Disparities in black and white patients with multiple myeloma referred for autologous hematopoietic transplantation: A single center study

Abstract

Background: Racial disparity in the incidence of multiple myeloma is well established; however, to the authors' knowledge, little is known regarding the impact of racial differences on disease characteristics, response to therapy, and clinical outcome. Methods: The authors studied 453 patients (174 of whom were black and 279 of whom were white) who underwent transplant between 2000 and 2013. The median follow-up was 4.4 years. Results: Black patients were significantly younger than white patients (median age, 54 years vs 59 years; P<.0001), more frequently presented with anemia (P 5 .04), had more of the immunoglobulin G isotype (P<.001), and had a borderline favorable cytogenetic risk (P 5 .06). Overall response to induction was similar, but deeper responses were observed in more white patients compared with black patients receiving immunomodulatory drug-based induction (P 5 .02). Referral for transplant was significantly delayed in black individuals (median, 1.3 years vs 0.9 years; P 5 .003). Overall survival from the time of transplant was similar for black and white patients, with medians of 6.2 years and 5.7 years, respectively, but survival from the time of diagnosis was significantly longer among black individuals (median, 7.7 years vs 6.1 years; P 5 .03). Maintenance therapy was found to positively impact progression-free survival but not overall survival, irrespective of race. Conclusions: The results of the current study confirm ethnic differences in age, referral patterns, response to therapy, and overall survival. Future validation of these disparities is urgently needed.

Hispanics have the lowest stem cell transplant utilization rate for autologous hematopoietic cell transplantation for multiple myeloma in the United States: A CIBMTR report

“…21 Previous literature, including reports from the CIBMTR, has indicated that post-transplantation outcomes are identical regardless of race. 9,16,22 Our current results extend that literature among ethnic subgroups with identical results. With this in mind, and recognizing the differences in the STUR, we believe it is time for a concerted effort to improve the STUR among all groups, with special emphasis on the low-performing ethnicities.…”

“…Previous literature, including reports from the CIBMTR, has indicated that post‐transplantation outcomes are identical regardless of race . Our current results extend that literature among ethnic subgroups with identical results.…”

“…Hispanic and non‐Hispanic black patients were also more likely to have advanced‐stage disease at diagnosis and to undergo transplantation later from diagnosis than non‐Hispanic white patients. This confirms the results of a small, single‐center study from Baltimore indicating that, among patients with MM who were referred for AHCT, black patients were younger and often had delayed referrals for AHCT compared with white patients . We now extend this finding to Hispanic patients as well.…”

“…This confirms the results of a small, single-center study from Baltimore indicating that, among patients with MM who were referred for AHCT, black patients were younger and often had delayed referrals for AHCT compared with white patients. 16 We now extend this finding to Hispanic patients as well.…”

Survival of ethnic and racial minority patients with multiple myeloma treated with newer medications

“…Several prior studies have demonstrated that patients of minority ethnic or racial background are less likely than nHws to receive autologous hematopoietic stem cell transplants (auto-HSCTs) as treatment for MM and that referral for transplantation may be delayed. [7][8][9][10][11][12] In addition, there is some evidence that minorities are less likely to receive treatment with newer agents (immunomodulatory [imid] drugs and proteasome inhibitors [PIs]) in treatment for myeloma. Several studies have demonstrated similar outcomes for minorities compared with nHws undergoing auto-HSCT when access is equal.…”