Habib et al. European Journal of Biomedical and Pharmaceutical Sciences www.ejbps.com │ Vol 8, Issue 8, 2021. │ ISO 9001:2015 Certified Journal │ 89 FOUR-DRUG REGIMENS FOR TREATMENT OF MULTIPLE MYELOMA: A SYSTEMATIC REVIEW ON THEIR EFFICACY AND SAFETY Ukasha Habib* 1 , Iyanu Victoria Olateju 2 , Azka Ali 3 , Raysha Farah 4 , Osazee Eguagie 5 , Chipo Makoni 6 , Ofure Harrison 7 , Jose Antonio Gomez Miranda 8 , Farzan Salehi 9 , Samia Jahan 10 , Dolly Ogwu 5 , Matthew Oluwafemi Owolabi 2 , Okoma Shed Akolokwu 11 , Lisandra Vega 12 , Nikitha Chellapuram 13 and Roland Oluwapelumi Ojo 14 1 Nishter Medical College, Pakistan. 2 Washington Adventist University, USA. 3 King Edward Medical University, Pakistan. 4 Faculty of Medicine, Universitas Indonesia. 5 University of Benin, Nigeria. 6 Windsor University School of Medicine, St. Kitts and Nevis. 7 V. N karazin Kharkiv National University. 8 University of El Salvador, El Salvador. 9 Institute of Fundamental Medicine and Biology, Kazan Federal University, Russia. 10 Dhaka Medical College, Bangladesh. 11 Avalon University School of Medicine, Curacao. 12 American University of Antigua, College of Medicine. 13 Bhaskar Medical College and Hospital, India. 14 College of Medicine, University of Lagos, Nigeria. Article Received on 14/06/2021 Article Revised on 04/07/2021 Article Accepted on 24/07/2021 INTRODUCTION Multiple myeloma (MM) is characterized by neoplastic plasma cell proliferation and accounts for 2% of all cancers. Long-term survival of myeloma patients is improving, and current median survival is reported around 5 years. [1] In the United States, the incidence of multiple myeloma in African Americans is more than twice the incidence among Caucasians. The exact cause of MM is unclear but it seems to be related to spontaneous acquired mutations, ionizing radiation, and agricultural exposures. [2] Overall survival (OS) is based mainly on the patient’s characteristics and the tumor’s biology. The most notable favorable factors are age < 65 years, initial mode of presentation of monoclonal gammopathy of unknown significance (MGUS), and standard-risk cytogenetic abnormalities. Short OS SJIF Impact Factor 6.044 Research Article ejbps, 2021, Volume 8, Issue 8, 89-93. European Journal of Biomedical AND Pharmaceutical sciences http://www.ejbps.com ISSN 2349-8870 Volume: 8 Issue: 8 89-93 Year: 2021 *Corresponding Author: Ukasha Habib Nishter Medical College, Pakistan. ABSTRACT Introduction: Despite multiple treatment options available for the treatment of Multiple myeloma (MM), the disease remains incurable and disease relapse ultimately occurs after a period of disease control. Our review aims to measure the efficacy and safety of four-drug regimens in terms of progression-free survival and disease responses. Methods: A comprehensive literature search yielded a total of 36429 articles. Our search strategy included the following MeSH terms: “multiple myeloma” and “antineoplastic agents”. Ten studies met the inclusion criteria: phase I/II trials, phase III trials, studies published after 2010, and use of four-drug regimens with clear documentation of outcomes such as overall response rates (ORR), progression-free survival (PFS), and overall survival (OS). Results: A total of ten studies with 2,416 patients were included. 2,275 patients had relapsed refractory MM (RRMM), and 141 patients had newly diagnosed MM (NDMM). Seven studies demonstrated a comparison between three-drug and four-drug regimens. Six studies reported four-drug regimens to be significantly superior to three-drug regimens in terms of ORR. Two of the three studies that did not make any such comparison, showed an ORR of more than 90% with four-drug regimens whereas one study reported an ORR of about 67%. Other parameters such as PFS and OS also showed the four-drug regimen as an effective MM strategy. Conclusion: Four-drug antineoplastic regimens significantly improve the responses in both newly diagnosed and relapsed/refractory multiple myeloma. However, data on survival is awaited. The cost and associated synergism in the toxicity profile need further analysis and follow-up. KEYWORDS: “multiple myeloma” and “antineoplastic agents”.