A Cochrane review (abstract , review [Abstract]) included 3 studies with a total of 131 subjects. Early MM was asymptomatic stage I in these trials. All trials used standard Melphalan treatment but not stem cell transplantation. Beneficial effects of early treatment were seen in delay of myeloma progression (Peto's OR = 0.16, 95% CI: 0.09-0.29), and reduced vertebral compression (OR = 0.18, 95%CI: 0.02-1.59, NNT = 23, 95% CI: an NNT of 11, via infinity, to an NNH of 50). No significant effects on mortality and response rate were seen (Peto's OR = 1.11, 95% CI: 0.67-1.84, and OR = 0.63, 95% CI: 0.33-1.23, respectively). Early treatment may increase the risk of acute leukemia (Peto's OR = 3.20, 95% CI: 0.55-18.73, NNH = 44, 95% CI: an NNT of 63, via infinity, to an NNH of 15).
Comment: The quality of evidence is downgraded by imprecise results; few patients and wide confidence intervals.
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