Disparities in utilization of autologous stem cell transplantation as consolidative therapy for multiple myeloma: A single-institution retrospective review.

Abstract

e20504 Background: Multiple Myeloma (MM) accounts for about 17% of hematologic malignancies in the United States. It is a disease of older adults, with a median age at diagnosis of 66 years. The incidence in African Americans is 2 to 3 times more that in Whites, and this disparity has been found to be greater among patients less than 50 years. Most guidelines recommend induction therapy with a triplet regimen followed by autologous hematopoietic cell transplantation (HCT). Unfortunately, racial and ethnic minorities have been found to be less likely to receive ASCT. A SEER-Medicare database analysis from 2000 to 2011 noted a lower utilization of ASCT and Bortezomib among black patients. The goal of this study was to evaluate patterns of acceptance of ASCT as consolidative therapy of MM. Because the receipt of upfront ASCT is dependent on response to induction therapy, our study also investigated disparity in transplant outcomes and time to transplant, which are areas that previous studies had not looked at. Methods: In this retrospective review we used Cox PH model to investigate the association between the survival time of the patients (OS) and age of the diagnosis, race, socioeconomic status, disease cytogenetic, and initial induction regimens. 194 patients with a confirmed diagnosis of MM who were referred for autologous hematopoietic stem cell transplantation (ASCT) between January 1st 2009 and June 30st 2019 were included in this study. Patients who received ASCT for relapsed MM were excluded. Results: Using Cox PH model, we found that high risk cytogenetic were significantly associated with shorter overall survival, higher transplant related mortality and relapse related mortality (P < 0.002). Use of aggressive induction choices was associated with poorer transplant outcomes (P 0.02). Time to transplant tended to be shorter in African American compared to other ethnic groups (P 0.07). Income category was not significantly associated with overall survival, time to transplant or transplant / relapse related mortality. Conclusions: Cytogenetic continues to be a significant factor in transplant outcomes affecting overall survival. Time to transplant tended to be shorter in African American comparing to others, potentially reflecting the differences in disease course. Our study provides a more real life data on ASCT outcome patterns. It is hoped that the results of this study will better guide interventions to improve utilization of ASCT as consolidative therapy for MM.