Targeted Interventions Benefit African Americans With Multiple Myeloma

African Americans have a disproportionately high prevalence of multiple myeloma (MM), and interventions targeted to specific factors may improve their outcomes, a study based on data from the National Cancer Database (NCDB) reported at the 2024 ASCO Annual Meeting.

“The analysis highlights significant demographic and treatment influences among African American patients with MM. Some identifiable factors associated with improved outcomes include younger age, female sex, private insurance, treatment in academic centers, and most importantly receipt of transplant and Immunotherapy,” Niraj Neupane, MD, and his coauthors wrote in their abstract, which also appears in Journal of Clinical Oncology.

To investigate factors that affect the disease’s progression, severity, and prognosis, the research team analyzed data from 241,446 patients with multiple myeloma underin the NCDB between 2010 and 2020. The researchers examined age, sex, insurance status, education, median household income, and they used multivariate Cox regression analysis to identify factors that influenced survival outcomes.

The mean age of the 51,668 Black patients with MM was 64.4 years, with 50.2% of cases occurring between 40 and 65 years of age, 47.3% over 65, and 2.5% between 18 and 40. Females accounted for 51.5% of cases, and most households earned less than $40,227 annually. The mean duration from diagnosis to therapy initiation was 37.5 days, with 83.8% of Black patients not receiving a transplant and 73.1% not receiving an immune-based option. On multivariate analysis (P<0.001 for all below) the researchers found that:

• Patients older than 65 had worse outcomes (HR, 1.52; 95% CI, 1.47-1.57) compared to those younger than 65.
• Better outcomes were found in females (HR, 0.88; 95% CI, 0.86- 0.91), patients with private insurance, (HR, 0.73; 95% CI, 0.68- 0.78), those treated in academic centers (HR, 0.89; 95% CI, 0.87- 0.92), patients receiving any form of transplant (HR, 0.45; 95% CI, 0.42-0.49), those undergoing chemotherapy (HR, 0.73; 95% CI, 0.68-0.78) and immunotherapy (HR, 0.67; 95% CI, 0.64-0.69).

“These findings underscore the importance of targeted interventions considering various factors and improving outcomes in this population,” the authors noted.

Slower Smoldering MM Progression in Older African Americans

In a related retrospective, single-site study presented at the 2022 ASCO Annual Meeting, Theresia Akhlaghi, MD, and her coauthors found that African American patients with smoldering multiple myeloma had lower risk for progression to MM than did White patients. Although both groups had similar Mayo-2018 risk scores, the African American patients had lower baseline immunoparesis.

MM incidence is two to three times higher in African American than in White patients when adjusted for socioeconomics, age, and sex, the researchers wrote in their abstract and in Journal of Clinical Oncology. But information on whether racial background affects the risk for progression from smoldering MM to MM is limited.

Dr. Akhlaghi and her colleagues analyzed data from patients with smoldering MM who presented to one academic cancer treatment center between 2000 and 2019. At baseline, the median age among the 70 patients who identified as African American was 60 years in and among the 506 who identified as White was 64 (P=0.01). The median follow-up time was 3 years for African Americans and 4 years for Whites.

The authors collected baseline laboratory, imaging, and pathology data. They analyzed the data using Kruskal-Wallis and chi-square tests, Kaplan-Meier analysis with log-rank tests, univariate, and multivariate Cox proportional hazard models.

The median hemoglobin was 12.3g/dL in African Americans and 12.8g/dL in Whites (P=0.02). Immunoparesis including one or two uninvolved immunoglobulins was 31% and 10%, respectively, in African Americans versus 56% and 27%, respectively, in Whites (P =0.002). Both groups were similar in bone marrow plasma cells, M-spike, free light chain ratio, and Mayo-2018 smoldering MM risk score. The researchers found that:

• African Americans had significantly lower risk for progression in the univariate model (HR, 0.57; CI, 0.34-0.94) and in the multivariate model that adjusted for age, sex, and variables linked with increased risk for progression in the univariate model: bone marrow plasma cells, M-spike, free light chain ratio, immunoparesis and low albumin (HR, 0.39; CI, 0.16-0.95).
• African American patients with smoldering multiple myeloma had a significantly longer median time to progression than Whites (9.7 vs. 6.2 years; P=0.027), and lower 2-year (12.6% vs. 20.1%) and 5-year (34% vs. 44.6%) progression rates than Whites.
• Among patients 65 years of age and older, African Americans had longer time to progression than Whites (9.8 vs. 5.2 years; P=0.02).

“Future studies are needed to better understand if these differences are explained by differences in disease biology including genomic mechanisms, immune microenvironment, and systemic immune response,” the authors advised.