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Survival Increasing in Patients with Myeloma, but Racial/Ethnic Disparities Continue

Value-Based Care in Myeloma - Maintenance Therapy, Multiple Myeloma
Caroline Helwick

Although overall survival (OS) has greatly improved in recent years for patients with multiple myeloma, there are variations and growing disparity for patients of minority race or ethnicity, according to an analysis from the Surveillance, Epidemiology, and End Results (SEER) program. Dianne Pulte, MD, of Thomas Jefferson University in Philadelphia, PA, presented the findings at the 2011 annual meeting of the American Society of Hematology.

“Survival for patients with myeloma has increased during the first decade of the twenty-first century, especially in people diagnosed at a younger age. But it’s unknown whether the improvements in survival have extended equally to people of minority ethnic and racial groups,” Dr Pulte said.

A recent study (Greenberg AJ, et al. Leukemia. 2011 Dec 23. Epub ahead of print) showed higher incidence of multiple myeloma and lower survival among African Americans than among white people, but did not provide data on changes in survival in different time periods. Because data are also largely unavailable for the Hispanic or Asian populations, Dr Pulte and colleagues examined changes in survival in patients with myeloma by racial and ethnic group, to fill this knowledge gap.

Data were extracted from the SEER9 database. A model-based period analysis was used to estimate the 5-year relative survival rates from 1993 to 1997 and from 2003 to 2007. Among 5692 cases identified during the 1990s and 6465 cases identified during the 2000s, the 5-year relative survival improved significantly between the 2 time periods for all age-groups. In patients aged 15 to 49 years, 5-year relative survival increased from 45% to 65%, a 20% difference; in patients aged 50 to 69 years, it increased from 36% to 46% (P <.001 for both age-groups); and for patients aged ≥70 years, survival increased from 23% to 27% (P = .001).

“But the improvement in survival that was observed was greater for non-Hispanic whites than for minorities,” Dr Pulte said. For non-Hispanic whites, the absolute increase in survival was 25% among younger patients, 12% among those aged 50 to 69 years, and 4% among the oldest patients. Only among young African American patients was there a survival increase in this racial group, from 44% to 59% (P = .02). For Hispanics, no data were available for the youngest cohort; however, for those aged 50 to 69 years, 5-year survival remained around 41%. For those aged ≥70 years, the rate was approximately 27%, with no increase over time. Asian Pacific Islanders had a 15% absolute improvement in survival among those aged 50 to 69 years (P = .011). The 5-year OS by racial/ethnic group, with all ages combined, is shown below.

5-Year Overall Survival, by Race/Ethnicity (All Ages Combined)

 

5-Year survival rate, %

Difference

P value

Race/ethnicity

1993-1997

2003-2007

 

 

All patients

30.4

38.8

+8.4

<.001

Non-Hispanic whites

29.2

38.5

+9.4

<.001

All nonwhites

32.9

38.9

+6.0

.025

African American

32.9

38.7

+5.8

.03

Hispanic

36.1

39.1

+3.0

.5

Asian Pacific

35.5

40.6

+5.1

.23

Dr Pulte said that further research was needed to determine the reasons for these differences and to improve equal access to treatment, “to ensure that all patients benefit from our improved treatment options.”

 

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Last modified: May 20, 2015
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