Racial Difference in Survival Outcomes of Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplant. 2010 to 2020 NCDB Database Analysis

Introduction Multiple myeloma is a hematological malignancy known for its disproportionate impact on racial and ethnic groups, with significant differences observed in medical treatment outcomes. This study aims to evaluate survival outcomes among Black and White multiple myeloma patients undergoing autologous stem cell transplantation (ASCT) using the National Cancer Database (NCDB). Methods Data was analyzed from a cohort of 180,006 multiple myeloma patients who received ASCT between 2010 and 2020. Utilization rates were compared between White and Black patients. Demographic disparities were examined, including age, gender, insurance status, educational attainment, and median household income. Overall survival rates at 3 and 5 years were calculated, and multivariate Cox regression analysis was performed to identify factors influencing survival outcomes. Results 15,062 patients underwent ASCT, of which 2,9337 were Black and 12,129 were White. Mean ages were 57.5 and 59.9 years, respectively, with the majority being male, 59.7% among Whites, and 51% among blacks. Blacks had a higher mean CCI than whites (0.33 vs 0.25). However, chemotherapy and immunotherapy utilization were equally distributed among both populations. Most patients in both groups received the first line of treatment within a month. Black patients exhibited significantly higher 3-year (90.4%) and 5-year (79.8%) overall survival rates compared to White patients (88.5% and 77%, respectively). On Multivariate analysis, age <65, female sex, use of immunotherapy, and receiving treatment at an academic center were associated with better outcomes. Importantly, Black patients experienced improved outcomes compared to their White counterparts (HR, 0.89; 95% CI, 0.82-0.98; P=0.02). Conclusion The results of our study show that Black patients have better survival outcomes than White patients after ASCT. This highlights the complex influence of racial factors on outcomes in multiple myeloma. Previous research suggests that Black patients may experience worse survival rates due to various factors, such as genetic differences and disparities in access to treatment. However, a recent study has shown that black patients seem to do better when both groups have equal access to the transplant. Our study further validates the finding in a large population cohort.