Investigators have uncovered persistent racial and social disparities that may impede access to autologous hematopoietic cell transplantation for some patients with multiple myeloma, according to a recent study published by Esteghamat et al in Clinical Lymphoma, Myeloma & Leukemia.
Background
Multiple myeloma is a hematologic malignancy of the plasma cells within the bone marrow. These cells typically secrete disease-fighting antibodies as part of the immune system; however, in those with multiple myeloma, cancerous plasma cells grow uncontrolled—causing fractures, bruising, fatigue, and weakness.
Although multiple myeloma isn’t curable, patients who receive first-line treatments—such as autologous hematopoietic cell transplantation among those who responded well to initial chemotherapy—may experience remission, increased progression-free survival, and heightened overall survival. High-dose chemotherapy wipes out patients’ healthy bone marrow cells, impairing their immune system and making them more susceptible to infections.
“Following that dose of chemotherapy, we supply them with their own stems cells intravenously, which helps them repopulate the cells of their bone marrow and immune system,” explained lead study author Naseem Esteghamat, MD, MS, Assistant Professor of Malignant Hematology, Cellular Therapy, and Transplantation at the University of California, Davis.
Autologous hematopoietic cell transplantation is capable of halting the progression of multiple myeloma. This type of treatment is associated with slowed disease progression and low treatment-related mortality rates as well as improved overall survival rates in comparison with other multiple myeloma treatments.
“With [autologous hematopoietic cell transplantation], we collect a patient’s healthy stem cells and freeze them. Then, they receive a high dose of chemotherapy to eradicate residual myeloma cancer cells,” noted Dr. Esteghamat. However, previous studies have shown lower rates of autologous hematopoietic cell transplantation related to socioeconomic status and race.
Study Methods and Results
In the recent study, the investigators used data from the California Cancer Registry, the Center for International Blood and Marrow Transplant Research, and the California Patient Discharge Database to examine the rates of autologous hematopoietic cell transplantation among 29,109 patients diagnosed with multiple myeloma between 1991 and 2016—with the goal of determining racial and social disparities in treatment persisted regardless of increased education about the efficacy of autologous hematopoietic cell transplantation. The California Cancer Registry provided demographic information such as race, ethnicity, insurance status as well as neighborhood socioeconomic status; an aggregate of education, employment status, poverty, and other measurements.
The investigators discovered that 18.9% of the patients involved in the study received autologous hematopoietic cell transplantation. They found that Black patients were less likely to receive autologous hematopoietic cell transplantation (15.8%) compared with other racial and ethnic groups, despite having nearly double the incidence of multiple myeloma compared with White patients. These rates declined after 2005.
Neighborhood socioeconomic status also played a role in treatment options, with higher rates of receipt of autologous hematopoietic cell transplantation among patients residing in neighborhoods with higher socioeconomic status. Further, the proportion of patients receiving autologous hematopoietic cell transplantation was higher among those with private or military health insurance (28.4%) compared with the those who had Medicaid, Medicare, or no insurance. The investigators revealed that the patients with older age at diagnosis or comorbidities also had a lower likelihood of receiving autologous hematopoietic cell transplantation.
Conclusions
“It’s important that we remain aware that these disparities exist in our state and our health-care system, since they do affect clinical outcomes for patients. Now, we want to move beyond recognizing that such disparities exist and address barriers to patients [with cancer] receiving care,” emphasized Dr. Esteghamat.
The investigators noted that while they were able to identify socioeconomic disparities in multiple myeloma treatment options, they did not fully understand the reasons behind their findings. They indicated that financial burdens, lack of caregiver support or transportation, physician bias, referral bias, and cultural beliefs may all be contributing to the lack of access to autologous hematopoietic cell transplantation.
“One previously published study showed that after patients were referred to a transplant center, there were no more disparities in treatment based on race or ethnicity—which means that we need to determine which social barriers are preventing access to these centers,” Dr. Esteghamat underscored.
Future studies may be needed to assess how Medicare and Medicaid plans could be affecting patient evaluation for autologous hematopoietic cell transplantation eligibility, frequency of referrals to transplant centers, and additional impacts of insurance options. The investigators concluded that mitigating social and economic barriers may lead to more equitable use of effective therapies and better outcomes in multiple myeloma.
Disclosure: For full disclosures of the study authors, visit clinical-lymphoma-myeloma-leukemia.com.
