Comparative Analysis of Baseline Demographics and Outcomes for CAR T-Cell Therapy Versus Autologous Hematopoietic Stem Cell Transplant in Multiple Myeloma Patients
Authors: Iqbal Rabia , Bazaz Aemen Shafqat , Htet Nyan Linn , Bajwa Ahmad Taimoor , Khan Fiqe , Kasire Sripada Preetham , Anwer Faiz 
Published: December 2024

Introduction:
Multiple Myeloma (MM) is a hematological malignancy characterized by abnormal plasma cell proliferation in the bone marrow. Autologous stem cell transplant (ASCT) is a standard treatment for MM. However, more focus has been given to chimeric antigen receptor T cells (CAR-T) as a treatment option in recent years. Research has shown that infusing CAR-T therapy after ASCT in MM patients helps to eliminate the tumor cells.
Objective:
In this study, we analyzed the baseline demographics and mortality in patients undergoing ASCT vs CAR-T therapy.
Methods:
We performed a retrospective analysis using the National Inpatient Sample (NIS) database using the ICD-10 code. We detected patients aged &gt;18 years with the primary diagnosis of Multiple Myeloma (MM). We divided the patients into two groups: those who underwent autologous stem cell transplant and those who received chimeric antigen receptor T cells (CAR-T). We used the chi-square test to analyze categorical variables and the student t-test to analyze continuous variables.
Result:
From 2016 to 2020, the NIS database recorded 580544 patients diagnosed with Multiple Myeloma (MM). Of these, 5% (n=290,27) underwent ASCT, while 0.1% (n=580) received CAR-T therapy as a treatment for MM.
Of patients who underwent ASCT, 44% were females, while the remaining 56% were males. The mean age of the patients was 61 years (p-value &lt;0.01). Analysis of racial distribution showed that 62% (n=17996) of the patients belonged to the white race, 20% (n=5805) belonged to African Americans, and 10% (n=2902) belonged to Hispanics (p-value &lt;0.001). The majority of the patients (77%, n=22,350) were admitted to large-sized hospitals, 12% (n=3483) were admitted to medium size hospitals, and 10% (n=2902) were admitted to smaller hospitals (p-value &lt;0.001). Regarding the hospital region, 23% (n=6676) of the patients were in the Northeast, 26% (n=7547) from the Midwest, 33% (n=9578) from the South, and 16% (n=4644) from the West (p-value &lt;0.001).
Of the patients who received CAR-T therapy, 45% (n=261) were females, while 55% (n=319) were males. The mean age of the patients was 62 years (p-value 0.001). Analysis of racial groups showed that patients included 72% (n=417) white, 14% (n=81) African Americans, and 8% (n=46) Hispanics (p-value 0.2). Most of the patients (78% n=452)) were admitted to large hospitals, 13% (n=75) were admitted to smaller hospitals with fewer beds, and 7% (n=40) were admitted to medium-sized hospitals (p-value 0.009). Almost 42% (n=243) of the patients belonged to the Northeast region,15% (n=87) from the Midwest, 21% (n=121) from the South, and 21% (n=121) from the West (p-value 0.006). The mortality of patients who underwent ASCT was 0.7% (aOR 0.03, p-value &lt;0.001), while it was 1.6% (aOR 11, p-value &lt; 0.007) in patients receiving CAR-T therapy. The mean length of stay (LOS) for ASCT groups was 18 days (p-value 0.1), while it was 27 days for CAR-T therapy. The hospital utilization charges for the ASCT group were $277,632 (p-value &lt; 0.001), while it was $588,388 (p-value &lt;0.001) for CART cell therapy.
Discussion:
Our study concludes that ASCT was more commonly performed than CAR-t cell therapy in the treatment of MM. Patients who underwent ASCT were also slightly younger. The racial distribution among the two groups varied. Our study helps better understand the factors that influence the treatment choice for MM. However, more research is needed to fully understand these factors and the long-term effectiveness of these treatments.