Race and Outcomes of Autologous Hematopoietic Cell Transplantation for Multiple Myeloma

Received 11 September 2009; accepted 8 November 2009. published online 16 November 2009.

Blacks are twice as likely to develop and die from multiple myeloma (MM), and are less likely to receive an autologous hematopoietic-cell transplant (AHCT) for MM compared to Whites. The influence of race on outcomes of AHCT for MM is not well described. We compared the probability of overall survival (OS), progression-free survival (PFS), disease progression, and nonrelapse mortality (NRM) among Black (N=303) and White (N=1892) recipients of AHCT for MM, who were reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) from 1995 to 2005. The Black cohort was more likely to be female, and had better Karnofsky performance scores, but lower hemoglobin and albumin levels at diagnosis. Black recipients were younger and more likely to be transplanted later in their disease course. Disease stage and treatment characteristics prior to AHCT were similar between the 2 groups. Black and White recipients had similar probabilities of 5-year OS (52% versus 47%, P=.19) and PFS (19% versus 21%, P=.64) as well as cumulative incidences of disease progression (72% versus 72%, P=.97) and NRM (9% versus 8%, P=.52). In multivariate analyses, race was not associated with any of these endpoints. Black recipients of AHCT for MM have similar outcomes compared to Whites, suggesting that the reasons underlying lower rates of AHCT in Blacks need to be studied further to ensure equal access to effective therapy.

Key Words: Autologous hematopoietic cell transplantation, Multiple myeloma, Race, Survival, Progression-free survival

1 Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin

2 Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota

3 University of Minnesota, Minneapolis Minnesota

4 Medical College of Wisconsin, Milwaukee, Wisconsin

5 Massachusetts General Hospital, Boston, Massachusetts

6 Blood and Marrow Transplant Group of Georgia, Atlanta, Georgia

7 Bristol Haematology and Oncology Centre, Bristol, United Kingdom

8 South Texas Veterans Health Care System and University of Texas Health Center at San Antonio, San Antonio, Texas

9 Royal Prince Alfred Hospital, Camperdown, Australia

10 A Children's Hospital, Saint Petersburg, Florida

11 Fred Hutchinson Cancer Research Center, Seattle, Washington

12 Baylor College of Medicine, Houston, Texas

13 Mayo Clinic, Rochester Minnesota

14 University Hospitals Case Medical Center, Cleveland, Ohio

15 Texas Transplant Institute, San Antonio, Texas

16 University of Nebraska Medical Center, Omaha, Nebraska

17 Hospital Univarstario Clementino Frago Filho, Rio de Janeiro, Brazil

18 Roswell Park Cancer Institute, Buffalo New York

19 Angelica Ocampo-Hospital and Research Center, Fundaleu Buenos Aires, Argentina

20 National Marrow Donor Program, Minneapolis, Minnesota

21 University of Toronto, Toronto, Ontario, Canada

22 CancerCare Manitoba, Manitoba, Canada

23 Merck & Co. Inc., Wilmington, Delaware

24 Loyola University Health System, Maywood, Illinois

25 Walter Reed Army Medical Center, Washington, DC

26 New York Medical College, Bronx, New York

27 University of Arkansas, Little Rock, Arkansas

Correspondence and reprint requests: Parameswaran Hari, MD, MS, CIBMTR, Medical College of Wisconsin, P.O. Box 26509, 8701 Watertown Plank Road, Milwaukee, WI 53226.

Financial disclosure: See Acknowledgments on page 401.

PII: S1083-8791(09)00524-2

doi:10.1016/j.bbmt.2009.11.007

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