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Background:
Upfront ASCT in eligible patients (pts) is currently considered a standard of care and has been shown to improve disease free survival and overall survival (OS) in randomized trials. The incidence of MM in AA population is twice compared to the Caucasian (C) population and the mortality rates are higher in AA pts with MM. The plausible reasons for this are higher incidence of poor risk disease, less upfront exposure to novel agents, lower referral rate for ASCT and poor access to health care. The aim of our study is to identify differences in clinical characteristics and outcomes in two groups.
Methods:
We performed a retrospective analysis in MM pts who underwent ASCT at Karmanos Cancer Center between January 2009 and May 2013. Comparisons of continuous variables between the two groups were assessed using student t-test and Wilcox log Rank Sum test; Chi-square test was used for categorical variables. Kaplan Meier curves were performed to assess survival and disease progression over time.
Results:
During this time 92 AA and 317 C patients underwent ASCT. Median follow-up was 721 days in AA (IQR, 392 – 1103) versus (vs.) 735 days in C (IQR, 375 – 1124). The mean age of AA at time of transplant was significantly lower than that of Caucasian pts (55.67 ± 8 years vs. 57.74 ± 8 years, p = .032). Durie-Salmon stage distribution was similar in two groups with about 60% of patients in stage III at diagnosis. Cytogenetic risk distribution was similar in two groups: (AA vs. C) standard risk 82% vs. 86%; intermediate risk 16% vs. 10%, p = 0.17; high risk 1.5% vs. 4%, p = 0.34. Disease status at the time of transplant was CR in 8% AA vs. 21% C (p=0.03), VGPR in 42% AA vs. 29% C (p=0.66) and PR in 34% AA vs. 33% C. The median time from diagnosis to ASCT in AA was significantly longer than that for C {288 days; IQR (216.75 – 677.50) vs. 213 days; IQR (173.50 – 371.50), p= <0.001}. Induction therapy prior to transplant consisted of novel agent (proteasome inhibitor and/or immunomodulatory agent) based regimens in all patients. Median number of cycles of induction therapy was 5 (range 4-16) vs. 4 (range 3-22) cycles in AA vs. C. Preparative regimen for ASCT was Melphalan 140mg/m2 in 31% vs. 26% (AA vs. C) and Melphalan 200mg/m2 in the rest. Rate of disease progression after two year median follow-up was higher in the AA pts 39% vs. 27%, OR 1.75 (1.08-2.85), p = 0.02 (Figure 1). There was no difference in the overall survival in two groups after median follow-up of two years 86% vs. 90%, OR 1.47 (0.73 – 2.93) p = 0.27 (Figure 2).
Conclusion:
AA pts are diagnosed with MM at a younger age as compared with C population. Time from diagnosis of MM to referral to ASCT in the AA patients is longer than in the C. In addition, the rate of disease progression post-ASCT is higher in AA pts.
