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

Abstract

Background Race/ethnicity remains an important barrier in clinical care. We investigated differences in autologous hematopoietic cell transplantation (AHCT) utilization in multiple myeloma (MM) and outcomes based on race/ethnicity in the United States. Methods The CIBMTR database identified 28,450 patients who underwent AHCT for MM from 2008–2014. Using SEER 18, the incidence of MM was calculated. A stem cell transplant utilization rate (STUR) was derived. Among patients 18–75 years undergoing melphalan-conditioned peripheral cell grafts (N=24,102), we analyzed post-AHCT outcomes. Results The STUR increased across all groups from 2008 to 2014. The increase was substantially lower among Hispanics (8.6% to 16.9%) and non-Hispanic Blacks (12.2% to 20.5%) than for non-Hispanic Whites (22.6% to 37.8%). There were 18,046 non-Hispanic Whites, 4123 non-Hispanic Blacks and 1933 Hispanic patients. The Hispanic group was younger (p <0.001). Fewer patients over 60 were transplanted in Hispanic (39%) and non-Hispanic Blacks (42%) vs. non-Hispanic Whites (56%). A Karnofsky score <90 and HCT-CI>3 were more common in non-Hispanic Blacks compared to Hispanic and non-Hispanic Whites (p<0.001). More Hispanic (57%) vs. non-Hispanic Blacks (54%) and non-Hispanic Whites (52%) (p<0.001) had stage III disease. More Hispanics (48%) vs. non-Hispanic Blacks (45%) and non-Hispanic Whites (44%) were in ≥very good partial response pre-transplant (p=0.005). Race/Ethnicity did not impact post-AHCT outcomes. Conclusions Although increasing, STUR remains low and significantly lower among Hispanic followed by non-Hispanic Blacks compared to non-Hispanic Whites. Race/ethnicity does not impact transplant outcomes. Efforts to increase transplant utilization for eligible MM patients, with emphasis on groups underutilizing transplant are warranted.

Impact of psychiatric comorbidities on health care utilization and cost of care in multiple myeloma

“…39,40 Specifically, decreased access to adequate MM care for patients of racial minorities has been reported in several studies. [41][42][43][44][45][46] Although these studies have explored differences in access to care and the financial benefits of eliminating disparities, to our knowledge, no prior study has demonstrated an interaction between cost of care and race in cancer patients with psychiatric comorbidities.…”

Use of bone‐modifying agents and clinical outcomes in older adults with multiple myeloma

“…Many novel anti-myeloma agents are expensive, and socioeconomically disadvantaged groups may experience impaired access to them. [16][17][18] Disparities in the application of supportive care have received less attention, yet BMA add to the cost and overall burden of an already complex therapy. Their use might thus constitute a valuable indicator of guideline adherence and overall quality of care in myeloma, important for policy-makers and other stakeholders.…”

Trends in multiple myeloma presentation, management, cost of care, and outcomes in the Medicare population: A comprehensive look at racial disparities

“…Despite these encouraging trends, disparities exist in MM outcomes by patient race/ethnicity . Several studies have described these disparities and investigated at their potential causes, and most have reported differences in access to therapeutics options, including novel drugs and stem cell transplantation (SCT) . With changing US population demographics and an increasing proportion of racial/ethnic minorities, comprehensive studies describing differences in various aspects of health care among patients according to racial/ethnic groups are warranted.…”