Multiple myeloma is a type of blood cancer. It accounts for approximately 2% of all cancers and is still considered incurable. For people with newly diagnosed multiple myeloma (NDMM), who are unsuitable for a procedure where damaged blood cells are replaced with healthy ones (stem-cell transplant), treatment is usually a multiple drug combination of bortezomib, lenalidomide, or thalidomide, plus melphalan and prednisolone (MP) or dexamethasone (D). Multiple drug combinations are approved for initial anti-myeloma therapy, however, access to these medicines is restricted in many countries worldwide.

The Cochrane Review used network meta-analysis (NMA) to compare the benefits and harms of selected anti-myeloma drugs (bortezomib (V), lenalidomide (R), thalidomide (T)) for transplant-unsuitable NDMM.

The review identified 25 studies involving 11,403 transplant-unsuitable adults with NDMM, and comparing 21 different treatment regimens. It looked at survival, harms and quality of life.

The review concluded that VRDc showed the highest overall survival benefits, compared to MP. RD and TMP also improved OS compared to MP. However, these combinations of drugs also led to more adverse events compared to MP, and led to more people stopping treatment. More trials are needed that look carefully at both harms and quality of life.

The results of this review informed a successful application to the World Health Organization (WHO) Essential Medicines List (EML), which previously had no anti-myeloma medicines included.

The editorial process for this review was managed by the Cochrane Fast-Track Service.

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