Demographic Patterns and Outcomes of Multiple Myeloma Patients Received Autologous Stem Cell Transplant: A Nationwide Analysis

Introduction:

Triplet or quadruplet regimens with autologous stem cell transplant(ASCT) in eligible patients has become the standard of care for multiple myeloma(MM) in recent years due to improved outcomes. Significant racial and socioeconomic variations were observed in the past in regards to treatment utilization and outcomes. We aim to explore the demographic, racial distribution and inpatient mortality trends among MM patients receiving ASCT in recent years.

Methods: Cases with a diagnosis of MM that received an ASCT were identified from the National Inpatient Sample database from 2016 to 2019 using the International Classification of Disease 10th Revision Diagnosis and Procedure Codes. Cochran Armitage test of trend, Chi-square tests and ANOVA tests were used to analyze trends, inpatient deaths (IPDs), and means between different groups of interest. The results are statistically weighted.

Results:

A total of 477,065 MM cases were identified from 2016-2019, out of which 25,145 received ASCT. The number of patients that received ASCT from 2016-2019 were 5925, 6185, 6625, and 6410 respectively. During the same time frame, the proportion of cases aged less than 65 were 3700 (62.4%), 3815 (61.7%), 3900 (58.9%), 3820 (59.6%), P<0.001. The number of cases in the age range 65-74 were 1840 (31.1%), 1920 (24%), 2155 (27%), 2075 (26%), P = 0.039 and the proportion of patients aged 75 and above were 135 (2.3%), 175 (2.8%), 240 (3.6%), 225 (3.5%), P <0.001. Females that received ASCT were 2660 (45%), 2585 (41.8%), 2805 (42.3%), 2690 (42%), P=0.003. The mean Charlson Comorbidity Index (Standard Deviation) from 2016 to 2019 was 4.36 (1.36), 4.37 (1.54), 4.48 (1.53), 4.53 (1.62), P <0.001. From 2016-19, the proportion of Caucasians, Blacks, Hispanics and Asian/Pacific Islanders are stated in Table 1. IPDs among ages less than 65, 65-74, and 75 and above from 2016-2019 were 125 (0.8%), 45 (0.6%) and 15 (1.9%) respectively. IPDs among Blacks was 10 (0.2%) when compared to Non-blacks 185 (0.9%), P<0.001. Caucasians noted to have an IPD of 125 (0.8%) compared to non-Caucasians 70 (0.7%), P=0.364, while Hispanics had IPDs in 20 (0.9%) compared to 175 (0.8%) in Non-hispanics, P=0.369.

Conclusion:

From 2016 to 2019, we observed an overall increase of MM patients receiving ASCT and continued to notice the similar trend among males. Hispanics and Asian/Pacific islanders were also noted to have an increasing trend of ASCT during the same time period. Conversely, there was a decrease in the proportion of MM patients receiving ASCT among the age group less than 65, 65-74, and females. IPD was noted to be lower in blacks; and also in the 65-74 years age group but higher among age 75 and above who received ASCT.

No relevant conflicts of interest to declare.