Lenalidomide or Thalidomide for Transplant-Ineligible Patients With Newly Diagnosed Multiple Myeloma? An Overview of Systematic Reviews

Objectives: To present an overview of evidence of ef ficacy, safety, and health -related quality of life of lenalidomide or thalidomide for transplant -ineligible multiple myeloma. Methods: A literature search was performed in 5 databases until July 2022. We included systematic reviews with network meta -analyses of randomized controlled trials on the use of lenalidomide compared with thalidomide for transplantineligible multiple myeloma. The A Measurement Tool to Assess Systematic Reviews 2 was used to appraise the quality of included reviews. The results were focused on the lenalidomide + dexamethasone until disease progression (RDc) versus thalidomide + dexamethasone until disease progression (TDc) and induction with melphalan + prednisone + lenalidomide, followed by maintenance with lenalidomide (MPR-R) versus induction with melphalan + prednisone + thalidomide, followed by maintenance with thalidomide (MPT-T) regimens. Results: Nine studies were included. Only 1 study did not show any weakness in critical domains of A Measurement Tool to Assess Systematic Reviews 2. For overall survival, RDc proved to be superior to TDc; however, no study showed signi ficant difference between MPR-R and MPT-T. For progression -free survival, 2 of 3 studies showed that RDc is better than TDc; however, no difference between MPR-R and MPT-T was found. Regarding safety, these lenalidomide-based regimens had a lower risk for neurologic adverse events, with an increased risk of hematologic adverse events. No health -related quality of life meta -analyses were found. Conclusions: These findings suggest that, in terms of ef ficacy and safety, lenalidomide-based regimen is a good option for treatment of transplant -ineligible multiple myeloma in the public health system of Brazil, especially for those patients who develop severe neuropathy with thalidomide.