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Outcomes after auto-SCT in African Americans with multiple myeloma
Y Khaled1, M H Abidi, N Janakiraman
1Blood and Marrow Transplant Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI 48109-0914, USA. ykhaled@umich.edu
Bone Marrow Transplantation
|January 14, 2009
Summary
African Americans (AA) with multiple myeloma (MM) experience early relapses post-autologous stem cell transplant (auto-SCT). Prognostic factors in Caucasian Americans may not apply to AA patients, necessitating further research.
Area of Science:
- Hematology
- Oncology
- Transplant Medicine
Background:
- Multiple myeloma (MM) outcomes can vary significantly across different racial groups.
- Autologous stem cell transplant (auto-SCT) is a standard treatment for MM, but its efficacy in African Americans (AA) requires further investigation.
- Traditional prognostic factors identified in Caucasian American (CA) MM patients may not be universally applicable.
Purpose of the Study:
- To evaluate the impact of auto-SCT on progression-free survival (PFS) and overall survival (OS) in African American (AA) patients with multiple myeloma (MM).
- To identify prognostic factors associated with outcomes after auto-SCT in AA MM patients.
- To determine the applicability of established prognostic variables from Caucasian American (CA) cohorts to AA MM patients.
Main Methods:
- Retrospective analysis of 101 consecutive African American (AA) patients with multiple myeloma (MM) who underwent auto-SCT.
- Evaluation of pre- and post-transplant prognostic variables, including beta-2 microglobulin (B2M), cytogenetics, response status, and treatment history.
- Univariate and multivariate analyses to identify predictors of PFS and OS.
Main Results:
- Median PFS was 15.6 months and median OS was 50.8 months. Median OS from diagnosis was 60 months.
- Traditional prognostic factors (B2M, chromosome 13 deletion, CR status, gender, stage, Ig subtype, time to transplant, prior regimens, lytic lesions) were not predictive of PFS or OS in AA patients.
- Age, lower CD34 cell dose, prior palliative radiation therapy (XRT), and refractory disease at auto-SCT predicted inferior PFS. Prior palliative XRT was the sole predictor of inferior PFS and OS on multivariate analysis.
Conclusions:
- Multiple myeloma (MM) in African Americans (AA) demonstrates a tendency for early relapse post-autologous stem cell transplant (auto-SCT).
- The impact of these early relapses on overall survival (OS) remains uncertain.
- Established peritransplant prognostic variables commonly used in Caucasian American (CA) MM cohorts may not be directly applicable to AA MM populations.
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