LACK of ASSOCIATION BETWEEN Race and Probability of TRANSPLANT AMONG PATIENTS Referred for Hematopoietic CELL TRANSPLANTATION (HCT) for MULTIPLE Myeloma

As documented in recently published large database reviews, race appears to be a barrier to the access to HCT. Hypotheses as to why this may be the case include (but are not limited to): 1. patient preference; 2. delayed time to referral from community physicians to transplant centers; 3. delays in transplant once evaluated by a transplant center; 4. Possible increased prevalence of comorbidities among racial minorities referred for transplant. We attempt to address some of these issues by reviewing our 20-year experience with transplantation for multiple myeloma.

We queried our core clinical database for potential associations between race and the following parameters: 1. Median interval between date of diagnosis and date of referral; 2. Median interval between date of initial visit and date of transplant 3. Probability of actually receiving a transplant following formal evaluation by a transplant physician by race; 4. Type of transplant recommended 5. Reasons for not receiving a transplant.

Between January 1990 and June 2011, 441 patients with multiple myeloma were referred to our center for consideration of HCT, of whom 293 (66%) were Caucasian, 94 (21%) were African American (AA), 27 (6%) were of unknown race, and 27 (6%) were of other races. The median interval from diagnosis to referral for transplant for AA patients was 145 days, versus 137 days for Caucasian patients (p=0.32). Fifty-three of the 94 AA patients (56%), versus 157 of the 293 Caucasian patients (54%) have received at least one transplant to date (p=0.72). The median interval between the date of the initial visit to our transplant center and the occurrence of an initial transplant was 120 days for AA, versus 150 days for Caucasians (p=0.39). The probability of being transplanted on an allogeneic or hybrid (auto-allo) initial transplant protocol was 0% for AA making it to transplant vs 6% for Caucasions making it to transplant (p=0.07). Reasons for not receiving a transplant are indicated in Table 1 (global p-value = 0.94).

African American and Caucasian patients with myeloma have similar intervals from diagnosis to referral, similar intervals from referral to transplant, and are equally likely to actually receive a transplant once referral to the transplant center took place. Therefore, the reported barrier to transplantation for myeloma patients appears to be prior to referral to the transplant center.

No relevant conflicts of interest to declare.