Abstract 4913: Differences in presentation and survival outcomes for African American patients with newly diagnosed multiple myeloma
Authors: Joseph Nisha , Gupta Vikas A. , Hofmeister Craig , Gleason Charise , Heffner Leonard T. , Jonathan Kafuman L. , Boise Lawrence H. , Dhodapkar Madhav D. , Lonial Sagar , Nooka Ajay K. 
Published: August 2019

Background: Though the incidence of MM is threefold higher in the African American (AA) population compared to Caucasians, reported long term outcomes are less favorable presumably due to inequities in access to healthcare. We have conducted a retrospective analysis of our institutional data of 1000 patients treated with RVD induction therapy, assessing differences in presentation, disease biology, and outcomes in AA patients.

Methods: A total of 1000 newly diagnosed MM patients were treated with RVD induction therapy from January 1st 2005 until August 31st 2016. Dose adjustments were made based on physician’s discretion and patient tolerability. Demographic and outcomes data for the patients were obtained from our IRB approved myeloma database and responses were evaluated per IMWG Uniform Response Criteria.

Results: 56.4%of patients were white (W), and 33.9% were AA, consistent with the demographic representation of the state of GA and our institutional referral population. Median age was 61 years (range 16-83), 57 for AA patients (range, 24-83) compared to 62 (range, 16-81) in white patients, suggesting the onset is earlier among AA. In regard to stage, AA: 73.9% stage I/II, 26.1% stage III; W: 77.1% stage I/II, 22.9% stage III, showing no difference in prognostic staging at presentation. There was no statistically significant difference in the presenting labs between AA and whites except for hemoglobin, with more AA patients presenting with Hgb≤9.9 g/dL (45.7% AA vs 32.5% W, p &lt;.0001). In terms of prevalence of high-risk cytogenetics, there was no significant difference between the two cohorts in: complex karyotype, t(4;14), t(11;14) or del1p. However, there were significant differences found in the rates of: amp 1q 19.2% W/10.6% AA, (p&lt;.0001), del13 28.3% W/19.6% AA (p=.003), and del17p 11.7% W/7.2% AA (p=.019). There was no significant difference in the number of patients who underwent ASCT (84% W vs 82% AA, p=.241), nor in ≥VGPR rates post-induction and 100 days post-ASCT. Median PFS for the entire cohort was 63 months, 62 months (54-69.9) for white patients versus 65 months (53-76.9) for AA patients (p=0.403). At a median follow up of 38 months, median OS has not yet been reached.

Conclusions: This is the largest reported cohort of myeloma patients treated with RVD induction, with one-third of the patients representing the AA population. In our dataset, AAs are diagnosed 5 years younger, with lower hemoglobin at presentation and lower rates of amp1q, del13 and del17p when compared to whites. When offered the same induction regimen and opportunity for ASCT, AAs tend to experience the same survival benefits as their white counterparts. The lack of significant difference in PFS or OS suggests standardization and improved access to care could lead to better long-term outcomes in the AA population.

Note: This abstract was not presented at the meeting.

Citation Format: Nisha Joseph, Vikas A. Gupta, Craig Hofmeister, Charise Gleason, Leonard T. Heffner, Kafuman L. Jonathan, Lawrence H. Boise, Madhav D. Dhodapkar, Sagar Lonial, Ajay K. Nooka. Differences in presentation and survival outcomes for African American patients with newly diagnosed multiple myeloma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4913.