Exploring racial disparities in treatment patterns and outcomes for patients with multiple myeloma using real world data

Maignan, Kathleen; Fashoyin-Aje, Lola A.; Torres, Aracelis Z.; Fernandes, Laura L.; Gwise, Thomas; Baxi, Shrujal; Roose, James; Rivera, Donna R.; Shen, Yuan Li; Kluetz, Paul G.; Gormley, Nicole

doi:10.1038/s41408-022-00665-x

Cited by 12 publications

(10 citation statements)

References 18 publications

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“…receive SCT during line 1 of therapy. This is consistent with findings from other US-based RW studies utilizing slightly earlier data sets from Flatiron Health[9,10]. Notably, use of PI + IMiD-based initial therapy in our study was higher among the SCT versus no-SCT group (72.2% vs. 49.0%, respectively), whereas PI-based initial therapy was more common in the no-SCT group (15.8% vs. 1.3% in the SCT group).…”

supporting

confidence: 91%

Real‐world multiple myeloma front‐line treatment and outcomes by transplant in the United States

Richter

Pan

Salinardi

et al. 2023

eJHaem

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Stem cell transplantation (SCT) has been an integral treatment modality for multiple myeloma (MM) for decades. However, as standard‐of‐care therapies have improved, the benefit of SCT has been repeatedly called into question. This retrospective study evaluated the association between SCT in the first line of therapy (LOT) and outcomes for patients with newly diagnosed multiple myeloma (NDMM) in the United States. We included patients from a de‐identified electronic health record‐derived database who initiated front‐line MM therapy between January 1, 2016, and January 31, 2022. Overall, 18.8% (1127 of 5996 patients) received SCT in the first LOT. Multivariable‐adjusted Cox proportional hazards models, in which SCT was modeled as time varying, revealed longer real‐world progression‐free survival (rwPFS; hazard ratio [HR] 0.49; 95% confidence interval [CI] 0.43–0.57) and real‐world overall survival (rwOS; HR 0.47; 95% CI 0.39–0.56) for patients who received SCT in the first LOT. The degree of rwPFS and rwOS benefit imparted by SCT was consistent across all subgroups examined, including patients aged ≥75 years, women, non‐Hispanic Black/African American patients, those with renal impairment, and those with high‐risk cytogenetics. Findings from this analysis of real‐world patients with NDMM suggest that SCT remains an important standard of care in the era of novel therapies.

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supporting

confidence: 91%

Real‐world multiple myeloma front‐line treatment and outcomes by transplant in the United States

Richter

Pan

Salinardi

et al. 2023

eJHaem

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“…This is consistent with studies in which outcomes are similar or even better when access to care is the same for Black patients with MM. 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 In the 2019 Surveillance Epidemiology, and End Results program data set, the 5-year relative survival of patients with MM was not different between Black (57.8%) and White (57.9%) patients. 4…”

Section: Discussionmentioning

confidence: 96%

Prevalence and impact of diabetes on survival of patients with multiple myeloma in different racial groups

Shah,

Moshier,

Derkach

et al. 2024

Blood Advances

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Multiple myeloma (MM) is twice as common in Black individuals compared to White, and diabetes mellitus (DM) disproportionately affects Black patients. While numerous studies have shown a correlation between DM and MM, this has not been studied in the context of race and in vivo mechanisms. We conducted a retrospective clinical study of 5383 patients with MM of which 15% had DM (12% White and 25% Black). Multivariable Cox models showed reduced overall survival (OS) for patients with DM (HR 1.27; 95% CI 1.11, 1.47; p<0.001). This appeared to be driven by a marked difference in OS between White patients with and without DM, but not Black patients. In contrast, obesity was associated with better OS in Black patients, but not White patients. To complement this analysis, we assessed MM growth in a genetically engineered immunocompromised non-obese diabetic (Rag1-/-/MKR) mouse model to evaluate the mechanisms linking DM and MM. MM.1S xenografts grew in more Rag1-/-/MKR mice and grew more rapidly in the Rag1-/-/MKR mice compared with controls. Western blot analysis found that MM1.S xenografts from Rag1-/-/MKR mice had higher phospho-S6 ribosomal protein(Ser235/236) levels indicating greater activation of the mammalian target of rapamycin pathway. Our study is the first to evaluate racial differences in DM prevalence and survival in MM as well as the effect of DM on tumor growth in mouse models. Our results suggest that DM may contribute to the higher incidence of MM in Black patients, and to improve survival in MM DM management cannot be ignored.

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“…Frequently, racial-ethnic disparities have been explored as differences amid the predominant Whites and minority NHB, with occasional studies including Hispanics and NHA as well. 9,12,15,16,[19][20][21][22] While such disparities are prevalent and must be addressed, we hypothesized that the factors contributing to them may be unique for a given racial-ethnic group, and as a result, the solutions needed to address them may have to be designed correspondingly. We took a unique approach to explore intra-racial disparities among patients who do or do not receive SCT as part of initial therapy for MM.…”

Section: Discussionmentioning

confidence: 99%

Factors Determining Utilization of Stem Cell Transplant for Initial Therapy of Multiple Myeloma by Patient Race: Exploring Intra-racial Healthcare Disparities.

Ailawadhi,

Adu,

Frank

et al. 2024

Preprint

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Multiple myeloma (MM) therapeutics have evolved tremendously in recent years, with significant improvement in patient outcomes. As newer treatment options are developed, stem cell transplant (SCT) remains an important modality that provides excellent disease control and delays the progression of disease. Over the years, SCT use has increased overall in the U.S., but two distinct gaps remain, including suboptimal use overall, and racial-ethnic disparities. We evaluated the National Cancer Database (NCDB) to study what sociodemographic factors might play a role within a given racial-ethnic group leading to disparate SCT utilization, such that targeted approaches can be developed to optimize SCT use for all. In nearly 112,000 cases belonging to mutually exclusive categories of non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB), Hispanics, non-Hispanic Asians (NHA), and others, we found certain factors including age, comorbidity index, payor type, facility type (academic vs. community) and facility volume to be uniformly associated with SCT use for all the racial-ethnic groups, while gender was not significant for any of the groups. There were several other factors which had a differential impact on SCT utilization among the various race-ethnicity groups studied, including year of diagnosis (significant for NHW, NHB and Hispanics), income level (significant for NHW and Hispanics), literacy level (significant for NHW and NHB), and geographic location of the treatment facility (significant for NHW and NHA). The suboptimal SCT utilization overall in the U.S., suggests that there may be room for improvement for all, even including the majority NHW, while we continue to work on factors that lead to disparities for the traditionally underserved populations. This study helps identify sociodemographic factors that may play a role specifically in each group and paves the way to devise targeted solutions such that resource utilization and impact can be maximized.

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Exploring racial disparities in treatment patterns and outcomes for patients with multiple myeloma using real world data

Cited by 12 publications

References 18 publications

Real‐world multiple myeloma front‐line treatment and outcomes by transplant in the United States

Real‐world multiple myeloma front‐line treatment and outcomes by transplant in the United States

Prevalence and impact of diabetes on survival of patients with multiple myeloma in different racial groups

Factors Determining Utilization of Stem Cell Transplant for Initial Therapy of Multiple Myeloma by Patient Race: Exploring Intra-racial Healthcare Disparities.

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