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Treatment Disparities in Minority Groups with Multiple Myeloma at a Large Safety-Net Hospital
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| Zeitschriftentitel: | Blood |
|---|---|
| Personen und Körperschaften: | , , , , , |
| In: | Blood, 132, 2018, Supplement 1, S. 4864-4864 |
| Format: | E-Article |
| Sprache: | Englisch |
| veröffentlicht: |
American Society of Hematology
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| Schlagwörter: |
| author_facet |
Dennis, Michael Cirstea, Diana Maoz, Asaf Lerner, Adam Patel, Ami K. Sarosiek, Shayna Dennis, Michael Cirstea, Diana Maoz, Asaf Lerner, Adam Patel, Ami K. Sarosiek, Shayna |
|---|---|
| author |
Dennis, Michael Cirstea, Diana Maoz, Asaf Lerner, Adam Patel, Ami K. Sarosiek, Shayna |
| spellingShingle |
Dennis, Michael Cirstea, Diana Maoz, Asaf Lerner, Adam Patel, Ami K. Sarosiek, Shayna Blood Treatment Disparities in Minority Groups with Multiple Myeloma at a Large Safety-Net Hospital Cell Biology Hematology Immunology Biochemistry |
| author_sort |
dennis, michael |
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Dennis, Michael Cirstea, Diana Maoz, Asaf Lerner, Adam Patel, Ami K. Sarosiek, Shayna 0006-4971 1528-0020 American Society of Hematology Cell Biology Hematology Immunology Biochemistry http://dx.doi.org/10.1182/blood-2018-99-118472 <jats:title>Abstract</jats:title> <jats:p>Background: Outcomes in multiple myeloma (MM) have improved in recent years, but disparities among racial-ethnic groups persist (Costa, 2017; Ailawadhi, 2012; Waxman, 2010). Differences in disease biology, treatment modalities, and access to care are likely explanations for these disparities. Currently the preferred induction therapy for MM is a three-drug regimen, such as bortezomib/cyclophosphamide/dexamethasone (VCD), bortezomib/lenalidomide/dexamethasone (VRD) or carfilzomib/pomalidomide/dexamethasone (KPd). This is often followed by high-dose melphalan with autologous stem cell transplant (HDM/SCT) and maintenance therapy. Older or frail adults may not tolerate this three-drug approach or HDM/SCT. Two-drug regimens without HDM/SCT are acceptable options in these groups. This retrospective study was designed to explore the utilization of preferred induction therapy and HDM/SCT across racial-ethnic groups at Boston Medical Center.</jats:p> <jats:p>Results: One hundred sixty-eight patients with MM were treated at our institution between 2004 and 2017. Sixty-six percent were non-Hispanic Black (NHB), 20% were non-Hispanic White (NHW), and 14% were Hispanic. The average age was 63 years and 56% of the population was male. There was no significant difference in age or sex between the NHB, NHW, and Hispanic groups. Only 83 patients (49%) received a three-drug induction regimen. Forty-six (51%) were < 65 years old, while 37 (48%) were ≥ 65 years old. The utilization of standard induction therapy was significantly different among racial-ethnic groups < 65 years old. Thirteen NHW patients (76%) received triplet induction therapy, compared to only 10 Hispanics (63%) and 23 NHB patients (40%) (p=0.02). A similar trend was observed in regards to treatment with HDM/SCT within the first year after diagnosis for patients age < 65 years and triplet therapy in patients undergoing HDM/SCT (any age), although these trends did not reach statistical significance (47% NHWs, 31% Hispanics, and 28% NHBs, p=0.31 and 91% NHWs, 78% Hispanics, and 58% NHBs, p=0.11 respectively). There were no significant differences among groups age ≥ 65 years in regards to triplet induction therapy, HDM/SCT within the first year, or HDM/SCT any time after diagnosis. The median time to HDM/SCT and overall survival were not significantly different between racial-ethnic groups, regardless of age above or below 65 years.</jats:p> <jats:p>Conclusion: NHB and Hispanic patients less than 65 years old are less likely to receive a standard three-drug induction regimen. There is also a trend towards fewer patients receiving HDM/SCT in the first year after diagnosis among these groups compared to NHW patients. Our study did not confirm a survival benefit in NHB patients under age 65, which has been reported in prior studies (Fillmore, 2018; Waxman, 2010). The lack of benefit seen in this study could be related to lower rates of three-drug induction therapy and HDM/SCT in the NHB group. Further research is needed to explore patient co-morbidities, socioeconomic factors, and physician biases to determine why minority groups have less utilization of standard therapies.</jats:p> <jats:p>Table. Table.</jats:p> <jats:sec> <jats:title>Disclosures</jats:title> <jats:p>No relevant conflicts of interest to declare.</jats:p> </jats:sec> Treatment Disparities in Minority Groups with Multiple Myeloma at a Large Safety-Net Hospital Blood |
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Biologie Medizin Chemie und Pharmazie |
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American Society of Hematology |
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| title |
Treatment Disparities in Minority Groups with Multiple Myeloma at a Large Safety-Net Hospital |
| title_unstemmed |
Treatment Disparities in Minority Groups with Multiple Myeloma at a Large Safety-Net Hospital |
| title_full |
Treatment Disparities in Minority Groups with Multiple Myeloma at a Large Safety-Net Hospital |
| title_fullStr |
Treatment Disparities in Minority Groups with Multiple Myeloma at a Large Safety-Net Hospital |
| title_full_unstemmed |
Treatment Disparities in Minority Groups with Multiple Myeloma at a Large Safety-Net Hospital |
| title_short |
Treatment Disparities in Minority Groups with Multiple Myeloma at a Large Safety-Net Hospital |
| title_sort |
treatment disparities in minority groups with multiple myeloma at a large safety-net hospital |
| topic |
Cell Biology Hematology Immunology Biochemistry |
| url |
http://dx.doi.org/10.1182/blood-2018-99-118472 |
| publishDate |
2018 |
| physical |
4864-4864 |
| description |
<jats:title>Abstract</jats:title>
<jats:p>Background: Outcomes in multiple myeloma (MM) have improved in recent years, but disparities among racial-ethnic groups persist (Costa, 2017; Ailawadhi, 2012; Waxman, 2010). Differences in disease biology, treatment modalities, and access to care are likely explanations for these disparities. Currently the preferred induction therapy for MM is a three-drug regimen, such as bortezomib/cyclophosphamide/dexamethasone (VCD), bortezomib/lenalidomide/dexamethasone (VRD) or carfilzomib/pomalidomide/dexamethasone (KPd). This is often followed by high-dose melphalan with autologous stem cell transplant (HDM/SCT) and maintenance therapy. Older or frail adults may not tolerate this three-drug approach or HDM/SCT. Two-drug regimens without HDM/SCT are acceptable options in these groups. This retrospective study was designed to explore the utilization of preferred induction therapy and HDM/SCT across racial-ethnic groups at Boston Medical Center.</jats:p>
<jats:p>Results: One hundred sixty-eight patients with MM were treated at our institution between 2004 and 2017. Sixty-six percent were non-Hispanic Black (NHB), 20% were non-Hispanic White (NHW), and 14% were Hispanic. The average age was 63 years and 56% of the population was male. There was no significant difference in age or sex between the NHB, NHW, and Hispanic groups. Only 83 patients (49%) received a three-drug induction regimen. Forty-six (51%) were < 65 years old, while 37 (48%) were ≥ 65 years old. The utilization of standard induction therapy was significantly different among racial-ethnic groups < 65 years old. Thirteen NHW patients (76%) received triplet induction therapy, compared to only 10 Hispanics (63%) and 23 NHB patients (40%) (p=0.02). A similar trend was observed in regards to treatment with HDM/SCT within the first year after diagnosis for patients age < 65 years and triplet therapy in patients undergoing HDM/SCT (any age), although these trends did not reach statistical significance (47% NHWs, 31% Hispanics, and 28% NHBs, p=0.31 and 91% NHWs, 78% Hispanics, and 58% NHBs, p=0.11 respectively). There were no significant differences among groups age ≥ 65 years in regards to triplet induction therapy, HDM/SCT within the first year, or HDM/SCT any time after diagnosis. The median time to HDM/SCT and overall survival were not significantly different between racial-ethnic groups, regardless of age above or below 65 years.</jats:p>
<jats:p>Conclusion: NHB and Hispanic patients less than 65 years old are less likely to receive a standard three-drug induction regimen. There is also a trend towards fewer patients receiving HDM/SCT in the first year after diagnosis among these groups compared to NHW patients. Our study did not confirm a survival benefit in NHB patients under age 65, which has been reported in prior studies (Fillmore, 2018; Waxman, 2010). The lack of benefit seen in this study could be related to lower rates of three-drug induction therapy and HDM/SCT in the NHB group. Further research is needed to explore patient co-morbidities, socioeconomic factors, and physician biases to determine why minority groups have less utilization of standard therapies.</jats:p>
<jats:p>Table. Table.</jats:p>
<jats:sec>
<jats:title>Disclosures</jats:title>
<jats:p>No relevant conflicts of interest to declare.</jats:p>
</jats:sec> |
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| author | Dennis, Michael, Cirstea, Diana, Maoz, Asaf, Lerner, Adam, Patel, Ami K., Sarosiek, Shayna |
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| description | <jats:title>Abstract</jats:title> <jats:p>Background: Outcomes in multiple myeloma (MM) have improved in recent years, but disparities among racial-ethnic groups persist (Costa, 2017; Ailawadhi, 2012; Waxman, 2010). Differences in disease biology, treatment modalities, and access to care are likely explanations for these disparities. Currently the preferred induction therapy for MM is a three-drug regimen, such as bortezomib/cyclophosphamide/dexamethasone (VCD), bortezomib/lenalidomide/dexamethasone (VRD) or carfilzomib/pomalidomide/dexamethasone (KPd). This is often followed by high-dose melphalan with autologous stem cell transplant (HDM/SCT) and maintenance therapy. Older or frail adults may not tolerate this three-drug approach or HDM/SCT. Two-drug regimens without HDM/SCT are acceptable options in these groups. This retrospective study was designed to explore the utilization of preferred induction therapy and HDM/SCT across racial-ethnic groups at Boston Medical Center.</jats:p> <jats:p>Results: One hundred sixty-eight patients with MM were treated at our institution between 2004 and 2017. Sixty-six percent were non-Hispanic Black (NHB), 20% were non-Hispanic White (NHW), and 14% were Hispanic. The average age was 63 years and 56% of the population was male. There was no significant difference in age or sex between the NHB, NHW, and Hispanic groups. Only 83 patients (49%) received a three-drug induction regimen. Forty-six (51%) were < 65 years old, while 37 (48%) were ≥ 65 years old. The utilization of standard induction therapy was significantly different among racial-ethnic groups < 65 years old. Thirteen NHW patients (76%) received triplet induction therapy, compared to only 10 Hispanics (63%) and 23 NHB patients (40%) (p=0.02). A similar trend was observed in regards to treatment with HDM/SCT within the first year after diagnosis for patients age < 65 years and triplet therapy in patients undergoing HDM/SCT (any age), although these trends did not reach statistical significance (47% NHWs, 31% Hispanics, and 28% NHBs, p=0.31 and 91% NHWs, 78% Hispanics, and 58% NHBs, p=0.11 respectively). There were no significant differences among groups age ≥ 65 years in regards to triplet induction therapy, HDM/SCT within the first year, or HDM/SCT any time after diagnosis. The median time to HDM/SCT and overall survival were not significantly different between racial-ethnic groups, regardless of age above or below 65 years.</jats:p> <jats:p>Conclusion: NHB and Hispanic patients less than 65 years old are less likely to receive a standard three-drug induction regimen. There is also a trend towards fewer patients receiving HDM/SCT in the first year after diagnosis among these groups compared to NHW patients. Our study did not confirm a survival benefit in NHB patients under age 65, which has been reported in prior studies (Fillmore, 2018; Waxman, 2010). The lack of benefit seen in this study could be related to lower rates of three-drug induction therapy and HDM/SCT in the NHB group. Further research is needed to explore patient co-morbidities, socioeconomic factors, and physician biases to determine why minority groups have less utilization of standard therapies.</jats:p> <jats:p>Table. Table.</jats:p> <jats:sec> <jats:title>Disclosures</jats:title> <jats:p>No relevant conflicts of interest to declare.</jats:p> </jats:sec> |
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| spelling | Dennis, Michael Cirstea, Diana Maoz, Asaf Lerner, Adam Patel, Ami K. Sarosiek, Shayna 0006-4971 1528-0020 American Society of Hematology Cell Biology Hematology Immunology Biochemistry http://dx.doi.org/10.1182/blood-2018-99-118472 <jats:title>Abstract</jats:title> <jats:p>Background: Outcomes in multiple myeloma (MM) have improved in recent years, but disparities among racial-ethnic groups persist (Costa, 2017; Ailawadhi, 2012; Waxman, 2010). Differences in disease biology, treatment modalities, and access to care are likely explanations for these disparities. Currently the preferred induction therapy for MM is a three-drug regimen, such as bortezomib/cyclophosphamide/dexamethasone (VCD), bortezomib/lenalidomide/dexamethasone (VRD) or carfilzomib/pomalidomide/dexamethasone (KPd). This is often followed by high-dose melphalan with autologous stem cell transplant (HDM/SCT) and maintenance therapy. Older or frail adults may not tolerate this three-drug approach or HDM/SCT. Two-drug regimens without HDM/SCT are acceptable options in these groups. This retrospective study was designed to explore the utilization of preferred induction therapy and HDM/SCT across racial-ethnic groups at Boston Medical Center.</jats:p> <jats:p>Results: One hundred sixty-eight patients with MM were treated at our institution between 2004 and 2017. Sixty-six percent were non-Hispanic Black (NHB), 20% were non-Hispanic White (NHW), and 14% were Hispanic. The average age was 63 years and 56% of the population was male. There was no significant difference in age or sex between the NHB, NHW, and Hispanic groups. Only 83 patients (49%) received a three-drug induction regimen. Forty-six (51%) were < 65 years old, while 37 (48%) were ≥ 65 years old. The utilization of standard induction therapy was significantly different among racial-ethnic groups < 65 years old. Thirteen NHW patients (76%) received triplet induction therapy, compared to only 10 Hispanics (63%) and 23 NHB patients (40%) (p=0.02). A similar trend was observed in regards to treatment with HDM/SCT within the first year after diagnosis for patients age < 65 years and triplet therapy in patients undergoing HDM/SCT (any age), although these trends did not reach statistical significance (47% NHWs, 31% Hispanics, and 28% NHBs, p=0.31 and 91% NHWs, 78% Hispanics, and 58% NHBs, p=0.11 respectively). There were no significant differences among groups age ≥ 65 years in regards to triplet induction therapy, HDM/SCT within the first year, or HDM/SCT any time after diagnosis. The median time to HDM/SCT and overall survival were not significantly different between racial-ethnic groups, regardless of age above or below 65 years.</jats:p> <jats:p>Conclusion: NHB and Hispanic patients less than 65 years old are less likely to receive a standard three-drug induction regimen. There is also a trend towards fewer patients receiving HDM/SCT in the first year after diagnosis among these groups compared to NHW patients. Our study did not confirm a survival benefit in NHB patients under age 65, which has been reported in prior studies (Fillmore, 2018; Waxman, 2010). The lack of benefit seen in this study could be related to lower rates of three-drug induction therapy and HDM/SCT in the NHB group. Further research is needed to explore patient co-morbidities, socioeconomic factors, and physician biases to determine why minority groups have less utilization of standard therapies.</jats:p> <jats:p>Table. Table.</jats:p> <jats:sec> <jats:title>Disclosures</jats:title> <jats:p>No relevant conflicts of interest to declare.</jats:p> </jats:sec> Treatment Disparities in Minority Groups with Multiple Myeloma at a Large Safety-Net Hospital Blood |
| spellingShingle | Dennis, Michael, Cirstea, Diana, Maoz, Asaf, Lerner, Adam, Patel, Ami K., Sarosiek, Shayna, Blood, Treatment Disparities in Minority Groups with Multiple Myeloma at a Large Safety-Net Hospital, Cell Biology, Hematology, Immunology, Biochemistry |
| title | Treatment Disparities in Minority Groups with Multiple Myeloma at a Large Safety-Net Hospital |
| title_full | Treatment Disparities in Minority Groups with Multiple Myeloma at a Large Safety-Net Hospital |
| title_fullStr | Treatment Disparities in Minority Groups with Multiple Myeloma at a Large Safety-Net Hospital |
| title_full_unstemmed | Treatment Disparities in Minority Groups with Multiple Myeloma at a Large Safety-Net Hospital |
| title_short | Treatment Disparities in Minority Groups with Multiple Myeloma at a Large Safety-Net Hospital |
| title_sort | treatment disparities in minority groups with multiple myeloma at a large safety-net hospital |
| title_unstemmed | Treatment Disparities in Minority Groups with Multiple Myeloma at a Large Safety-Net Hospital |
| topic | Cell Biology, Hematology, Immunology, Biochemistry |
| url | http://dx.doi.org/10.1182/blood-2018-99-118472 |