Efficacy and safety of pegylated liposomal doxorubicin for multiple myeloma: a systematic review and meta-analysis of randomized controlled trials

Pegylated liposomal doxorubicin (PLD) which is an improved formulation of doxorubicin has been used for the treatment of multiple myeloma (MM). We perform a systemic review to evaluate the efficacy and safety of PLD in patients with MM. Three Randomized controlled trials (RCTs) involving 1100 patients were included. One RCT evaluated PLD versus no PLD for patients with relapsed or refractory myeloma. Results showed that PLD prolonged time to progression (TTP) (HR 0.55, 95% CI 0.43 to 0.71; moderate quality of evidence) and progression free survival (PFS) (HR 0.59, 95% CI 0.46 to 0.76; moderate quality of evidence), but did not confer significant benefit on overall survival (OS). Patients are more likely to experience grade 3/4 myelosuppression. The other two RCTs assessed PLD versus conventional doxorubicin for newly diagnosed MM. Results showed that no difference was found in OS, TTP, PFS, response rates, although PLD reduced the risks of grade 3/4 neutropenia. In summary, compared with no PLD for patients with relapsed or refractory myeloma, PLD prolonged TTP and PFS, but did not confer significant benefit on OS. The currently available evidence did not show fewer AEs between PLD and conventional doxorubicin used in induction therapy of newly diagnosed myeloma.