Variations in Multiple Myeloma Disease Presentation By Race
Authors: Fiala Mark A , Wildes Tanya M , Slade Michael , Keller Jesse , Stockerl-Goldstein Keith , Tomasson Michael , Vij Ravi 
Published: October 2019

Abstract
Background: Black patients with multiple myeloma (MM) have poorer outcomes than their white counterparts. This has largely been attributed to reduced access to health care; however, little data exists comparing the disease and overall health status at MM presentation between the two races. More severe disease burden, symptom burden, or comorbidities could also explain the differences in outcome.
Objective: To compare disease burden, symptom burden, and comorbidities between black and white patients with MM.
Methods: Two datasets were analyzed: 1) the Multiple Myeloma Research Foundation (MMRF) CoMMpass study interim analysis 6, and 2) the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS) 2015 dataset (SEER years 1973-2011; MHOS years 1998-2013). The CoMMpass dataset included 625 patients who completed the EORTC QLQ-C30 and QLQ-MY20 at MM diagnosis. The SEER-MHOS dataset included 377 patients who completed the HOS survey the year of or year prior to MM diagnosis. All patients identified as a race other than white or black/African American were excluded. Data was analyzed using SPSS 21. Categorical variables were compared using χ2, continuous with the Mann-Whitney U test.
Results: CoMMpass: 585 patients were eligible for analysis. 477 (82%) were white, 108 (19%) were black. Whites and blacks were similar in median age, but a significantly higher percentage of white patients were female (p=0.027). Overall, black patients were more likely to be stage III (p=0.041), have higher LDH (p=0.006) and creatinine (p=0.001), and lower hemoglobin (p<0.001), but were more likely to have CD117+ MM cells (p=0.049). While quality of life measures were similar between the two races, white race was associated with better performance status (p=0.021). Results are summarized in Table 1. SEER-MHOS: 275 patients were eligible for analysis. 234 (85%) were white, 41 (15%) were black. Whites and blacks were similar in median age and sex distribution; there were no significant (p<0.05) differences in quality of life measures or comorbidities between the two races. Results are summarized in Table 2.
Conclusions: The presentation of MM was similar between blacks and whites, but black patients tended to have a higher disease burden than whites. Despite this, both races reported similar symptom burden. Further studies are required to determine if higher disease burden account for part of the outcome disparities seen between the two races.
Table 1. CoMMpass Whiten= 477 Black n = 108 p Demographics Age in years 65 63 NS Female 63% 49% 0.027 Disease Burden ISS Stage 0.041 Stage I/II 71% 61% Stage III 29% 40% Heavy Chain NS IgG 78% 81% IgA 22% 19% Light Chain NS Kappa 60% 73% Lambda 38% 27% Biclonal 2% 0% Serum M-Protein g/dL 2.9 2.5 NS LDH ukat/L 2.8 3.0 0.006 Bone Marrow Plasma Cells* 9% 9% NS Circulating Plasma Cells* 0% 0% NS Calcium mmol/L 2.4 2.4 NS Creatinine umol/L 93 111 0.001 Hgb mmol/L 6.7 6.0 <0.001 Platelets x109/L 213 207 NS Bone Lesions 56% 51% NS Molecular Characteristics Abnormal Karyotype 43% 39% NS Deletion 13 31% 32% NS Deletion 17p 20% 16% NS Translocation 11;14 19% 14% NS Translocation 4;14 10% 8% NS Phenotype** CD13+ 22% 27% NS CD20+ 17% 10% NS CD33+ 27% 29% NS CD52+ 12% 10% NS CD56+ 78% 79% NS CD117+ 56% 67% 0.049 FGFR3+ 15% 13% NS Symptom Burden/Quality of Life ECOG Performance Status 0.021 0-1 87% 78% 2-4 13% 22% Global Health Scale 58 66 NS Physical Functioning Scale 80 73 NS Cognitive Functioning Scale 83 83 NS Emotional Functioning Scale 75 83 NS Social Functioning Scale 66 66 NS Role Functioning Scale 66 50 NS Disease Symptom Scale 22 27 NS Fatigue Scale 33 33 NS Pain Scale 33 33 NS Median presented unless specified *- CD38+/CD138+ by flow cytometry **- performed on CD38+/CD138+ bone marrow cells
Table 2. SEER-MHOS Whiten= 234 Black n = 41 p Demographics Age in years 77 75 NS Female 46% 41% NS Symptom Burden/Quality of Life General Health Scale 54 59 NS Physical Functioning Scale 58 70 NS Emotional Well-Being Scale 80 82 NS Social Functioning Scale 75 88 NS Role Limitation Physical Scale 25 50 NS Role Limitation Emotional Scale 100 100 NS Energy/Fatigue Scale 50 55 NS Pain Scale 51 57 NS Comorbidities Prior Malignancy 21% 10% NS Hypertension 60% 68% NS Coronary Artery Disease 16% 8% NS Congestive Heart Failure 7% 0% NS Myocardial Infarction 12% 10% NS Cerebral Vascular Accident 10% 10% NS Chronic Obstructive Pulmonary Disease 13% 12% NS Diabetes 81% 78% NS Obesity 20% 11% NS
Median presented unless specified

Disclosures
Vij: Takeda, Onyx: Research Funding; Celgene, Onyx, Takeda, Novartis, BMS, Sanofi, Janssen, Merck: Consultancy.