Analysis Finds White, African American Patients Have Similar Access to Optimal MM Treatments

A new analysis of treatment patterns and survival outcomes in white and African American people with multiple myeloma (MM) finds the two groups seemed to have equal access to standard-of-care treatment.

The findings contradict some earlier research, which suggested that African American patients had not benefited equally from new therapies.

Corresponding author Sikander Ailawadhi, MD, of Mayo Clinic Florida, and colleagues report on their findings in the journal Cancer.¹

The investigators noted that a previous comparison using the Surveillance Epidemiology and End Results (SEER) registry found 5-year relative survival rates of African Americans with MM improved only marginal after the introduction of autologous stem cell transplantation (SCT) and the development of novel drugs, while at the same time white patients had statistically significant improvement in survival.² Other studies raised similar concerns, Ailawadhi and colleagues said, prompting them to conduct the new analysis.

The resulting study leverages data from the Connect MM Registry, a multicenter, prospective observational cohort of people in the US who were newly diagnosed with MM. The registry yielded 2,837 patients in total, of whom 397 were African American and 2,440 were white. The first patients were enrolled in 2009 and the cutoff date for the data in the study was August of 2018.

The authors quantified how many patients were given first-line SCT and the duration of post-transplantation maintenance in those who underwent SCT. Other endpoints were first-line triplet therapy, as well as overall survival (OS) and progression-free survival (PFS).

The investigators found 32% of African American and 36% of white patients received first-line SCT. Rates of triplet therapy in first induction were also similar. Among those receiving SCT, triplet use rates were 72% for both African American and white patients. Among those who did not receive SCT, triplet therapy rates were 44% for African American patients and 48% for white patients. Neither race nor transplantation status appeared to play a statistically significant role in whether or not a patient received first-line triplet therapy, the authors said.

Race did not affect OS in patients who did not receive SCT. However, in patients who did receive SCT, African American patients had longer survival compared to white patients (not reached versus 88.2 months).

Ailawadhi and colleagues noted that the African American cohort tended to be younger, but they said that even after adjusting for age, African American SCT patients still had a survival advantage. Another factor could be that African American patients had longer durations of maintenance therapy. The longer length was not statistically significant, they said, but it might have played a role in their superior survival rates.

As for the conflict between their findings and the findings of the SEER study, Ailawadhi said one factor could be that patients in the SEER database are required to be in the database, while those in the Connect MM Registry chose to be enrolled.

“Voluntary participation in a registry (in contrast to the required participation in SEER) might favor the enrollment of better-insured and better-informed patients who are treated by physicians who follow similar practices (e.g., evidence-based medicine), which could lead to more homogenous treatment patterns and help to reduce the treatment disparities that have been observed in population-based studies,” the investigators wrote.

However, the authors also noted that the Connect MM Registry is primarily made up of patients receiving care in the community setting, and thus it offers a better view of real-world practice than studies based only on data from clinical trial settings.

They concluded that their study underscores the importance of taking proactive steps to ensure new therapies are rolled out equally across racial and other lines, and to ensure that survival benefits are shared equally.

References:

1. Ailawadhi S, Jagannath S, Lee HC, et al. Association between race and treatment patterns and survival outcomes in multiple myeloma: A Connect MM Registry analysis. Cancer. Published online July 24, 2020. doi:10.1002/cncr.33089
2. Waxman AJ, Mink PJ, Devesa SS, et al. Racial disparities in incidence and outcome in multiple myeloma: a population-based study. Blood. 2010;116(25):5501-5506. doi:10.1182/blood-2010-07-298760