Race Has No Effect on Survival in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation.

Multiple myeloma (MM) is more common in African Americans (AA) compared to White Americans (WA) with an incidence ratio of 2:1. The incidence of MM as well as mortality from MM has been on the rise in AA. SEER data shows a higher death rate in AA than WA diagnosed with multiple myeloma. The benefit of autologous stem cell trasnplantation (ASCT) for multiple myeloma has been clearly demonstrated in randomized trials. However the influence of race on survival in patients receiving ASCT for multiple myeloma has not been well studied. Between January 1996 and December 2003, 60 patients with multiple myeloma underwent ASCT in our program. We evaluated the influence of race on survival and also compared the survival of all transplanted patients to 74 myeloma patients from the hospital tumor registry who were diagnosed with multiple myeloma in the same time period, who received standard chemotherapy without ASCT, and who are in the same age range at diagnosis as the transplant patients. The transplant group included 32 AA and 28 WA, while the registry group had 42 AA and 32 WA. There was no difference between groups in the distribution by gender, but the transplant patients were significantly younger (median age 56.5 years, range 37–72 years) than the registry patients (median age 65 years, range 39–72 years). At analysis, median time from diagnosis was 4.6 years (range 1.2–10.3 years) for the transplant group and 7.7 years (range 3.7–10.6 years) for the registry group. For AA patients, median survival was 2.1 years in the registry group and 5.9 years in the transplant group (p=0.003). For WA patients, median survival was 2.0 years in the registry group and 5.8 years in the transplant group (p<0.0001). Median survivals did not differ in the transplant group when compared by race (5.9 years vs 5.8 years). The benefit of ASCT was seen in all age groups, so the difference in survival was not due to the younger age of the transplant patients. In a multivariate analysis of all 134 patients, ASCT was predictive of improved survival, but gender, race and quartile of age at diagnosis had no significant association with survival. We conclude that the improvement in survival with ASCT is independent of race.