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Comment & Response
November 2018

Meta-analysis to Evaluate High-Dose Therapy Followed by Stem Cell Transplant in Patients With Multiple Myeloma

Author Affiliations
  • 1Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Stanford Medical School, Stanford University, Stanford, California
  • 3Department of Biostatistics, Harvard University, Boston, Massachusetts
JAMA Oncol. 2018;4(11):1617-1618. doi:10.1001/jamaoncol.2018.3483

To the Editor Dhakal et al1 used conventional meta-analysis techniques to address an important question regarding the efficacy of high-dose therapy followed by autologous stem cell transplant (HDT/ASCT) vs standard care in patients with multiple myeloma. The primary outcome was progression-free survival (PFS), with overall survival (OS) as a secondary end point. Four comparative randomized clinical trials were included in this meta-analysis. For each study, the hazard ratio (HR) was used to quantify the treatment effect for both PFS and OS. Because significant heterogeneity in HR was observed across studies for both PFS and OS, a random-effects model was used to obtain a pooled HR for the overall treatment effect from HDT/ASCT. Specifically, those underlying HRs from 4 study populations were likely different and we assume that these 4 separate HRs were a random sample from a hypothetical superpopulation characterized by log-normal distribution. This resulted in the combined HR of 0.55 for PFS (95% CI, 0.41-0.74; P < .001) and of 0.76 for OS (95% CI, 0.42-1.36; P = .20) in favor of HDT/ASCT.

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