Racial differences in treatment and outcomes in multiple myeloma: a multiple myeloma research foundation analysis

Benjamin A Derman,Jagoda Jasielec,Andrzej J Jakubowiak,Spencer S Langerman,Brian C-H Chiu,Wei Zhang

doi:10.1038/s41408-020-00347-6

Abstract

Findings on racial differences in survival in multiple myeloma (MM) have been inconclusive. We assessed differences in outcomes between White and Black individuals among 639 newly diagnosed MM patients in the MM Research Foundation CoMMpass registry with baseline cytogenetic data. Survival curves were constructed using the Kaplan–Meier method. Hazard ratios and 95% confidence intervals were derived from Cox proportional hazard regression models. Age, gender, and stage were similar between Whites (n = 526) and Blacks (n = 113). Blacks had inferior overall survival (OS) compared with Whites and were less likely to receive triplet therapies or frontline autologous stem cell transplant (ASCT). The following factors were significantly associated with inferior OS in multivariate analysis: higher international staging system (ISS) score, ≥1 or ≥2 high-risk cytogenetic abnormalities (HRCA), high-risk gene expression profile (GEP), and lack of ASCT. Multivariate analysis in the Black subset found that only lack of ASCT was significantly associated with inferior OS. The receipt of both triplet induction and ASCT only partly abrogated the effect of race on survival. HRCA did not track with survival in Blacks, emphasizing the need for race-specific risk prognostication schema to guide optimal MM therapy.

Highlights

Multiple myeloma (MM) is part of a spectrum of monoclonal plasma cell disorders with an age-adjusted incidence of 7.0/100,000 in the United States and comprising 1.8% of all new cancer diagnoses in 20201
Patients receiving modern treatment approaches, we show that Blacks had inferior overall survival (OS) compared with Whites and that this risk was only partly abrogated by receipt of triplet therapy and autologous stem cell transplant (ASCT)
Using the SEER registries from 1973 to 2005, Waxman et al found that Blacks experienced superior disease-specific survival and OS compared with Whites with MM2

Summary

Introduction

Multiple myeloma (MM) is part of a spectrum of monoclonal plasma cell disorders with an age-adjusted incidence of 7.0/100,000 in the United States and comprising 1.8% of all new cancer diagnoses in 20201. Populationbased studies using surveillance, epidemiology, and end results (SEER) registry and studies using trial data have suggested either similar or superior relative survival for Blacks compared to Whites with MM2,7–11. These findings are surprising in light of the fact that Blacks face barriers that may lead to inferior survival, including lower socioeconomic status and lower likelihood to receive contemporary MM agents or undergo autologous stem cell transplant (ASCT)[9,12]. In a retrospective analysis of 15,717 patients with MM in the Veterans Association (VA) health care system with equal access to care between 2000 and 2017, Fillmore et al.[13] found that Blacks had better overall survival (OS) compared with Whites, even after adjusting for age, sex, rurality, income, stage, transplantation, and induction therapies. Several studies have shown similar OS between Blacks and Whites, though this is despite later access to novel therapies or ASCT9,15–18

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Results

Conclusion