Race as a predictor of outcome in young patients with myeloma.
Authors: Cottini Francesca , Bao Alicia , Sharma Nidhi , Khan Abdullah Mohammad , Bumma Naresh , Chaudhry Maria , Devarakonda Srinivas S. , Efebera Yvonne Adeduni , Rosko Ashley Elizabeth , Benson Don M. 
Published: June 2021

e20019

Background: Multiple myeloma (MM) is a malignancy that affects Black Americans (BA) more often and at earlier age than White Americans (WA). BAs still frequently receive suboptimal care and are underrepresented in clinical trials or retrospective analyses. However, recent studies have shown that BA MM patients treated with standard-of-care regimens have similar if not superior outcomes than WA patients. The median age of MM diagnosis is 69 years; but ten percent of individuals develop MM before age of 50 years. Limited data are available regarding the outcomes and characteristics of this younger patient population. Herein, we specifically investigate the outcome of young MM patients. Methods: We retrospectively analyzed young MM patients (age < 50) diagnosed between 1992 and 2016 at The Ohio State University Comprehensive Cancer Center. After informed consent, data pertaining to patient demographics and MM characteristics were collected in a coded database. Descriptive statistics was used to summarize disease characteristics; chi-square or Wilcoxon rank-sum tests were used to compare outcomes between BA and WA patients. Overall Survival (OS) was estimated by Kaplan-Meier method, with log-rank test applied to test the statistical differences between survival curves. Two-sided p-values <0.05 were considered statistically significant. Results: In our institutional database, we identified 264 individuals who developed MM before age of 50 years (median age=46; range: 17-50 years). 211 of them had matched cytogenetic studies and were included in the final analysis. The majority of these patients were male (66%), had IgG disease (47%), and stage II-III at presentation (52%). 196 of patients (93%) underwent at least one autologous stem cell transplant-ASCT, with 23 of them receiving more than one ASCT (15%) and 9 of them undergoing allogeneic stem cell transplant (4%). In all, median OS was 9.84 years (95% CI, 6.75-12.92 years), which is higher than in unselected older MM patients. 24% of the patients (n=51) were BA while the remaining (n=160) were WA. We observed no statistical differences in terms of patient characteristics, disease stage, or cytogenetics between BA or WA, except for a statistically significant prevalence of del(13q) in WA patients (39% vs. 30%; p= 0.012). In our cohort, BA and WA patients received transplant at similar rates (94% vs. 88%, p-value=0.137). Finally, we observed an inferior median OS of 8.59 years (95% CI, 6.40-10.78 years) in WA compared with BA patients (median OS: not reached; p-value= 0.038), with 5-year OS of 86% in BA compared with 65% in WA patients. Conclusions: We report a retrospective cohort of young MM patients. In our cohort, we observed less prevalence of del(13q) and superior OS of BA compared with age-matched WA patients. This suggests that young BA MM patients benefit from standard-of-care approaches and strategies should continue to be pursued to improve access to care and optimize treatments.