Variations in Multiple Myeloma Disease Presentation By Race

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 χ 2, 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. | | White n= 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 1. CoMMpass | | White n= 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 | Table 2. SEER-MHOS Median presented unless specified Disclosures Vij: Takeda, Onyx: Research Funding; Celgene, Onyx, Takeda, Novartis, BMS, Sanofi, Janssen, Merck: Consultancy.