Race and Outcomes of Autologous Hematopoietic Cell Transplantation for Multiple Myeloma

Abstract

Blacks are twice as likely to develop and die from multiple myeloma (MM) and are less likely to receive an autologous hematopoietic-cell transplant (AHCT) for MM compared to whites. The influence of race on outcomes of AHCT for MM is not well described. We compared the probability of overall survival, progression-free survival, disease progression and non-relapse mortality among black (N=303) and white (N=1892) recipients of AHCT for MM, who were reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) from 1995 to 2005. The black cohort was more likely to be female, had better Karnofsky performance scores but lower hemoglobin and albumin levels at diagnosis. Black recipients were younger and more likely to be transplanted later in their disease course. Disease stage and treatment characteristics prior to AHCT were similar between the two groups. Black and white recipients had similar probabilities of 5-year overall survival (52% vs. 47%, P=0.19) and progression-free survival (19% vs. 21%, P=0.64) as well as cumulative incidences of disease progression (72% vs. 72%, P=0.97) and non-relapse mortality (9% vs. 8%, P=0.52). In multivariate analyses, race was not associated with any of these endpoints. Black recipients of AHCT for MM have similar outcomes compared to whites, suggesting that the reasons underlying lower rates of AHCT in blacks need to be studied further to ensure equal access to effective therapy.

The Shreveport Myeloma Experience: Survival, Risk Factors and Other Malignancies in the Age of Stem Cell Transplantation

“…Our data confirm the data from transplant series [29] that show the prognosis of African American and Caucasian patients with MM is comparable if access to care is equal. We were able to add to these findings that, in an academic center with equal access to care, the outcome of MM in all patients is equal regardless of race.…”

Racial disparities in incidence and outcome in multiple myeloma: a population-based study

“…This suggests that blacks may not have had the same access to new therapies as whites, consistent with previous reports that blacks are 50% less likely than whites to undergo ASCT, 46 while other studies have reported blacks and whites to have similar outcomes with ASCT. 18,19 Likewise, a SEER Medicare-based study found that among MM patients Ն 65 years of age, blacks were less likely than whites to receive chemotherapy. 47 Based on small numbers, we attempted to separately assess changes in survival after the introduction of ASCT and novel drugs.…”

“…17 A recent study of 91 patients receiving ASCT in an equal access health system observed no difference in survival by race 18 a registry study by the Center for International Bone Marrow Transplantation confirmed this finding. 19 Four population-based studies [20][21][22][23] have demonstrated improved survival in MM after the advent of novel therapies such as ASCT (1994), [24][25][26] immunomodulatory drugs (IMiDs; 1999), 27-30 and bortezomib (2003). 31,32 None of these studies assessed the impact of new treatments on survival by race.…”

Multiethnic myeloma

“…2 5 The reasons for all of these differences are not clear, but taken together they suggest underlying biological differences between MM tumors in AA and EA patients. Baker and colleagues sought to answer whether different genomic alterations between AA and EA with MM could account for these clinical observations.…”

“…Physiological mechanisms for regulation of ADP-mediated platelet activation also exist, among which are the activities of ecto-nucleotidases that hydrolyze ADP (and ATP) to AMP and adenosine. [5][6][7] CD39 is one such ecto-nucleotidase. CD39 is normally expressed on the surfaces of endothelial cells in the vasculature, where it helps to keep platelets from becoming activated in the presence of an intact endothelium.…”