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

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.

Differences in survival among multiple myeloma patients in the United States SEER population by neighborhood socioeconomic status and race/ethnicity

“…Recent data suggest that disparities exist in the use of novel myeloma therapies and suggest that a lack of access to treatment could result in poorer patient outcomes. [22] In one study, receipt of autologous stem cell transplant (ASCT) was associated with improved overall survival among patients with MM; this increased survival was notably higher among White patients compared with Black patients, and adults with higher SES compared to adults with lower SES [23].…”

Socioeconomic Status Is Globally a Prognostic Factor for Overall Survival of Multiple Myeloma Patients; Synthesis of Studies and Review of the Literature

“…), meaning that ASCT can overcome biological differences among racial subgroups or that equality of treatment overcomes all racial disparities. 16 , 17 , 18 A recent study by Munshi et al conducted on army veterans showed that O.S. disparities across different races are lost and possibly reversed when all patients have the same insurance and access to health system providers.…”

Phase 2 study of venetoclax plus carfilzomib and dexamethasone in patients with relapsed/refractory multiple myeloma

“…13,40 In previous venetoclax monotherapy and combination therapy studies, improved responses to venetoclax were observed in patients with t(11;14) RRMM. 13,14,20 [41][42][43] Notably, Black patients with MM are less likely to receive triplet therapies or frontline stem cell transplantation, 43 the latter of which improves survival in patients with t(11;14). 42 The limited number of Black or African American patients enrolled in this study, of which only 3 had t (11;14), precludes assessment of outcomes by race and supports the observed underrepresentation of racial minorities in cancer trials in general.…”