Disparities in treatment patterns and outcomes among younger and older adults with newly diagnosed multiple myeloma: A population-based study

Idecabtagene Vicleucel (Abecma)

“…63 As 1 study suggests, differences in multiple myeloma incidence at different ages among different groups could affect the type of treatment received. 55 Disparities in access to and receipt of multiple myeloma treatment (or similar treatments for other cancers) have been described with respect to age 61,70,87,93,94 ; race and ethnicity [55][56][57][58]61,64,65,[68][69][70][71][72][73][74]76,77,91,92,98,99,102 ; socioeconomic status 55,61,70,71,74,76,77,91 ; geography, proximity, or access to treatment centres 55,61,64,[76][77][78]101 ; insurance status 61,70,76,77,89,…”

“…101 For example, some studies have found that older age is associated with a lower likelihood of receiving some treatments 61 or receiving any treatment at all. 70,87 Some therapies for multiple myeloma have been found to used less frequently or later in racial and ethnic minority groups, even when equally beneficial and controlling for other factors, which may point to inequities related to referral patterns, sociodemographic factors, cultural beliefs, and other factors. 55,61,69,72,77,91,98 However, some study authors note that disparities in access to treatments may be attenuated for autologous transplants because these are not dependent on finding suitable donors, as is the case for other forms of transplant (e.g., stem cell transplant).…”

“…71,74,77,91 With respect to supply, some authors have argued that considerations of distributive and procedural justice may arise where the demand for CAR T-cell therapies exceeds manufacturing and administration capacities, which may be constrained by access to highly trained personnel and facilities capable of collecting, shipping, and handling cells, as well as administering the therapy. 101 Finally, disparities in multiple myeloma outcomes have been described with respect to age 53,55,66,79,81,87 ; race and ethnicity [53][54][55]58,65,71,73,75,[79][80][81]86,88,92,96 ; socioeconomic status 52,66,71,75,80,83,85,86,88,96,100,103,104 ; geography, proximity, and access to treatment centres 52,55,79,80,84,97 ; and insurance status. 66,79,...…”

Characterize, Optimize, and Harmonize: Caring for Older Adults With Hematologic Malignancies

“…Although the efficacy and tolerability of the treatment of myeloma have, overall, improved survival in patients over age 65, 43 a proportion of older adults with myeloma still receive no treatment, a proportion that increases with age. 44,45 Only half of patients over age 80 received any antimyeloma therapy in one study. 46 Reasons for nontreatment are unexplored in the literature, but presumably center on concerns about toxicity.…”

“…Rates of early mortality are improving overall, but remain substantial, with 10% of patients older than age 65 dying within the first 6 months and 18% within the first year after diagnosis. 45,58,59 The most commonly reported causes of death contributing to early mortality include myeloma, cardiac causes, infection, and renal failure. 58 Given the frequency of infection and immunodeficient state of individuals with newly diagnosed multiple myeloma, a randomized trial aimed to reduce the risk of infection with prophylactic levofloxacin for the first 12 weeks after diagnosis.…”