Background: Black patients with multiple myeloma (MM) have poorer outcomes than their white counterparts. This has largely been attributed to reduced access to health care; however, little data exists comparing the disease and overall health status at MM presentation between the two races. More severe disease burden, symptom burden, or comorbidities could also explain the differences in outcome.

Objective: To compare disease burden, symptom burden, and comorbidities between black and white patients with MM.

Methods: Two datasets were analyzed: 1) the Multiple Myeloma Research Foundation (MMRF) CoMMpass study interim analysis 6, and 2) the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS) 2015 dataset (SEER years 1973-2011; MHOS years 1998-2013). The CoMMpass dataset included 625 patients who completed the EORTC QLQ-C30 and QLQ-MY20 at MM diagnosis. The SEER-MHOS dataset included 377 patients who completed the HOS survey the year of or year prior to MM diagnosis. All patients identified as a race other than white or black/African American were excluded. Data was analyzed using SPSS 21. Categorical variables were compared using χ2, continuous with the Mann-Whitney U test.

Results: CoMMpass: 585 patients were eligible for analysis. 477 (82%) were white, 108 (19%) were black. Whites and blacks were similar in median age, but a significantly higher percentage of white patients were female (p=0.027). Overall, black patients were more likely to be stage III (p=0.041), have higher LDH (p=0.006) and creatinine (p=0.001), and lower hemoglobin (p<0.001), but were more likely to have CD117+ MM cells (p=0.049). While quality of life measures were similar between the two races, white race was associated with better performance status (p=0.021). Results are summarized in Table 1. SEER-MHOS: 275 patients were eligible for analysis. 234 (85%) were white, 41 (15%) were black. Whites and blacks were similar in median age and sex distribution; there were no significant (p<0.05) differences in quality of life measures or comorbidities between the two races. Results are summarized in Table 2.

Conclusions: The presentation of MM was similar between blacks and whites, but black patients tended to have a higher disease burden than whites. Despite this, both races reported similar symptom burden. Further studies are required to determine if higher disease burden account for part of the outcome disparities seen between the two races.

Table 1.

CoMMpass

White
n= 477		Black
n = 108		p
Demographics 
Age in years  65 63 NS 
Female 63% 49% 0.027 
Disease Burden 
ISS Stage   0.041 
Stage I/II 71% 61%  
Stage III 29% 40%  
Heavy Chain   NS 
IgG 78% 81%  
IgA 22% 19%  
Light Chain    NS 
Kappa 60% 73%  
Lambda 38% 27%  
Biclonal 2% 0%  
Serum M-Protein g/dL  2.9 2.5 NS 
LDH ukat/L  2.8 3.0 0.006 
Bone Marrow Plasma Cells* 9% 9% NS 
Circulating Plasma Cells* 0% 0% NS 
Calcium mmol/L 2.4 2.4 NS 
Creatinine umol/L 93 111 0.001 
Hgb mmol/L 6.7 6.0 <0.001 
Platelets x109/L  213 207 NS 
Bone Lesions 56% 51% NS 
Molecular Characteristics 
Abnormal Karyotype 43% 39% NS 
Deletion 13 31% 32% NS 
Deletion 17p 20% 16% NS 
Translocation 11;14  19% 14% NS 
Translocation 4;14  10% 8% NS 
Phenotype** 
CD13+ 22% 27% NS 
CD20+ 17% 10% NS 
CD33+ 27% 29% NS 
CD52+ 12% 10% NS 
CD56+ 78% 79% NS 
CD117+  56% 67% 0.049 
FGFR3+  15% 13% NS 
Symptom Burden/Quality of Life 
ECOG Performance Status   0.021 
0-1 87% 78%  
2-4 13% 22%  
Global Health Scale 58 66 NS 
Physical Functioning Scale 80 73 NS 
Cognitive Functioning Scale 83 83 NS 
Emotional Functioning Scale 75  83  NS 
Social Functioning Scale 66 66 NS 
Role Functioning Scale 66 50 NS 
Disease Symptom Scale 22 27  NS 
Fatigue Scale 33 33 NS 
Pain Scale 33 33 NS 
White
n= 477		Black
n = 108		p
Demographics 
Age in years  65 63 NS 
Female 63% 49% 0.027 
Disease Burden 
ISS Stage   0.041 
Stage I/II 71% 61%  
Stage III 29% 40%  
Heavy Chain   NS 
IgG 78% 81%  
IgA 22% 19%  
Light Chain    NS 
Kappa 60% 73%  
Lambda 38% 27%  
Biclonal 2% 0%  
Serum M-Protein g/dL  2.9 2.5 NS 
LDH ukat/L  2.8 3.0 0.006 
Bone Marrow Plasma Cells* 9% 9% NS 
Circulating Plasma Cells* 0% 0% NS 
Calcium mmol/L 2.4 2.4 NS 
Creatinine umol/L 93 111 0.001 
Hgb mmol/L 6.7 6.0 <0.001 
Platelets x109/L  213 207 NS 
Bone Lesions 56% 51% NS 
Molecular Characteristics 
Abnormal Karyotype 43% 39% NS 
Deletion 13 31% 32% NS 
Deletion 17p 20% 16% NS 
Translocation 11;14  19% 14% NS 
Translocation 4;14  10% 8% NS 
Phenotype** 
CD13+ 22% 27% NS 
CD20+ 17% 10% NS 
CD33+ 27% 29% NS 
CD52+ 12% 10% NS 
CD56+ 78% 79% NS 
CD117+  56% 67% 0.049 
FGFR3+  15% 13% NS 
Symptom Burden/Quality of Life 
ECOG Performance Status   0.021 
0-1 87% 78%  
2-4 13% 22%  
Global Health Scale 58 66 NS 
Physical Functioning Scale 80 73 NS 
Cognitive Functioning Scale 83 83 NS 
Emotional Functioning Scale 75  83  NS 
Social Functioning Scale 66 66 NS 
Role Functioning Scale 66 50 NS 
Disease Symptom Scale 22 27  NS 
Fatigue Scale 33 33 NS 
Pain Scale 33 33 NS 

Median presented unless specified

*- CD38+/CD138+ by flow cytometry

**- performed on CD38+/CD138+ bone marrow cells

View Large

Table 2.

SEER-MHOS

White
n= 234		Black
n = 41		p
Demographics 
Age in years  77 75 NS 
Female 46% 41% NS 
Symptom Burden/Quality of Life 
General Health Scale 54 59 NS 
Physical Functioning Scale 58 70 NS 
Emotional Well-Being Scale 80  82 NS 
Social Functioning Scale 75 88 NS 
Role Limitation Physical Scale 25 50 NS 
Role Limitation Emotional Scale 100 100 NS 
Energy/Fatigue Scale 50 55 NS 
Pain Scale 51 57 NS 
Comorbidities 
Prior Malignancy 21% 10% NS 
Hypertension 60% 68% NS 
Coronary Artery Disease 16% 8% NS 
Congestive Heart Failure 7% 0% NS 
Myocardial Infarction 12% 10% NS 
Cerebral Vascular Accident 10% 10% NS 
Chronic Obstructive Pulmonary Disease 13% 12% NS 
Diabetes 81% 78% NS 
Obesity 20% 11% NS 
White
n= 234		Black
n = 41		p
Demographics 
Age in years  77 75 NS 
Female 46% 41% NS 
Symptom Burden/Quality of Life 
General Health Scale 54 59 NS 
Physical Functioning Scale 58 70 NS 
Emotional Well-Being Scale 80  82 NS 
Social Functioning Scale 75 88 NS 
Role Limitation Physical Scale 25 50 NS 
Role Limitation Emotional Scale 100 100 NS 
Energy/Fatigue Scale 50 55 NS 
Pain Scale 51 57 NS 
Comorbidities 
Prior Malignancy 21% 10% NS 
Hypertension 60% 68% NS 
Coronary Artery Disease 16% 8% NS 
Congestive Heart Failure 7% 0% NS 
Myocardial Infarction 12% 10% NS 
Cerebral Vascular Accident 10% 10% NS 
Chronic Obstructive Pulmonary Disease 13% 12% NS 
Diabetes 81% 78% NS 
Obesity 20% 11% NS 
View Large

Median presented unless specified

Disclosures

Vij:Takeda, Onyx: Research Funding; Celgene, Onyx, Takeda, Novartis, BMS, Sanofi, Janssen, Merck: Consultancy.

Topics:
continental population groups, multiple myeloma, obesity, creatinine, fatigue, hemoglobin, pain scale, antigens, cd98 light chains, bone lesion, calcium

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2015 by The American Society of Hematology
2015
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