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Objective <p>This systematic review and meta-analysis compared the efficacy and safety of anti-CD38-containing quadruplet and triplet regimens in transplant-ineligible patients with newly diagnosed multiple myeloma (TIE-NDMM).</p> Methods <p>A comprehensive literature search was conducted across PubMed, Embase, and Cochrane databases up to April 30, 2025. Randomized controlled trials (RCTs) comparing anti-CD38-based quadruplet and triplet regimens were analysed for outcomes including efficacy and toxicity.</p> Results <p>Six RCTs with 2089 patients were included. Quadruplet regimens yielded significantly greater PFS (HR 0.49, 95% CI: 0.39–0.61; P &lt; 0.00001, I<sup>2</sup> = 56%) and OS (HR 0.64, 95% CI: 0.44–0.93; P = 0.02, I<sup>2</sup> = 70%) than triplet regimens. The addition of anti-CD38 increased the rates of MRD negativity (RR 1.95, 95% CI: 1.32–2.89, P = 0.0008, I<sup>2</sup> = 89%) and sustained MRD negativity at ≥ 12&#xa0;months (RR 2.70, 95% CI: 1.54–4/75, P = 0.0005, I<sup>2</sup> = 80%), despite a slight increase in severe adverse events (RR 1.16, 95% CI: 1.05–1.30, P = 0.006, I<sup>2</sup> = 17%) and grade 3/4 infections (RR 1.36, 95% CI: 1.14–1.6, P = 0.0004, I<sup>2</sup> = 0%).</p> Conclusion <p>Anti-CD38-based quadruplet regimens are superior to triplet regimens for non-frail TIE-NDMM patients, improving key efficacy outcomes with manageable safety concerns.</p>

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Anti-CD38-based quadruplet versus triplet induction regimens in transplant-ineligible newly diagnosed multiple myeloma: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年4月2日

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  • Grace Lau,
  • Madhu Bhargavi Chandra,
  • Henri Fero,
  • Fahad Alabbas

摘要

Objective

This systematic review and meta-analysis compared the efficacy and safety of anti-CD38-containing quadruplet and triplet regimens in transplant-ineligible patients with newly diagnosed multiple myeloma (TIE-NDMM).

Methods

A comprehensive literature search was conducted across PubMed, Embase, and Cochrane databases up to April 30, 2025. Randomized controlled trials (RCTs) comparing anti-CD38-based quadruplet and triplet regimens were analysed for outcomes including efficacy and toxicity.

Results

Six RCTs with 2089 patients were included. Quadruplet regimens yielded significantly greater PFS (HR 0.49, 95% CI: 0.39–0.61; P < 0.00001, I2 = 56%) and OS (HR 0.64, 95% CI: 0.44–0.93; P = 0.02, I2 = 70%) than triplet regimens. The addition of anti-CD38 increased the rates of MRD negativity (RR 1.95, 95% CI: 1.32–2.89, P = 0.0008, I2 = 89%) and sustained MRD negativity at ≥ 12 months (RR 2.70, 95% CI: 1.54–4/75, P = 0.0005, I2 = 80%), despite a slight increase in severe adverse events (RR 1.16, 95% CI: 1.05–1.30, P = 0.006, I2 = 17%) and grade 3/4 infections (RR 1.36, 95% CI: 1.14–1.6, P = 0.0004, I2 = 0%).

Conclusion

Anti-CD38-based quadruplet regimens are superior to triplet regimens for non-frail TIE-NDMM patients, improving key efficacy outcomes with manageable safety concerns.