title: Disparities in black and white patients with multiple myeloma referred for autologous hematopoietic transplantation: a single center study.
abstract: BACKGROUND
  Racial disparity in the incidence of multiple myeloma is well established; however, to the authors' knowledge, little is known regarding the impact of racial differences on disease characteristics, response to therapy, and clinical outcome.
  
  
  METHODS
  The authors studied 453 patients (174 of whom were black and 279 of whom were white) who underwent transplant between 2000 and 2013. The median follow-up was 4.4 years.
  
  
  RESULTS
  Black patients were significantly younger than white patients (median age, 54 years vs 59 years; P<.0001), more frequently presented with anemia (P = .04), had more of the immunoglobulin G isotype (P<.001), and had a borderline favorable cytogenetic risk (P = .06). Overall response to induction was similar, but deeper responses were observed in more white patients compared with black patients receiving immunomodulatory drug-based induction (P = .02). Referral for transplant was significantly delayed in black individuals (median, 1.3 years vs 0.9 years; P = .003). Overall survival from the time of transplant was similar for black and white patients, with medians of 6.2 years and 5.7 years, respectively, but survival from the time of diagnosis was significantly longer among black individuals (median, 7.7 years vs 6.1 years; P = .03). Maintenance therapy was found to positively impact progression-free survival but not overall survival, irrespective of race.
  
  
  CONCLUSIONS
  The results of the current study confirm ethnic differences in age, referral patterns, response to therapy, and overall survival. Future validation of these disparities is urgently needed.
authors.affiliation: Marlene & Stewart, Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland.
authors.forename: Vishal
authors.initials: V
authors.lastname: Bhatnagar
authors.forename: Yin
authors.initials: Y
authors.lastname: Wu
authors.forename: Olga G
authors.initials: OG
authors.lastname: Goloubeva
authors.forename: Kathleen T
authors.initials: KT
authors.lastname: Ruehle
authors.forename: Todd E
authors.initials: TE
authors.lastname: Milliron
authors.forename: Carolynn G
authors.initials: CG
authors.lastname: Harris
authors.forename: Aaron P
authors.initials: AP
authors.lastname: Rapoport
authors.forename: Saul
authors.initials: S
authors.lastname: Yanovich
authors.forename: Edward A
authors.initials: EA
authors.lastname: Sausville
authors.forename: Maria R
authors.initials: MR
authors.lastname: Baer
authors.forename: Ashraf Z
authors.initials: AZ
authors.lastname: Badros
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000208:ethnology / Q000401:mortality / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000208:ethnology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D014182:Transplantation, Autologous; D044465:White People / Q000706:statistics & numerical data*
keywords: African Americans; black; disparities; induction; maintenance; multiple myeloma; white