Racial differences in treatment and outcomes in multiple myeloma: a multiple myeloma research foundation analysis
Racial differences in treatment and outcomes in multiple myeloma: a multiple myeloma research foundation analysis
复制标题
DOI：
10.1038/s41408-020-00347-6
复制
发表时间：
2020-08-07
影响因子：
12.8
通讯作者：
Chiu, Brian C-H
中科院分区：
文献类型：
--
作者：
Derman, Benjamin A.;Jasielec, Jagoda;Chiu, Brian C-H
关于多发性骨髓瘤（MM）生存率的种族差异的研究结果尚不确定。我们评估了MM研究基金会CoMMPass登记中心639例新诊断MM患者中白色和黑色个体之间结局的差异，这些患者具有基线细胞遗传学数据。使用Kaplan-Meier方法构建存活曲线。风险比和95%置信区间来自考克斯比例风险回归模型。白人（n = 526）和黑人（n = 113）之间的年龄、性别和分期相似。与白人相比，黑人的总生存期（OS）较差，并且不太可能接受三联疗法或一线自体干细胞移植（ASCT）。多因素分析显示，以下因素与OS较差显著相关：较高的国际分期系统（ISS）评分、>= 1或>= 2例高危细胞遗传学异常（HRCA）、高危基因表达谱（GEP）和缺乏ASCT。在黑人亚组的多变量分析发现，只有缺乏ASCT与较差的OS显着相关。接受三联诱导和ASCT仅部分消除种族对生存的影响。HRCA没有追踪黑人的生存率，强调需要种族特异性风险预测方案来指导最佳MM治疗。
Findings on racial differences in survival in multiple myeloma (MM) have been inconclusive. We assessed differences in outcomes between White and Black individuals among 639 newly diagnosed MM patients in the MM Research Foundation CoMMpass registry with baseline cytogenetic data. Survival curves were constructed using the Kaplan-Meier method. Hazard ratios and 95% confidence intervals were derived from Cox proportional hazard regression models. Age, gender, and stage were similar between Whites (n = 526) and Blacks (n = 113). Blacks had inferior overall survival (OS) compared with Whites and were less likely to receive triplet therapies or frontline autologous stem cell transplant (ASCT). The following factors were significantly associated with inferior OS in multivariate analysis: higher international staging system (ISS) score, >= 1 or >= 2 high-risk cytogenetic abnormalities (HRCA), high-risk gene expression profile (GEP), and lack of ASCT. Multivariate analysis in the Black subset found that only lack of ASCT was significantly associated with inferior OS. The receipt of both triplet induction and ASCT only partly abrogated the effect of race on survival. HRCA did not track with survival in Blacks, emphasizing the need for race-specific risk prognostication schema to guide optimal MM therapy.