately and used the GRADE approach to rate the quality of evidence. Rates in patients with individual IMiDs at different treatment status ranged from 7.00 to 23.00%. The use of thalidomide- or lenalidomide-based regimen induction therapy for autologous stem cell transplantation (ASCT)-ineligible patients suggests increase in serious infection (RR = 1.59, 95% CI 1.31–1.93, p < 0.01). Compared to conventional therapy, IMiDs’ induction in ASCT-eligible patients significantly decreases the risk of serious infection (RR = 0.82, 95% CI 0.72–0.94, p < 0.01). Lenalidomide-based therapy was associated with a significant increase in risk of serious infection in patients treated compared with conventional therapy (RR = 2.45, 95% CI 1.57–3.83, p < 0.01). The current evidence suggests that patients with MM treated with IMiDs are at a high risk of serious infection.

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Acknowledgements

The authors thank Hongmin Ge for providing language help.

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Authors and Affiliations

  1. Department of Pharmacy, Yangtze University Affiliated Hospital Jingzhou, Hangkong Street 8, Jingzhou, Hubei, 434000, China

    Min Chen, Chuanxin Xu, Xian Wang & Xianping Zhang

  2. Department of Hematology, Yangtze University Affiliated Hospital Jingzhou, Jinlong Street 8, Jingzhou, Hubei, 434000, China

    Yongfeng Zhao

  3. Department of Gastrointestinal Surgery, Yangtze University Affiliated Hospital Jingzhou, Hangkong Street 8, Jingzhou, Hubei, 434000, China

    Benyu Mao

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  1. Min Chen
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  2. Yongfeng Zhao
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  4. Xian Wang
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  5. Xianping Zhang
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Correspondence to Min Chen.

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Chen, M., Zhao, Y., Xu, C. et al. Immunomodulatory drugs and the risk of serious infection in multiple myeloma: systematic review and meta-analysis of randomized and observational studies. Ann Hematol 97, 925–944 (2018). https://doi.org/10.1007/s00277-018-3284-y

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