Association between race and treatment patterns and survival outcomes in multiple myeloma: A Connect MM Registry analysis

Abstract

Background: Studies have reported racial disparities in access to and use of multiple myeloma (MM) treatments between African American (AA) and White patients. Although AA patients demonstrate longer disease-specific survival, this has not uniformly translated into improved survival over time. The association between race and treatment patterns and survival outcomes was analyzed using data from the Connect MM Registry.

Methods: The Connect MM Registry is a large US, multicenter, prospective observational cohort study of patients with newly diagnosed MM. Patients who received first-line (1L) stem cell transplantation (SCT) or who did not receive SCT (non-SCT or non-stem cell transplantation [NSCT]) were grouped by raceEffects of race and transplantation status on the use of triplet treatment were estimated using logistic regression.

Results: Treatment patterns in 1L (types and duration of induction, posttransplantation maintenance) were similar between AA and White patients. SCT rates in 1L (32% vs 36%) and triplet treatment use (AA: 44% for NSCT patients and 72% for SCT patients; and White: 48% for NSCT patients and 72% for SCT patients) during first induction were similar. No significant effect of race or transplantation status on 1L triplet treatment use was observed. Race was not found to be associated with survival outcomes among patients who underwent NSCT; however, AA patients who received SCT had significantly longer overall survival compared with White patients who underwent SCT (not reached vs 88.2 months; hazard ratio, 0.56; 95% CI, 0.35-0.89 [P = .0141]).

Conclusions: AA and White patients were found to have similar treatment patterns in the Connect MM Registry, suggesting that both groups had equal access to health care. In this real-world setting, AA patients received standard-of-care treatment, which might have contributed to better MM-specific survival compared with White patients.

Keywords: African American; myeloma; race; survival; treatment.

Conflict of interest statement

Sikander Ailawadhi has acted as a paid consultant for Bristol‐Myers Squibb for work performed as part of the current study and has acted as a paid consultant for Takeda Pharmaceuticals, Novartis, Celgene, A Bristol‐Myers Squibb Company, Amgen, and Sanofi; has received institutional research funding from AstraZeneca, Ascentage Pharma, Pharmacyclics LLC, and Amgen; and has received other fees from Janssen and Cellectar Biosciences Inc for work performed outside of the current study. Sundar Jagannath has acted as a paid consultant/member of the advisory board for Celgene, A Bristol‐Myers Squibb Company, AbbVie, Karyopharm Therapeutics, Janssen Pharmaceuticals, Merck and Company, Bristol‐Myers Squibb, and Novartis, and has participated in speakers' bureaus for MMRF and Medicom for work performed outside of the current study. Hans C. Lee has acted as a paid consultant for Adaptive Biotechnologies, Amgen, Celgene, A Bristol‐Myers Squibb Company, Pimera, and Takeda Pharmaceuticals; has received research funding from Amgen, Celgene, A Bristol‐Myers Squibb Company, Daiichi Sankyo, Eutropics Pharmaceuticals, Janssen Pharmaceutical, Prothena Corporation, and Takeda Pharmaceuticals; has received grants and personal fees from GlaxoSmithKline; and has received personal fees from Sanofi for work performed outside of the current study. Mohit Narang has acted as a paid consultant and participated in speakers' bureaus for Celgene, A Bristol‐Myers Squibb Company and has participated in speakers' bureaus for Janssen. Robert M. Rifkin has acted as a paid consultant/member of the advisory board for Amgen, Boehringer Ingelheim, Bristol‐Myers Squibb/Celgene, A Bristol‐Myers Squibb Company, EMD Serono, Sandoz, and Takeda Pharmaceuticals for work performed outside of the current study and owns stock in McKesson. Howard R. Terebelo has acted as a member of the scientific advisory board for Bristol‐Myers Squibb for work performed as part of the current study and has acted as a paid consultant for Celgene, A Bristol‐Myers Squibb Company and participated in speakers' bureaus for Janssen, Takeda Pharmaceuticals, and Pharmacyclics LLC. Brian G.M. Durie has acted in a consulting or advisory role for Amgen, Janssen, Celgene, A Bristol‐Myers Squibb Company, and Takeda Pharmaceuticals. Kathleen Toomey participated in speakers’ bureaus for Myriad Genetics, and received travel reimbursement from Dava Oncology. Kathleen Toomey has acted as a member of the advisory board for Celgene, A Bristol‐Myers Squibb Company/Bristol‐Myers Squibb for work performed as part of the current study. James W. Hardin has received payment for services on the Connect MM scientific advisory board from Celgene, A Bristol‐Myers Squibb Company/Bristol‐Myers Squibb for work performed as part of and outside of the current study. Cristina J. Gasparetto has acted as paid consultant, member of the advisory board, and member of the speakers' bureau for Celgene, A Bristol‐Myers Squibb Company/Bristol‐Myers Squibb; has acted as a member of the advisory board and speakers' bureau for Karyopharm and Sanofi; has acted as a member of the advisory board for GlaxoSmithKline and AbbVie; has acted as a member of the advisory board and as a paid consultant for Adaptive and Janssen; has acted as a paid consultant for Takeda Pharmaceuticals; has received travel reimbursement from Janssen, Bristol‐Myers Squibb, and Celgene, A Bristol‐Myers Squibb Company; and has received research funding from Celgene, A Bristol‐Myers Squibb Company for work performed outside of the current study. Lynne Wagner has acted as a paid member of the Connect MM Steering Committee for Celgene, A Bristol‐Myers Squibb Company as part of the current study; has received honoraria for her role as a Section Editor for Cancer from the American Cancer Society; and has acted as a paid scientific consultant for EveryFit, Gilead, and Janssen. James L. Omel has received honoraria from and is a member of the board of directors/advisory committee for Takeda Oncology and Celgene, A Bristol‐Myers Squibb Company. Mia He, Lihua Yue, Elizabeth Dawn Flick, and Amit Agarwal are employed by Bristol‐Myers Squibb. Rafat Abonour is a member of steering committees for Celgene, A Bristol‐Myers Squibb Company and Takeda Pharmaceuticals and has received research funding from Celgene, A Bristol‐Myers Squibb Company, Takeda Pharmaceuticals, and Prothena.

© 2020 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.

Figures

Figure 1

Adjusted duration of (A) induction therapy in patients who underwent non–stem cell transplantation* and (B) posttransplantation maintenance therapy in patients who underwent stem cell transplantation† by racial group. *Adjusted for the following covariates: cohort, age group, history of asymptomatic myeloma, family history of other cancers, sex, calcium, creatinine, hemoglobin, calculated ISS stage, pathological fractures. †Adjusted for the following covariates: cohort, age group, bone lesions/osteopenia/fractures, calculated ISS stage, family history of other cancers, pathological fractures. AA indicates African American; HR, hazard ratio; ISS, International Staging System.

Figure 2

Adjusted (A and B) progression‐free survival (PFS) in patients who underwent stem cell transplantation (SCT)* and non–stem cell transplantation (NSCT)† and (C and D) overall survival (OS) in patients who underwent SCT* and NSCT† by racial group. *100 days postSCT. Patients with first disease progression/death before transplant + 100 days (n = 23 for PFS, n = 11 for OS) were excluded. Adjusted for the following covariates: cohort, age group, family history of other cancers, history of MGUS, history of smoldering myeloma, hemoglobin, calculated ISS stage, sex. †Adjusted for the following covariates: cohort, age group, history of asymptomatic myeloma, history of amyloidosis, family history of other cancers, sex, calcium, hemoglobin, calculated ISS stage. AA indicates African American; HR, hazard ratio; ISS, International Staging System; MGUS, monoclonal gammopathy of undetermined significance; NR, not reported.