Abstract
BACKGROUND: Race/ethnicity remains an important barrier in clinical care. The authors investigated differences in the receipt of autologous hematopoietic cell transplantation (AHCT) among patients with multiple myeloma (MM) and outcomes based on race/ethnicity in the United States. METHODS: The Center for International Blood and Marrow Transplant Research database was used to identify 28,450 patients who underwent AHCT for MM from 2008 through 2014. By using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results 18 registries, the incidence of MM was calculated, and a stem cell transplantation utilization rate (STUR) was derived. Post-AHCT outcomes were analyzed among patients ages 18 to 75 years who underwent melphalan-conditioned peripheral cell grafts (N = 24,102). RESULTS: The STUR increased across all groups from 2008 to 2014. The increase was substantially lower among Hispanics (range, 8.6%-16.9%) and non-Hispanic blacks (range, 12.2%-20.5%) compared with non-Hispanic whites (range, 22.6%-37.8%). There were 18,046 non-Hispanic whites, 4123 non-Hispanic blacks, and 1933 Hispanic patients. The Hispanic group was younger (P <.001). Fewer patients older than 60 years underwent transplantation among Hispanics (39%) and non-Hispanic blacks (42%) compared with non-Hispanic whites (56%). A Karnofsky score <90% and a hematopoietic cell transplantation comorbidity index score >3 were more common in non-Hispanic blacks compared with Hispanic and non-Hispanic whites (P <.001). More Hispanics (57%) versus non-Hispanic blacks (54%) and non-Hispanic whites (52%; P <.001) had stage III disease. More Hispanics (48%) versus non-Hispanic blacks (45%) and non-Hispanic whites (44%) had a very good partial response or better before transplantation (P =.005). Race/ethnicity did not impact post-AHCT outcomes. CONCLUSIONS: Although the STUR increased, it remained low and was significantly lower among Hispanics followed by non-Hispanic blacks compared with non-Hispanic whites. Race/ethnicity did not impact transplantation outcomes. Efforts to increase the rates of transplantation for eligible patients who have MM, with an emphasis on groups that underuse transplantation, are warranted. Cancer 2017;123:3141–9.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 3141-3149 |
| Number of pages | 9 |
| Journal | Cancer |
| Volume | 123 |
| Issue number | 16 |
| DOIs | |
| State | Published - Aug 15 2017 |
Keywords
- Hispanic
- blacks
- myeloma
- transplantation utilization
ASJC Scopus subject areas
- Oncology
- Cancer Research
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In: Cancer, Vol. 123, No. 16, 15.08.2017, p. 3141-3149.
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}
TY - JOUR
T1 - Hispanics have the lowest stem cell transplant utilization rate for autologous hematopoietic cell transplantation for multiple myeloma in the United States
T2 - A CIBMTR report
AU - Schriber, Jeffrey R.
AU - Hari, Parameswaran N.
AU - Ahn, Kwang Woo
AU - Fei, Mingwei
AU - Costa, Luciano J.
AU - Kharfan-Dabaja, Mohamad A.
AU - Angel-Diaz, Miguel
AU - Gale, Robert P.
AU - Ganguly, Siddharatha
AU - Girnius, Saulius K.
AU - Hashmi, Shahrukh
AU - Pawarode, Attaphol
AU - Vesole, David H.
AU - Wiernik, Peter H.
AU - Wirk, Baldeep M.
AU - Marks, David I.
AU - Nishihori, Taiga
AU - Olsson, Richard F.
AU - Usmani, Saad Z.
AU - Mark, Tomer M.
AU - Nieto, Yago L.
AU - D'Souza, Anita
N1 - Funding Information: This publication is funded in part by the Research and Education Program Fund, a component of the Advancing a Healthier Wisconsin endowment at the Medical College of Wisconsin, and by grant KL2TR001438 from the Clinical and Translational Science Award program of the National Center for Advancing Translational Sciences (to Anita D'Souza). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health. The Center for International Blood and Marrow Transplant Research (CIBMTR) is supported by Public Health Service grant/cooperative agreement 5U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI), and the National Institute of Allergy and Infectious Diseases; a grant/cooperative agreement (5U10HL069294) from the NHLBI and the NCI; a contract (HHSH250201200016C) with the Health Resources and Services Administration (Health Resources and Services Administration/Department of Health and Human Services); 2 grants (N00014-15-1-0848 and N00014-16-1-2020) from the Office of Naval Research; and grants from Alexion; Amgen, Inc. (corporate member); an anonymous donation to the Medical College of Wisconsin; Astellas Pharma US; AstraZeneca; Be the Match Foundation; Bluebird Bio, Inc. (corporate member); Bristol-Myers Squibb Oncology (corporate member); Celgene Corporation (corporate member); Cellular Dynamics International, Inc.; Chimerix, Inc. (corporate member); the Fred Hutchinson Cancer Research Center; Gamida Cell Ltd.; Genentech, Inc.; Genzyme Corporation; Gilead Sciences, Inc. (corporate member); Health Research, Inc.; Roswell Park Cancer Institute; HistoGenetics, Inc.; Incyte Corporation; Janssen Scientific Affairs, LLC; Jazz Pharmaceuticals, Inc. (corporate member); Jeff Gordon Children's Foundation; The Leukemia and Lymphoma Society; Medac, GmbH; MedImmune; The Medical College of Wisconsin; Merck & Company, Inc. (corporate member); Mesoblast; MesoScale Diagnostics, Inc.; Miltenyi Biotec, Inc. (corporate member); the National Marrow Donor Program; Neovii Biotech NA, Inc.; Novartis Pharmaceuticals Corporation; Onyx Pharmaceuticals; Optum Healthcare Solutions, Inc.; Otsuka America Pharmaceutical, Inc.; Otsuka Pharmaceutical Company, Ltd.–Japan; PCORI; Perkin Elmer, Inc.; Pfizer, Inc.; Sanofi US (corporate member); Seattle Genetics (corporate member); Spectrum Pharmaceuticals, Inc. (corporate member); St. Baldrick's Foundation; Sunesis Pharmaceuticals, Inc. (corporate member); Swedish Orphan Biovitrum, Inc.; Takeda Oncology; Telomere Diagnostics, Inc.; the University of Minnesota; and Wellpoint, Inc. (corporate member). The CIBMTR registry is a prospectively maintained transplantation database that collects transplantation data from over 450 centers worldwide. Data are submitted to the Statistical Center at the Medical College of Wisconsin in Milwaukee, where computerized checks for discrepancies, physicians' review of submitted data, and on-site audits of participating centers ensure data quality. Collected data include disease type, age, sex, self-identified race/ethnicity, date of diagnosis, graft type, conditioning regimen, post-transplantation disease progression, survival, and cause of death and along with all transplantations reported to the CIBMTR. Data are collected before transplantation, 100 days and 6 months after transplantation, and annually thereafter until death or last follow-up. Between 2008 and 2014, the CIBMTR captured from 75% to 80% of all autologous transplantations performed in the United States. For the purposes of this study, it was assumed that there was no systematic age, sex, or race/ethnicity biases in reporting AHCT to the CIBMTR. The CIBMTR registry is a prospectively maintained transplantation database that collects transplantation data from over 450 centers worldwide. Data are submitted to the Statistical Center at the Medical College of Wisconsin in Milwaukee, where computerized checks for discrepancies, physicians' review of submitted data, and on-site audits of participating centers ensure data quality. Collected data include disease type, age, sex, self-identified race/ethnicity, date of diagnosis, graft type, conditioning regimen, post-transplantation disease progression, survival, and cause of death and along with all transplantations reported to the CIBMTR. Data are collected before transplantation, 100 days and 6 months after transplantation, and annually thereafter until death or last follow-up. Between 2008 and 2014, the CIBMTR captured from 75% to 80% of all autologous transplantations performed in the United States. For the purposes of this study, it was assumed that there was no systematic age, sex, or race/ethnicity biases in reporting AHCT to the CIBMTR. All US patients registered with the CIBMTR for a first AHCT for MM during the period from 2008 to 2014 were collected (N = 28,450) and used to determine the stem cell transplantation utilization rate (STUR). Only first transplantations were counted. Among these, patients ages 18 to 75 years who underwent peripheral hematopoietic cells with melphalan conditioning, provided informed consent, and had a 100-day follow-up form reported were included in the descriptive and multivariate analyses (N = 24,102). The incidence of MM was obtained from the National Cancer Institute's SEER Program. SEER data are derived from registries covering approximately 27.8% of the US population; we used the SEER 18 database, which contains patients diagnosed from 2002 through 2013. By using publicly available software, which also provides US population estimates (SEER*Stat), we calculated incidence rates per 100,000 persons for the years 2008 through 2013. SEER provides information according to race and ethnicity, yielding the categorization of individuals as Hispanics (irrespective of race), non-Hispanic blacks, and non-Hispanic whites. For patients with MM, SEER provides information on age at diagnosis, sex, and prior and subsequent malignancies, but not on staging, biologic characteristics (including chromosome abnormalities), or the receipt of systemic therapy, including hematopoietic cell transplantation (HCT). We combined MM incidence derived from the SEER program with transplantation activity reported to the CIBMTR for the period from 2008 to 2013 to assess the impact of disparities in AHCT. An estimate of the transplantation rate was calculated. This STUR was defined as the number of new AHCTs in a given year divided by the number of patients with newly diagnosed MM for that year. The number of new AHCTs each year was calculated as the number of AHCTs reported to the CIBMTR divided by the CIBMTR capture rate. Because the estimated CIBMTR capture rate during this time ranged from 75% to 80%, a sensitivity analysis was performed to provide a range to the rate of ±5% for the CIBMTR AHCT transplantation capture rate in each year. Patient-related, disease-related, and treatment-related factors were compared using the chi-square test for categorical variables and the Kruskal-Wallis test for continuous variables. The outcomes analyzed included transplantation-related mortality, relapse/progression, progression-free survival, and overall survival (OS). Estimates of outcomes were reported as probabilities with 95% confidence intervals (CIs). The probability of OS was calculated using the Kaplan-Meier estimator, and variance was estimated with the Greenwood formula. Survival curves were compared using the log-rank test. Multivariate analysis on OS was performed using a Cox proportional-hazards model with race/ethnicity as the main effect. We explored interactions between the main effect and the variables in the final model. The assumption of proportional hazards was tested for each variable, and factors that violated the proportionality assumption were adjusted by stratification. Potential interactions between the main effect and all other significant risk factors were tested. All P values are 2-sided; and, given the large sample size, P values <.01 were considered significant, a priori. Recent studies have confirmed the role of upfront autologous hematopoietic cell transplantation (AHCT) in patients with newly diagnosed multiple myeloma (MM), even in the age of novel induction therapies. Despite these data and continued recommendations from the National Comprehensive Cancer Center (NCCN) that transplantation should be considered in patients who have symptomatic disease, studies from the United States suggest that only approximately 30% of patients with MM undergo transplantation. Understanding barriers is critical to developing strategies to increase the use of AHCT as a therapeutic option. The role of race in the receipt and efficacy of AHCT among patients with MM has been previously studied. Despite a significantly higher incidence of MM among blacks compared with whites, these studies have demonstrated lower utilization rates in blacks. It is noteworthy that studies have also demonstrated no differences in outcomes, such as treatment-related mortality and survival after AHCT for MM, based on race. Data are sparse on the use and efficacy of AHCT in other ethnic groups, especially among patients who self-identify as Hispanic, which is the fastest growing segment of the population in the United States. We used the Center for International Blood and Marrow Transplant Research (CIBMTR) and Surveillance, Epidemiology and End Results (SEER) databases to identify differences in transplantation receipt and outcomes in self-identified racial and ethnic groups among patients with MM who underwent AHCT in the United States. All US patients registered with the CIBMTR for a first AHCT for MM during the period from 2008 to 2014 were collected (N = 28,450) and used to determine the stem cell transplantation utilization rate (STUR). Only first transplantations were counted. Among these, patients ages 18 to 75 years who underwent peripheral hematopoietic cells with melphalan conditioning, provided informed consent, and had a 100-day follow-up form reported were included in the descriptive and multivariate analyses (N = 24,102). The incidence of MM was obtained from the National Cancer Institute's SEER Program. SEER data are derived from registries covering approximately 27.8% of the US population; we used the SEER 18 database, which contains patients diagnosed from 2002 through 2013. By using publicly available software, which also provides US population estimates (SEER*Stat), we calculated incidence rates per 100,000 persons for the years 2008 through 2013. SEER provides information according to race and ethnicity, yielding the categorization of individuals as Hispanics (irrespective of race), non-Hispanic blacks, and non-Hispanic whites. For patients with MM, SEER provides information on age at diagnosis, sex, and prior and subsequent malignancies, but not on staging, biologic characteristics (including chromosome abnormalities), or the receipt of systemic therapy, including hematopoietic cell transplantation (HCT). We combined MM incidence derived from the SEER program with transplantation activity reported to the CIBMTR for the period from 2008 to 2013 to assess the impact of disparities in AHCT. The Center for International Blood and Marrow Transplant Research database was used to identify 28,450 patients who underwent AHCT for MM from 2008 through 2014. By using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results 18 registries, the incidence of MM was calculated, and a stem cell transplantation utilization rate (STUR) was derived. Post-AHCT outcomes were analyzed among patients ages 18 to 75 years who underwent melphalan-conditioned peripheral cell grafts (N = 24,102). Publisher Copyright: © 2017 American Cancer Society
PY - 2017/8/15
Y1 - 2017/8/15
N2 - BACKGROUND: Race/ethnicity remains an important barrier in clinical care. The authors investigated differences in the receipt of autologous hematopoietic cell transplantation (AHCT) among patients with multiple myeloma (MM) and outcomes based on race/ethnicity in the United States. METHODS: The Center for International Blood and Marrow Transplant Research database was used to identify 28,450 patients who underwent AHCT for MM from 2008 through 2014. By using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results 18 registries, the incidence of MM was calculated, and a stem cell transplantation utilization rate (STUR) was derived. Post-AHCT outcomes were analyzed among patients ages 18 to 75 years who underwent melphalan-conditioned peripheral cell grafts (N = 24,102). RESULTS: The STUR increased across all groups from 2008 to 2014. The increase was substantially lower among Hispanics (range, 8.6%-16.9%) and non-Hispanic blacks (range, 12.2%-20.5%) compared with non-Hispanic whites (range, 22.6%-37.8%). There were 18,046 non-Hispanic whites, 4123 non-Hispanic blacks, and 1933 Hispanic patients. The Hispanic group was younger (P <.001). Fewer patients older than 60 years underwent transplantation among Hispanics (39%) and non-Hispanic blacks (42%) compared with non-Hispanic whites (56%). A Karnofsky score <90% and a hematopoietic cell transplantation comorbidity index score >3 were more common in non-Hispanic blacks compared with Hispanic and non-Hispanic whites (P <.001). More Hispanics (57%) versus non-Hispanic blacks (54%) and non-Hispanic whites (52%; P <.001) had stage III disease. More Hispanics (48%) versus non-Hispanic blacks (45%) and non-Hispanic whites (44%) had a very good partial response or better before transplantation (P =.005). Race/ethnicity did not impact post-AHCT outcomes. CONCLUSIONS: Although the STUR increased, it remained low and was significantly lower among Hispanics followed by non-Hispanic blacks compared with non-Hispanic whites. Race/ethnicity did not impact transplantation outcomes. Efforts to increase the rates of transplantation for eligible patients who have MM, with an emphasis on groups that underuse transplantation, are warranted. Cancer 2017;123:3141–9.
AB - BACKGROUND: Race/ethnicity remains an important barrier in clinical care. The authors investigated differences in the receipt of autologous hematopoietic cell transplantation (AHCT) among patients with multiple myeloma (MM) and outcomes based on race/ethnicity in the United States. METHODS: The Center for International Blood and Marrow Transplant Research database was used to identify 28,450 patients who underwent AHCT for MM from 2008 through 2014. By using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results 18 registries, the incidence of MM was calculated, and a stem cell transplantation utilization rate (STUR) was derived. Post-AHCT outcomes were analyzed among patients ages 18 to 75 years who underwent melphalan-conditioned peripheral cell grafts (N = 24,102). RESULTS: The STUR increased across all groups from 2008 to 2014. The increase was substantially lower among Hispanics (range, 8.6%-16.9%) and non-Hispanic blacks (range, 12.2%-20.5%) compared with non-Hispanic whites (range, 22.6%-37.8%). There were 18,046 non-Hispanic whites, 4123 non-Hispanic blacks, and 1933 Hispanic patients. The Hispanic group was younger (P <.001). Fewer patients older than 60 years underwent transplantation among Hispanics (39%) and non-Hispanic blacks (42%) compared with non-Hispanic whites (56%). A Karnofsky score <90% and a hematopoietic cell transplantation comorbidity index score >3 were more common in non-Hispanic blacks compared with Hispanic and non-Hispanic whites (P <.001). More Hispanics (57%) versus non-Hispanic blacks (54%) and non-Hispanic whites (52%; P <.001) had stage III disease. More Hispanics (48%) versus non-Hispanic blacks (45%) and non-Hispanic whites (44%) had a very good partial response or better before transplantation (P =.005). Race/ethnicity did not impact post-AHCT outcomes. CONCLUSIONS: Although the STUR increased, it remained low and was significantly lower among Hispanics followed by non-Hispanic blacks compared with non-Hispanic whites. Race/ethnicity did not impact transplantation outcomes. Efforts to increase the rates of transplantation for eligible patients who have MM, with an emphasis on groups that underuse transplantation, are warranted. Cancer 2017;123:3141–9.
KW - Hispanic
KW - blacks
KW - myeloma
KW - transplantation utilization
UR - http://www.scopus.com/inward/record.url?scp=85018446637&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85018446637&partnerID=8YFLogxK
U2 - 10.1002/cncr.30747
DO - 10.1002/cncr.30747
M3 - Article
C2 - 28472539
AN - SCOPUS:85018446637
SN - 0008-543X
VL - 123
SP - 3141
EP - 3149
JO - Cancer
JF - Cancer
IS - 16
ER -