During the past decades, agents with novel mechanisms of action, such as monoclonal antibodies (MAbs) and histone deacetylase\ninhibitors (HDACis) have been applied to treat relapsed or refractory multiple myeloma (RRMM). The treatment outcomes of\nMAbs versus HDACi in combination with bortezomib or lenalidomide plus dexamethasone remain unknown. We conducted this\nmeta-analysis to compare indirectly the efficacy and safety of MAbs and HDACis in combination with bortezomib or\nlenalidomide plus dexamethasone. Six trials (eight articles) were included in the meta-analysis with 3270 RRMM patients\nenrolled. We synthesized hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS), risk ratios (RRs) for\ncomplete response (CR),very good partial response (VGPR), overall response (OR), progressive disease plus stable disease (PD\n+ SD) and common at least grade 3 adverse events, and their corresponding 95%confidence intervals (95% CI). Treatment with\nMAbs in combination with bortezomib or lenalidomide plus dexamethasone resulted in longer PFS (HR 0.83, 95% CI: 0.66ââ?¬â??0.98),\nfewer incidences of at least grade 3 thrombocytopenia (RR 0.35, 95% CI: 0.23ââ?¬â??0.53), neutropenia (RR 0.70, 95% CI: 0.51ââ?¬â??0.96),\nand sense of fatigue (RR 0.37, 95% CI: 0.17ââ?¬â??0.82) than HDACis. The daratumumab plus bortezomib or lenalidomide and\ndexamethasone might significantly improve PFS in comparison with HDACis plus bortezomib or lenalidomide and\ndexamethasone (HR 0.55, 95% CI: 0.40ââ?¬â??0.74). In conclusion, MAbs may be superior to HDACis in achieving longer PFS and may\nbe better tolerated when in combination therapy with bortezomib or lenalidomide plus dexamethasone.
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