1
|
Tembhare PR, Sriram H, Khanka T, Gawai S, Bagal B, Ghogale SG, Deshpande N, Girase K, Patil J, Hasan SK, Shetty D, Ghosh K, Chatterjee G, Rajpal S, Patkar NV, Jain H, Punatar S, Gokarn A, Nayak L, Mirgh S, Jindal N, Sengar M, Khattry N, Subramanian PG, Gujral S. Circulating tumor plasma cells and peripheral blood measurable residual disease assessment in multiple myeloma patients not planned for upfront transplant. Hemasphere 2024; 8:e63. [PMID: 38566804 PMCID: PMC10983024 DOI: 10.1002/hem3.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/16/2024] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Circulating tumor plasma cells (CTPCs) provide a noninvasive alternative for measuring tumor burden in newly diagnosed multiple myeloma (NDMM). Moreover, measurable residual disease (MRD) assessment in peripheral blood (PBMRD) can provide an ideal alternative to bone marrow MRD, which is limited by its painful nature and technical challenges. However, the clinical significance of PBMRD in NDMM still remains uncertain. Additionally, data on CTPC in NDMM patients not treated with transplant are scarce. We prospectively studied CTPC and PBMRD in 141 NDMM patients using highly sensitive multicolor flow cytometry (HS-MFC). PBMRD was monitored at the end of three cycles (PBMRD1) and six cycles (PBMRD2) of chemotherapy in patients with detectable baseline CTPC. Patients received bortezomib-based triplet therapy and were not planned for an upfront transplant. Among baseline risk factors, CTPC ≥ 0.01% was independently associated with poor progression-free survival (PFS) (hazard ratio [HR] = 2.77; p = 0.0047) and overall survival (OS) (HR = 2.9; p = 0.023) on multivariate analysis. In patients with detectable baseline CTPC, undetectable PBMRD at both subsequent time points was associated with longer PFS (HR = 0.46; p = 0.0037), whereas detectable PBMRD at any time point was associated with short OS (HR = 3.25; p = 0.004). Undetectable combined PBMRD (PBMRD1 and PBMRD2) outperformed the serum-immunofixation-based response. On multivariate analysis, detectable PBMRD at any time point was independently associated with poor PFS (HR = 2.0; p = 0.025) and OS (HR = 3.97; p = 0.013). Thus, our findings showed that CTPC and PBMRD assessment using HS-MFC provides a robust, noninvasive biomarker for NDMM patients not planned for an upfront transplant. Sequential PBMRD monitoring has great potential to improve the impact of the existing risk stratification and response assessment models.
Collapse
Affiliation(s)
- Prashant R. Tembhare
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Harshini Sriram
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Twinkle Khanka
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Sanghamitra Gawai
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Bhausaheb Bagal
- Department of Medical Oncology, Tata Memorial CentreHBNI UniversityMumbaiMaharashtraIndia
| | - Sitaram G. Ghogale
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Nilesh Deshpande
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Karishma Girase
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Jagruti Patil
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Syed Khaizer Hasan
- Hasan Laboratory, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Dhanalaxmi Shetty
- Department of Cancer Cytogenetics, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Kinjalka Ghosh
- Department of Biochemistry, Tata Memorial CentreHBNI UniversityMumbaiMaharashtraIndia
| | - Gaurav Chatterjee
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Sweta Rajpal
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Nikhil V. Patkar
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Hasmukh Jain
- Department of Medical Oncology, Tata Memorial CentreHBNI UniversityMumbaiMaharashtraIndia
| | - Sachin Punatar
- Bone Marrow Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Anant Gokarn
- Bone Marrow Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Lingaraj Nayak
- Bone Marrow Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Sumeet Mirgh
- Bone Marrow Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Nishant Jindal
- Bone Marrow Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial CentreHBNI UniversityMumbaiMaharashtraIndia
| | - Navin Khattry
- Bone Marrow Transplant Unit, Department of Medical Oncology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Papagudi G. Subramanian
- Department of Hematopathology, ACTREC, Tata Memorial CentreHBNI UniversityNavi MumbaiMaharashtraIndia
| | - Sumeet Gujral
- Department of Pathology, Tata Memorial Hospital, Tata Memorial CentreHBNI UniversityMumbaiMaharashtraIndia
| |
Collapse
|
2
|
Salafian K, Mazimba C, Volodin L, Varadarajan I, Pilehvari A, You W, Knio ZO, Ballen K. The impact of social vulnerability index on survival following autologous stem cell transplant for multiple myeloma. Bone Marrow Transplant 2024; 59:459-465. [PMID: 38238453 PMCID: PMC10994832 DOI: 10.1038/s41409-024-02200-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 04/06/2024]
Abstract
Autologous hematopoietic stem cell transplantation (ASCT) is the standard of care for eligible patients with multiple myeloma (MM) to prolong progression-free survival (PFS). While several factors affect survival following ASCT, the impact of social determinants of health such as the CDC Social Vulnerability Index (SVI) is not well documented. This single-center retrospective analysis evaluated the impact of SVI on PFS following ASCT in MM patients. 225 patients with MM who underwent ASCT participated, with 51% transplanted in the last 5 years. At 5 years post-transplant, 55 (50%) achieved PFS and 66 (60%) remained alive. Higher SVI values were significantly associated with lower odds of PFS (OR = 0.521, p < 0.01, 95% CI [0.41, 0.66]) and OS (OR = 0.592, p < 0.01, 95% CI [0.46, 0.76]) post-transplant. Greater vulnerability scores in the socioeconomic status (OR = 0.890; 95% CI: [0.82, 0.96]), household characteristics (OR = 0.912; 95% CI: [0.87, 0.95]), and racial and ethnic minority status (OR = 0.854; 95% CI: [0.81, 0.90]) themes significantly worsened the odds of PFS. These results suggest high SVI areas may need more resources to achieve optimal PFS and OS. Future studies will focus on addressing factors within the socioeconomic status, household characteristics, and racial and ethnic minority subthemes, as these have a more pronounced effect on PFS.
Collapse
Affiliation(s)
- Kiarash Salafian
- Department of Medicine, University of Virginia Health, Charlottesville, VA, USA
| | - Christine Mazimba
- Division of Hematology/Oncology, University of Virginia Health, Charlottesville, VA, USA
| | - Leonid Volodin
- Division of Hematology/Oncology, University of Virginia Health, Charlottesville, VA, USA
| | - Indumathy Varadarajan
- Division of Hematology/Oncology, University of Virginia Health, Charlottesville, VA, USA
| | - Asal Pilehvari
- Department of Public Health Sciences, University of Virginia, and University of Virginia Comprehensive Cancer Center, Charlottesville, VA, USA
| | - Wen You
- Department of Public Health Sciences, University of Virginia, and University of Virginia Comprehensive Cancer Center, Charlottesville, VA, USA
| | - Ziyad O Knio
- Department of Anesthesiology, University of Virginia Health, Charlottesville, VA, USA
| | - Karen Ballen
- Division of Hematology/Oncology, University of Virginia Health, Charlottesville, VA, USA.
| |
Collapse
|
3
|
Mikhael J, Cichewicz A, Mearns ES, Girvan A, Pierre V, Rawashdh NA, Yellow-Duke A, Cornell RF, Nixon M. Overall Survival in Patients With Multiple Myeloma in the U.S.: A Systematic Literature Review of Racial Disparities. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:e1-e12. [PMID: 37923653 DOI: 10.1016/j.clml.2023.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/26/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
Multiple myeloma (MM) accounts for 10% of hematologic cancers in the U.S.; however, incidence and mortality occur disproportionately between racial groups in real-world settings. Our study's objective was to systematically characterize the disparities in overall survival (OS) among Black and White patients with MM in the US using real-world evidence studies. A systematic literature review was undertaken by searching Embase and MEDLINE for observational studies conducted in the US, published between January 1, 2015 and October 25, 2021, and reporting OS for Black and White patients with MM. Records were reviewed by 2 independent researchers. OS data were extracted as hazard ratios (HR), median survival, or %, with methods of adjustment, as reported. Evidence quality was assessed by data source, population, and variables for which HRs for risk of death were adjusted. We included 33 US studies comprising 410,086 patients (21.5% Black; 78.5% White) with MM. Receipt of treatment varied; however, most studies reported that patients either underwent stem cell transplant and/or received systemic therapy. HRs from 9 studies were considered "high quality" by comparing nationally representative, generalizable cohorts and adjusting for key prognostic, treatment, and/or socioeconomic factors. After adjustment, these data suggested that Black patients exhibit similar or superior survival outcomes compared with their White counterparts. When data are adjusted for important confounders, Black patients exhibit better or equal survival to White patients, indicating that similarities in patient populations and equal access to treatment can bridge the disparity in patient outcomes between races.
Collapse
Affiliation(s)
| | | | | | | | - Vicki Pierre
- Evidera, a part of Thermo Fisher Scientific, Waltham, MA
| | | | | | | | | |
Collapse
|
4
|
Bar N, Firestone RS, Usmani SZ. Aiming for the cure in myeloma: Putting our best foot forward. Blood Rev 2023; 62:101116. [PMID: 37596172 DOI: 10.1016/j.blre.2023.101116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/20/2023]
Abstract
Frontline therapy for multiple myeloma (MM) is evolving to include novel combinations that can achieve unprecedented deep response rates. Several treatment strategies exist, varying in induction regimen composition, use of transplant and or consolidation and maintenance. In this sea of different treatment permutations, the overarching theme is the powerful prognostic factors of disease risk and achievement of minimal residual disease (MRD) negativity. MM has significant inter-patient variability that requires treatment to be individualized. Risk-adapted and response-adapted strategies which are increasingly being explored to define the extent and duration of therapy, and eventually aim for functional curability. In addition, with T-cell redirection therapies rapidly revolutionizing myeloma treatments, the current standard of care for myeloma will change. This review analyzes the current relevant literature in upfront therapy for fit myeloma patients and provides suggestions for treatment approach while novel clinical trials are maturing.
Collapse
Affiliation(s)
- Noffar Bar
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine University, New Haven, CT, USA.
| | - Ross S Firestone
- Multiple Myeloma Service, Department of medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Saad Z Usmani
- Multiple Myeloma Service, Department of medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
5
|
Holstein SA, Grant SJ, Wildes TM. Chimeric Antigen Receptor T-Cell and Bispecific Antibody Therapy in Multiple Myeloma: Moving Into the Future. J Clin Oncol 2023; 41:4416-4429. [PMID: 37471687 PMCID: PMC10522112 DOI: 10.1200/jco.23.00512] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/18/2023] [Accepted: 06/13/2023] [Indexed: 07/22/2023] Open
Abstract
Historically, the outcomes for individuals with triple-class refractory and penta-drug refractory multiple myeloma (MM) have been poor because of a dearth of effective treatment options. However, the advent of chimeric antigen receptor (CAR) T-cell and T-cell redirecting bispecific antibody (BsAb) therapies has led to unprecedented response rates and durations of response in heavily relapsed/refractory (R/R) populations. Currently, two B-cell maturation antigen (BCMA)-directed CAR T-cell therapies (idecabtagene vicleucel and ciltacabtagene autoleucel) as well as one BCMA/CD3 BsAb (teclistamab) have been approved for late-line (greater than four previous lines) R/R MM in the United States. The purpose of this review is to analyze the recent data for these approved therapies as well as provide an overview of other related CAR T-cell and BsAb therapies under development, including non-BCMA-targeting agents. We review efficacy and safety considerations, with particular focus on cytokine release syndrome, neurotoxicity, and infection risk. The relative merits and limitations of each class of therapy are discussed, as well as the areas of unmet need with respect to optimal sequencing and supportive care measures. We examine the factors that challenge equitable access to these novel therapies across minoritized racial, ethnic, and socioeconomic populations. Although it is evident that CAR T-cell and BsAb therapies will transform treatment paradigms in MM for years to come, significant work remains to identify the optimal utilization of these novel therapies and ensure equitable access.
Collapse
Affiliation(s)
- Sarah A. Holstein
- Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE
| | - Shakira J. Grant
- Division of Hematology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Tanya M. Wildes
- Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
6
|
Blue B, Pierre A, Mikhael J. Culturally Responsive Care Delivery in Oncology: The Example of Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:651-659. [PMID: 37290997 DOI: 10.1016/j.clml.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 06/10/2023]
Abstract
Multiple myeloma (MM) represents ∼1% of all cancers and is the second most common hematologic malignancy worldwide. The incidence of MM is at least two times higher in Blacks/African Americans compared with their White counterparts, and Hispanics/Latinxs are among the youngest patients diagnosed with the disease. Recent advances in available treatments for MM have demonstrated significant improvement in survival outcomes; however, patients from non-White racial/ethnic groups clinically benefit less due to multiple factors including access to care, socioeconomic status, medical mistrust, underutilization of novel therapies, and exclusion from clinical trials. Health inequities in disease characteristics and risk factors based on race also contribute to inequities in outcomes. In this review, we highlight racial/ethnic factors as well as structural barriers attributed to variations in MM epidemiology and management. We focus on three populations-Black/African American, Hispanic/Latinx, and American Indian/Alaska Native-and review factors that healthcare professionals may consider when treating patients of color. We offer tangible advice for healthcare professionals on how to incorporate cultural humility into their practice by following the five key steps: establishing trust, respecting cultural diversity, undergoing cross-cultural training, counseling patients on appropriate available clinical trial options, and connecting patients to community resources. The outlined recommendations will help the medical community to better understand and apply the important concept of cultural humility into their practice to provide the best care for all their patients, regardless of race/ethnicity.
Collapse
Affiliation(s)
- Brandon Blue
- H. Lee Moffitt Cancer Center and Research Institute, Department of Malignant Hematology, Tampa, FL.
| | - Amy Pierre
- Memorial Sloan Kettering Cancer Center, Division of Multiple Myeloma and Lymphoma, Montvale, NJ; Flatiron Health, Division of Research Oncology and Real World Evidence, New York, NY
| | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ; International Myeloma Foundation, Chief Medical Officer, Studio City, CA
| |
Collapse
|
7
|
Ailawadhi S, Ailawadhi M, Dutta N, Parrondo RD, Roy V, Sher T, Baksh M, Rasheed A, Das S, Fernandez AJ, Paulus A, Chanan‐Khan AA. The digital divide: Racial disparities in adoption and utilization of health information technology among patients with lymphoid cancers. Cancer Med 2023; 12:19013-19020. [PMID: 37587868 PMCID: PMC10557846 DOI: 10.1002/cam4.6454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/23/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Health information technology (HIT) has the potential to improve healthcare delivery and engagement. Studying racial-ethnic disparities in HIT engagement will help understand and overcome challenges to healthcare utilization. METHODS We undertook a patient-reported survey among patients with lymphoid malignancies at two campuses of Mayo Clinic, Florida to explore HIT-related disparities. Variables between Whites and non-Whites, and non-Whites from the two campuses were compared. RESULTS The survey was completed by 1004 respondents, with 71% whites, 27% non-Whites (race-ethnicity not reported by 2%). Non-Whites included 30% responders at the main campus and 64% at an inner-city campus. Whites were significantly older and had higher education, while non-Whites had lesser access to a computer. Only 51% of non-Whites were registered to use electronic medical records (EMR) as compared to 72% Whites (p < 0.001) and significantly lesser number of non-Whites even knew that EMR existed (81% vs. 92%, p < 0.001). Encouragingly, a higher number of non-Whites wanted to engage in EMR. Non-Whites from the main campus were older, more educated and had more access to a computer as compared to those from the inner-city campus. Similar disparate factors were noted among minorities from the two campuses, suggesting impact of socioeconomic backgrounds on EMR usage among non-Whites. Linguistic barriers were more striking among inner-city campus non-Whites. CONCLUSIONS Non-Whites continue to struggle with suboptimal utilization of the healthcare system and barriers related to integration in HIT, including disparities representing socioeconomic differences. Efforts need to be made at several levels to help racial-ethnic minorities overcome awareness, access, and linguistic barriers to HIT utilization.
Collapse
Affiliation(s)
- Sikander Ailawadhi
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
- Division of Cancer BiologyMayo ClinicJacksonvilleFloridaUSA
| | - Meghna Ailawadhi
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
| | - Navnita Dutta
- Division of Cancer BiologyMayo ClinicJacksonvilleFloridaUSA
| | | | - Vivek Roy
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
| | - Taimur Sher
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
| | - Mizba Baksh
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
| | - Ahsan Rasheed
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
| | - Saurav Das
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
| | | | - Aneel Paulus
- Division of Cancer BiologyMayo ClinicJacksonvilleFloridaUSA
| | - Asher A. Chanan‐Khan
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
- Division of Cancer BiologyMayo ClinicJacksonvilleFloridaUSA
| |
Collapse
|
8
|
Mateos MV, Ailawadhi S, Costa LJ, Grant SJ, Kumar L, Mohty M, Aydin D, Usmani SZ. Global disparities in patients with multiple myeloma: a rapid evidence assessment. Blood Cancer J 2023; 13:109. [PMID: 37460466 PMCID: PMC10352266 DOI: 10.1038/s41408-023-00877-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/05/2023] [Accepted: 06/15/2023] [Indexed: 07/20/2023] Open
Abstract
There are disparities in outcomes for patients with multiple myeloma (MM). We evaluated the influence of sociodemographic factors on global disparities in outcomes for patients with MM. This rapid evidence assessment (PROSPERO, CRD42021248461) followed PRISMA-P guidelines and used the PICOS framework. PubMed and Embase® were searched for articles in English from 2011 to 2021. The title, abstract, and full text of articles were screened according to inclusion/exclusion criteria. The sociodemographic factors assessed were age, sex, race/ethnicity, socioeconomic status, and geographic location. Outcomes were diagnosis, access to treatment, and patient outcomes. Of 84 articles included, 48 were US-based. Worldwide, increasing age and low socioeconomic status were associated with worse patient outcomes. In the US, men typically had worse outcomes than women, although women had poorer access to treatment, as did Black, Asian, and Hispanic patients. No consistent disparities due to sex were seen outside the US, and for most factors and outcomes, no consistent disparities could be identified globally. Too few studies examined disparities in diagnosis to draw firm conclusions. This first systematic analysis of health disparities in patients with MM identified specific populations affected, highlighting a need for additional research focused on assessing patterns, trends, and underlying drivers of disparities in MM.
Collapse
Affiliation(s)
| | - Sikander Ailawadhi
- Division of Hematology/Oncology, Department of Medicine, Mayo Clinic, Jackson, FL, USA
| | - Luciano J Costa
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shakira J Grant
- Department of Medicine, Division of Hematology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Mohamad Mohty
- Sorbonne University, Department of Hematology, Saint-Antoine Hospital, Paris, France
| | | | - Saad Z Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
9
|
Doucette K, Taylor AO, Chan B, Ma X, Ahn J, Vesole DH, Lai C. Hospital facility characteristics and socioeconomic factors on outcomes and treatment in patients with multiple myeloma: National Cancer Database analysis. Ann Hematol 2023; 102:1443-1458. [PMID: 37093241 DOI: 10.1007/s00277-023-05194-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/19/2022] [Indexed: 04/25/2023]
Abstract
Previous studies have shown that socioeconomic factors play an important role in multiple myeloma (MM) health outcomes. We postulated that the type of treatment facilities and their volume of cases also affect overall survival, utilization of various therapies including palliative care services in newly diagnosed MM. Using the National Cancer Database (NCDB), we analyzed 174,551 newly diagnosed MM participants from across the country. We found that at high volume facility centers (over 90th percentile of new patient volume from 2004 to 2016), the median overall survival (OS) was 62.3 months versus 35.3 months at lower volume facilities (p <0.001). Similarly, high volume academic cancer centers had an improved median OS of 66.4 months (65.3-67.4 CI) versus 39.2 months (37.9-40.4 months CI) in lower volume academic centers (p <0.001). The odds of utilizing chemotherapy, immunotherapy, and autologous transplants were higher in academic cancer centers compared to community cancer centers, after adjusting for demographic and socioeconomic factors (OR 1.10, 1.23, and 2.06 respectively, all with p<0.001). There was significantly decreased odds of receiving palliative care (OR 0.89, 95% CI 0.85-0.93) in high volume facilities compared to low volume. Palliative care services were more frequently utilized at integrated network cancers and comprehensive community cancer centers compared to community cancer centers, with similar odds of receiving palliative care between community and academic facility types. Our results likely reflect increased provider experience and resources in higher volume and academic facilities. This highlights the need to integrate resources and improve access to community programs.
Collapse
Affiliation(s)
- Kimberley Doucette
- Divison of Hematology and Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, USA.
| | - Allison O Taylor
- Department of Medicine, Duke University Hospital, Durham, NC, USA
| | - Bryan Chan
- Divison of Hematology and Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, USA
| | - Xiaoyang Ma
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - David H Vesole
- Divison of Hematology and Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, USA
- Division of Hematology and Oncology, Hackensack Meridian John Theurer Cancer Center, Hackensack, NJ, USA
| | - Catherine Lai
- Division of Hematology and Oncology, Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
10
|
Habr D, Corsaro M. Reimagining diversity in multiple myeloma clinical trials. Hematol Oncol 2022; 40:689-694. [PMID: 35391496 PMCID: PMC9790672 DOI: 10.1002/hon.2997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Dany Habr
- Pfizer OncologyPfizer Inc.New York CityNew YorkUSA
| | | |
Collapse
|
11
|
Xie C, Wei M, Yang F, Liu Q, Wu F, Huang J. Efficacy and toxicity of carfilzomib- or bortezomib-based regimens for treatment of transplant-ineligible patients with newly diagnosed multiple myeloma: A meta-analysis. Medicine (Baltimore) 2022; 101:e30715. [PMID: 36181088 PMCID: PMC9524967 DOI: 10.1097/md.0000000000030715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Multiple myeloma is a clonal disorder of malignant plasma cells that comprises approximately 10% of hematologic malignancies. The aim of this study was to investigate the efficacy and toxicity of carfilzomib- or bortezomib-based regimens for treatment of transplant-ineligible patients with newly diagnosed multiple myeloma by performing a meta-analysis of randomized controlled trials (RCTs). METHODS Data mining was conducted in March 2022 across PubMed, EMBASE and ClinicalTrials.gov. All published RCTs which assessed efficacy and toxicity of carfilzomib-based regimens treatment for transplant-ineligible patients with newly diagnosed multiple myeloma when compared with a bortezomib-based regimens were included. RESULTS Our meta-analysis showed that the overall response rate (ORR) (Odds ratio = 1.33, 95% CI 1.05-1.69, P = .02) was significantly higher in the carfilzomib-based regimens group than in the bortezomib-based regimens group. However, the difference in ORR did not translate into improvements in progression-free survival (PFS), overall survival (OS) and complete response rate (CRR). Adverse events of grade 3 or worse that occurred with a higher incidence in the carfilzomib-based regimens group compared with the bortezomib-based regimens group were dyspnea, hypertension, acute kidney injury, and heart failure. CONCLUSIONS The carfilzomib-based regimens did not improve PFS, OS and CRR compared with the bortezomib-based regimens in transplant-ineligible patients with newly diagnosed multiple myeloma, and they showed higher toxicity.
Collapse
Affiliation(s)
- Chunhong Xie
- Department of Hematology, Affiliated Liuzhou People’s Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Min Wei
- Department of Hematology, Affiliated Liuzhou People’s Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Feiyan Yang
- Department of Hematology, Affiliated Liuzhou People’s Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Qin Liu
- Department of Hematology, Affiliated Liuzhou People’s Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Fuzhen Wu
- Department of Hematology, Affiliated Liuzhou People’s Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Jinxiong Huang
- Department of Hematology, Affiliated Liuzhou People’s Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
- *Correspondence: Jinxiong Huang, Department of Hematology, Affiliated Liuzhou People’s Hospital of Guangxi Medical University, No. 8, Wenchang Road, Liuzhou 545006, Guangxi, China (e-mail: )
| |
Collapse
|
12
|
Fatoki RA, Koehn K, Kelkar A, Al Hadidi S, Mehra N, Mian H, Landgren O, Kazandjian D, Hoffman J, Sborov DW, Mohyuddin GR. Global Myeloma Trial Participation and Drug Access in the Era of Novel Therapies. JCO Glob Oncol 2022; 8:e2200119. [PMID: 35960904 PMCID: PMC9470137 DOI: 10.1200/go.22.00119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/23/2022] [Accepted: 06/29/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The globalization of clinical trials has accelerated recent advances in multiple myeloma (MM). However, it is unclear whether trial enrollment locations are reflective of the global burden of MM and whether access to novel therapies is timely and equitable for countries that participate in those trials. METHODS To assess this, we characterized where MM trials that led to US Food and Drug Administration (FDA) approvals were conducted and determined how often and quickly these drug regimens received approval in their participating trial countries on the basis of country income level and geographic region. RESULTS A systematic review was conducted to identify all MM clinical trials that met their primary endpoint, enrolled patients outside the United States, and resulted in FDA approval from 2005 to 2019. A total of 18 pivotal MM clinical trials were identified. High-income countries enrolled patients in 100% (18/18) of the trials identified, whereas upper-middle and lower-middle-income countries were represented in 61% (11/18) and 28% (5/18) of trials, respectively. No patients from low-income countries were enrolled. One trial enrolled patients in sub-Saharan Africa, and no trials enrolled patients in South Asia/Caribbean. For drugs/regimens that were approved in their participating countries, the median time from FDA approval to approval was 10.9 months. There were no drugs approved in lower-middle-income trial countries. MM trials leading to FDA approval are generally run in high-income, European, and Central Asian countries. CONCLUSION There are substantial disparities in where novel therapies are evaluated and where they are ultimately approved for use on the basis of income level and geography.
Collapse
Affiliation(s)
- Raleigh Ayoolu Fatoki
- Internal Medicine Department, Kaiser Permanente – Oakland Medical Center, Oakland, CA
| | - Kelly Koehn
- Division of Hematological Malignancies and Cellular Therapeutics, University of Kansas, Kansas City, KS
| | - Amar Kelkar
- Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Brigham Cancer Center, Boston, MA
| | - Samer Al Hadidi
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Nikita Mehra
- Department of Medical Oncology and Molecular Oncology, Cancer Institute (WIA), Chennai, India
| | - Hira Mian
- Department of Oncology, Juravinski Hospital and Cancer Centre-Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ola Landgren
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Dickran Kazandjian
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - James Hoffman
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Douglas W. Sborov
- Division of Hematology and Hematological Malignancies, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT
| | - Ghulam Rehman Mohyuddin
- Division of Hematology and Hematological Malignancies, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT
| |
Collapse
|
13
|
Hewamana S, Gunasena P, Jayasinghe C, Skandarajah T, Harischandra M, Abeyaratne S, Ekanayake L, Somasundaram G, Somiah S, Srinivasan V, Arseculeratne G, Perera N, Fernando J, Faiz M, Munasinghe N, Mowlana A, Deshapriya S, Mawathakubura S, Wickramarathna C, Wijewickrama A, Jayawardena P, Perera E, Peiris N, Paranawithane S, Perera C, Kariyawasam C, Munasinghe S, De Silva C, Wadanamby R, Galagoda G, Lin TT, Wijesiriwardena B, Balawardena J. Response and Survival Estimates of Patients With Plasma Cell Myeloma in a Resource-Constrained Setting Using Protocols From High-Income Countries: A Single-Center Experience From Sri Lanka. JCO Glob Oncol 2022; 8:e2100352. [PMID: 35772042 PMCID: PMC9276119 DOI: 10.1200/go.21.00352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
There is a significant disparity in global cancer care and outcome between countries. Progress in the treatment of symptomatic plasma cell myeloma (PCM) in high-income countries is not seen in low- and middle-income countries. Is it possible to set up dedicated hemato-oncology centers and use protocols from high-income countries in a resource-constrained setting? It is possible to successfully apply treatment and supportive care protocols in the correct setting of dedicated hemato-oncology centers. Patients with plasma cell myeloma were treated with thalidomide- and/or bortezomib-containing regimens adapted from high-income countries. After a median follow-up of 40.6 months (range, 35.2-59.07 months), the median overall survival (OS) was 84.2 months (95% CI, 60.87 to NA) and the 5-year estimated OS was 65%, comparable to parameters in phase III randomized trials in high-income countries.![]()
Collapse
Affiliation(s)
- Saman Hewamana
- Clinical Haematology Unit, Lanka Hospitals, Colombo, Sri Lanka
- Asiri Surgical Hospital, Colombo, Sri Lanka
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Chandu De Silva
- Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | | | - Thet Thet Lin
- Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
| | | | | |
Collapse
|
14
|
Racial and ethnic differences in clonal hematopoiesis, tumor markers, and outcomes of patients with multiple myeloma. Blood Adv 2022; 6:3767-3778. [PMID: 35500227 PMCID: PMC9631567 DOI: 10.1182/bloodadvances.2021006652] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/07/2022] [Indexed: 11/20/2022] Open
Abstract
Age of onset and survival disparities exist for racial and ethnic minority patients diagnosed with MM. Differences in somatic mutations in tumor and blood (ie, clonal hematopoiesis) may contribute to disparities in outcomes observed.
Multiple myeloma (MM) incidence, mortality, and survival vary by race and ethnicity, but the causes of differences remain unclear. We investigated demographic, clinical, and molecular features of diverse MM patients to elucidate mechanisms driving clinical disparities. This study included 495 MM patients (self-reported Hispanic, n = 45; non-Hispanic Black, n = 52; non-Hispanic White, n = 398). Hispanic and non-Hispanic Black individuals had an earlier age of onset than non-Hispanic White individuals (53 and 57 vs 63 years, respectively, P < .001). There were no differences in treatment by race and ethnicity groups, but non-Hispanic Black patients had a longer time to hematopoietic cell transplant than non-Hispanic White patients (376 days vs 248 days; P = .01). Overall survival (OS) was improved for non-Hispanic Black compared with non-Hispanic White patients (HR, 0.50; 95% CI, 0.31-0.81; P = .005), although this association was attenuated after adjusting for clinical features (HR, 0.62; 95% CI, 0.37-1.03; P = .06). Tumor mutations in IRF4 were most common in Hispanic patients, and mutations in SP140, AUTS2, and SETD2 were most common in non-Hispanic Black patients. Differences in tumor expression of BCL7A, SPEF2, and ANKRD26 by race and ethnicity were observed. Clonal hematopoiesis was detected in 12% of patients and associated with inferior OS in non-Hispanic Black patients compared with patients without clonal hematopoiesis (HR, 4.36; 95% CI, 1.36-14.00). This study provides insight into differences in molecular features that may drive clinical disparities in MM patients receiving comparable treatment, with the novel inclusion of Hispanic individuals.
Collapse
|
15
|
Jagannath S, Mikhael J, Nadeem O, Raje N. Digital Health for Patients With Multiple Myeloma: An Unmet Need. JCO Clin Cancer Inform 2021; 5:1096-1105. [PMID: 34735265 DOI: 10.1200/cci.20.00145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Multiple myeloma (MM) is associated with the highest symptom burden and lowest health-related quality of life (HRQoL) among patients with hematologic malignancies. HRQoL in MM is heterogeneous, varying over the course of disease, with the highest burden at diagnosis and relapse. Patients with MM are increasingly being treated with oral maintenance medications at home. As a result, longitudinal monitoring of medication adherence and patient-reported outcomes, including HRQoL, could inform on disease status, therapeutic tolerability, and satisfaction with care. Digital health technologies, including telemedicine, mobile health, and wearable devices, are poised to become an integral part of modern health care, in part due to the surge in telemedicine necessitated by the COVID-19 pandemic. Although the literature has many reports on the use of digital health technologies in other types of cancers, fewer studies report on their application to MM. In the current narrative review, we survey the applications of digital health for MM. Although there is evidence that some are associated with improved health outcomes, challenges exist that must be met to ensure more widespread adoption. These include the need for increased awareness by patients and health care providers, lack of access by the typical older patient with MM, absence of randomized clinical trials, and low integration with current workflows such as electronic health records. Following our summary of technologies that could benefit patients with MM, we end by describing our vision for how they can be integrated into each phase of the patient journey.
Collapse
Affiliation(s)
| | - Joseph Mikhael
- Translational Genomics Research Institute (TGen), City of Hope Cancer Center, Phoenix, AZ
| | - Omar Nadeem
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Noopur Raje
- Center for Multiple Myeloma, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
16
|
Lack of differential impact of del17p on survival in African Americans compared with White patients with multiple myeloma: a VA study. Blood Adv 2021; 5:3511-3514. [PMID: 34428278 DOI: 10.1182/bloodadvances.2020004001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/18/2021] [Indexed: 01/09/2023] Open
Abstract
Multiple myeloma (MM) is a heterogeneous disease that has an increased incidence in African Americans (AAs). We previously observed that, with equal access to health care, younger AA patients (age < 65 years) have superior overall survival (OS) compared with younger White patients. Because MM prognosis is influenced by 17p deletion (del17p), we investigated racial differences in its occurrence and impact in a large cohort of MM patients from the Veterans Affairs (VA) system. Among 2243 VA patients with MM for whom del17p data were available, del17p was present in 8.83% of all patients, with a significantly lower prevalence in AAs (5.56%) compared with Whites (10.52%; P < .001). The difference was even more pronounced among younger AAs (<65 years) vs younger Whites (4.34% vs 9.8%, respectively; P = .004). However, we did not observe any significant difference in survival between AA and White patients with del17p, regardless of age category, suggesting that del17p carries a poor prognosis across race and age. Interestingly, among patients without del17p, we still noted a significantly superior OS in younger AAs compared with younger Whites (7.75 vs 5.10 years; P = .042). Our study shows a lower incidence of del17p in AAs but suggests that the survival advantage for younger AAs is primarily due to factors other than del17p.
Collapse
|
17
|
Gayle HD, Childress JF. Race, Racism, and Structural Injustice: Equitable Allocation and Distribution of Vaccines for the COVID-19. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:4-7. [PMID: 33616485 DOI: 10.1080/15265161.2021.1877011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
|
18
|
Bergin K, Wellard C, Moore E, McQuilten Z, Blacklock H, Harrison SJ, Ho PJ, King T, Quach H, Mollee P, Walker P, Wood E, Spencer A. The Myeloma Landscape in Australia and New Zealand: The First 8 Years of the Myeloma and Related Diseases Registry (MRDR). CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e510-e520. [PMID: 33785297 DOI: 10.1016/j.clml.2021.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Real-world multiple myeloma (MM) data are scarce, with most data originating from clinical trials. The Myeloma and Related Diseases Registry (MRDR) is a prospective clinical-quality registry of newly diagnosed cases of plasma cell disorders established in 2012 and operating at 44 sites in Australia and New Zealand as of April 2020. METHODS We reviewed all patients enrolled onto the MRDR between June 2012 and April 2020. Baseline characteristics, treatment, and outcome data were reviewed for MM patients with comparisons made by chi-square tests (categorical variables) and rank sum tests (continuous variables). Kaplan-Meier analysis was used to estimate progression-free survival and overall survival (OS). RESULTS As of April 2020, a total of 2405 MM patients were enrolled (median age, 67 years, with 40% aged > 70 years). High-risk features were present in 13% to 31% of patients: fluorescence in-situ hybridization (FISH) ≥ 1 of t(4;14), t(14;16), or del(17p) 18%, International Staging System (ISS)-3 31%, and Revised ISS (R-ISS)-3 13%. Cytogenetic/FISH analyses were performed in 50% and 68% of patients, respectively, with an abnormal karyotype result in 34%. Bortezomib-containing therapy was the most common first-line therapy (79.3%, n = 1706). Patients not receiving bortezomib were older (median age, 76 vs 65 years, P < .001) with inferior performance status (Eastern Cooperative Oncology Group performance status ≥ 2, 41% vs 18%, P < .001). Median progression-free survival and OS were 30.8 and 65.8 months, respectively. Younger patients had superior OS (76.3 vs 46.7 months, P < .001, < 70 and ≥ 70 years, respectively). R-ISS score was available in 50.7% (n = 1220) of patients, and higher R-ISS was associated with inferior OS (R-ISS-1 vs R-ISS-2 vs R-ISS-3: not reached vs 68.1 months vs 33.2 months, respectively, P < .001). CONCLUSION Clinical registries provide a more complete picture of MM diagnosis and treatment, and highlight the challenges of adhering to best practices in a real-world context.
Collapse
Affiliation(s)
- Krystal Bergin
- Department of Haematology, Alfred Health-Monash University, Melbourne, Victoria, Australia
| | - Cameron Wellard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth Moore
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zoe McQuilten
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Hilary Blacklock
- Clinical Haematology, Middlemore Hospital, Middlemore, Auckland, New Zealand
| | - Simon J Harrison
- Clinical Haematology, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Melbourne, Victoria, Australia; Clinical Haematology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - P Joy Ho
- Royal Prince Alfred Hospital, Camperdown, and University of Sydney, Sydney, New South Wales, Australia
| | - Tracy King
- Royal Prince Alfred Hospital, Camperdown, and University of Sydney, Sydney, New South Wales, Australia
| | - Hang Quach
- Clinical Haematology, University of Melbourne and St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Peter Mollee
- Clinical Haematology, Princess Alexandra Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - Patricia Walker
- Clinical Haematology, Peninsula Health, Frankston, Victoria, Australia
| | - Erica Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew Spencer
- Department of Haematology, Alfred Health-Monash University, Melbourne, Victoria, Australia.
| | | |
Collapse
|
19
|
Ailawadhi S, Frank R, Ailawadhi M, Kanji Z, Jani P, Fiala M, Abdulazeez M, Ahmed S, Aggarwal CS, Aulakh S, Hodge D, Roy V, Alegria VR, Paulus A, Chanan-Khan A, Sher T. Utilization of radiation therapy in multiple myeloma: trends and changes in practice. Ann Hematol 2021; 100:735-741. [PMID: 33438047 DOI: 10.1007/s00277-020-04371-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
Plasma cell disorders including plasmacytomas and multiple myeloma (MM) are exquisitely radiosensitive, and thus, radiation therapy (XRT) is used effectively in their management. The role of XRT in the setting of novel MM therapeutics has not been explored. The 2016 National Cancer Database (NCDB) for MM with patients diagnosed between 2004 and 2013 was studied. Association between utilization of XRT as part of initial therapy and patient, disease, or treating facility characteristics was studied. A total of 111,281 cases with 91.6% MM, 7% osseous plasmacytoma (PLA-O), and 1.4% extramedullary plasmacytoma (PLA-E) were identified. XRT was utilized as part of initial therapy in 25.4% cases, including 69.3% of PLA-O, 60% of PLA-E, and 21.5% of MM patients. Patients with PLA-E and MM were significantly less likely to receive XRT as compared to PLA-O (p < 0.001). A significantly decreased use of XRT was noted over time (p < 0.001), and for advancing patient age (p < 0.001), women (p < 0.001), and blacks (p < 0.001), and with increasing income (p = 0.015). Patients with Medicare were less likely to receive XRT (OR 0.86, 95% CI 0.78, 0.94) as compared to uninsured as were those with initial treatment at academic or high-volume facilities and facilities performing stem cell transplant. There was overall decreased utilization of XRT in recent years, possibly due to advent of efficacious systemic agents for MM therapy, with a higher XRT utilization for plasmacytomas. Patterns of XRT use need to be explored prospectively, so that uniform standards of healthcare delivery can be maintained and treatment heterogeneity can be minimized.
Collapse
Affiliation(s)
- Sikander Ailawadhi
- Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA. .,Division of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA.
| | - Ryan Frank
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Meghna Ailawadhi
- Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Zahara Kanji
- Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Prachi Jani
- Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Mark Fiala
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Mays Abdulazeez
- Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Salman Ahmed
- Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | | | - Sonikpreet Aulakh
- Department of Hematology-Oncology, West Virginia Cancer Institute, Morgantown, WV, USA
| | - David Hodge
- Department of Health Science Research, Mayo Clinic, Jacksonville, FL, USA
| | - Vivek Roy
- Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Victoria R Alegria
- Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Aneel Paulus
- Division of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - Asher Chanan-Khan
- Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.,Hematology-Oncology, St. Vincent's Cancer Center, Jacksonville, FL, USA
| | - Taimur Sher
- Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| |
Collapse
|
20
|
Belcher SM, Watkins Bruner D, Hofmeister CC, Kweon J, Meghani SH, Yeager KA. Characterizing Pain Experiences: African American Patients With Multiple Myeloma Taking Around-the-Clock Opioids. Clin J Oncol Nurs 2020; 24:538-546. [PMID: 32945786 PMCID: PMC10432153 DOI: 10.1188/20.cjon.538-546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite known disparities by race, studies to date have not focused on pain characterization among African American patients with multiple myeloma. OBJECTIVES This study aimed to characterize the pain experience, beliefs about pain and pain control, and additional symptoms among African American patients with multiple myeloma taking around-the-clock opioids. METHODS This study employed secondary analysis of baseline data from a completed longitudinal study of opioid adherence. Descriptive statistics were used to characterize the sample, pain experience, beliefs regarding pain and pain control, and related symptoms. FINDINGS Participants (N = 34) experienced everyday pain and additional symptoms, and half experienced depression. Pain management barriers included dislike of pills, fear of addiction, and bothersome side effects from pain and medication. Additional larger studies can incorporate multilevel factors contributing to high symptom burden.
Collapse
|
21
|
Abstract
Despite considerable advances in treatment approaches in the past two decades, multiple myeloma remains an incurable disease. Treatments for myeloma continue to evolve with many emerging immunotherapies. The first immunotherapy used to treat hematologic cancers, including multiple myeloma, was an allogeneic stem cell transplant. In the mid-2000s, immunomodulatory drugs thalidomide, lenalidomide, and subsequently pomalidomide were proven to be effective in multiple myeloma and substantially improved survival. The next wave of immunotherapies for multiple myeloma included the monoclonal antibodies daratumumab and elotuzumab, which were approved by the Food and Drug Administration in 2015. Subsequently, a variety of immunotherapies have been developed for multiple myeloma, including chimeric antigen receptor T cells, bispecific antibodies, antibody drug conjugates, and checkpoint inhibitors. Many of these emerging treatments target the B cell maturation antigen, which is expressed on plasma cells, although several other novel receptors are also being studied. This review summarizes the evidence of these various immunotherapies, their mechanism of action, and data from clinical trials regarding the treatments' safety and efficacy.
Collapse
Affiliation(s)
- Urvi A Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, New York, NY 10021, USA
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, New York, NY 10021, USA
| |
Collapse
|
22
|
Xu L, Wang X, Pan X, Wang X, Wang Q, Wu B, Cai J, Zhao Y, Chen L, Li W, Li J. Education level as a predictor of survival in patients with multiple myeloma. BMC Cancer 2020; 20:737. [PMID: 32770980 PMCID: PMC7414648 DOI: 10.1186/s12885-020-07178-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 07/13/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Disparities in multiple myeloma (MM) prognosis based on sociodemographic factors may exist. We investigated whether education level at diagnosis influenced Chinese MM patient outcomes. METHODS We performed a multicenter retrospective analysis of data from 773 MM patients across 9 centers in China from 2006 to 2019. Sociodemographic and clinical factors at diagnosis and treatment regimens were recorded, and univariate and multivariate analyses were performed. RESULTS Overall, 69.2% of patients had low education levels. Patients with low education levels differed from those with high education levels in that they were more likely to be older, and a higher proportion lived in rural areas, were unemployed, had lower annual incomes and lacked insurance. Additionally, compared to patients with high education levels, patients with low education levels had a higher proportion of international staging system (ISS) stage III classification and elevated lactate dehydrogenase (LDH) levels and underwent transplantation less often. Patients with high education levels had a median progression-free survival (PFS) of 67.50 (95% confidence interval (CI): 51.66-83.39) months, which was better than that of patients with low education levels (30.60 months, 95% CI: 27.38-33.82, p < 0.001). Similarly, patients with high education levels had a median overall survival (OS) of 122.27 (95% CI: 117.05-127.49) months, which was also better than that of patients with low education levels (58.83 months, 95% CI: 48.87-62.79, p < 0.001). In the multivariable analysis, patients with high education levels had lower relapse rates and higher survival rates than did those with low education level in terms of PFS and OS (hazard ratio (HR) = 0.50 [95% CI: 0.34-0.72], p < 0.001; HR = 0.32 [0.19-0.56], p < 0.001, respectively). CONCLUSIONS Low education levels may independently predict poor survival in MM patients in China.
Collapse
Affiliation(s)
- Limei Xu
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiuju Wang
- Department of Hematology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xueyi Pan
- Department of Hematology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Xiaotao Wang
- Department of Hematology, The Second Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Qing Wang
- Department of Hematology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Bingyi Wu
- Department of Hematology, Shunde Hospital of Southern Medical University, Shunde, Guangdong, China
| | - Jiahui Cai
- Department of Hematology, Shunde Hospital of Southern Medical University, Shunde, Guangdong, China
| | - Ying Zhao
- Department of Hematology, First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Lijuan Chen
- Department of Hematology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wuping Li
- Department of Internal Medicine, Jiangxi Tumor Hospital, Nanchang, Jiangxi, China
| | - Juan Li
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
| |
Collapse
|
23
|
Chiu RG, Fuentes AM, Mehta AI. Gunshot wounds to the head: racial disparities in inpatient management and outcomes. Neurosurg Focus 2019; 47:E11. [DOI: 10.3171/2019.8.focus19484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 08/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVESeveral studies have indicated that racial disparities may exist in the management and outcomes of acute trauma care. One segment of trauma care that has not been as extensively investigated, however, is that of cranial trauma care. The goal of this study was to determine whether significant differences exist among racial and ethnic groups in various measures of inpatient management and outcomes after gunshot wounds to the head (GWH).METHODSIn this study, the authors used the Nationwide (National) Inpatient Sample (NIS) to investigate all-cause mortality, receipt of surgery, days from admission to initial intervention, discharge disposition, length of hospital stay, and total hospital charges of those with GWH from 2012 to 2016. A 1:1 propensity score–matched analysis was conducted to evaluate the effect of race on these endpoints, while controlling for baseline demographics and comorbidities.RESULTSA total of 333 patients met the inclusion and exclusion criteria: 148 (44.44%) white/Caucasian, 123 (36.94%) black/African American, 54 (16.22%) Hispanic/Latinx, and 8 (2.40%) Asian. African American patients were sent to immediate care and rehabilitation significantly less often than Caucasian patients (RR 0.17 [95% CI 0.04–0.71]). There were no significant differences in mortality, length of stay, rates of surgical intervention, or total hospital charges among any of the racial groups.CONCLUSIONSThe authors’ findings suggest that racial disparities in inpatient cranial trauma care and outcomes may not be as prevalent as previously thought. In fact, the disparities seen were only in disposition. More research is needed to further elucidate and address disparities within this population, particularly those that may exist prior to, and after, hospitalization.
Collapse
|