Ethnicity's Impact on Myeloma Outcomes After Stem Cell Transplant | Frances Cervoni, MD | #ASH24

So my name is Doctor Frances Cervoni.
I am a stem cell fellow MD Anderson and previously did a myeloma fellowship at MD Anderson as well.
I'm here to talk about my current research on the impact of ethnicity in the outcomes of newly diagnosed myeloma patients who go on upfront autologous stem cell transplant.

So in this study, we look at a score of patients over a span of almost over ten years that were treated at MD Anderson and who receive autologous stem cell transplant upfront. These patients were over 1900 patients.
We looked into the impact of their ethnicity, background, separating them by Caucasian group, African-American and Hispanics.
What we found was that patients who were of Hispanic origin were greatly affected, the more so than African-Americans and Caucasian when it came down to the outcomes of myeloma treatments.

All of these patients underwent transplantation upfront.
And even though they underwent transplantation upfront, the patients of Hispanic background were observed to have lower overall survival and also progression free survival, which compared to their counterparts, globally, those of minority origin and both African American and Hispanics were more affected than their Caucasian counterparts.
A more is to be elucidated into why this is occurring.

It's not just a single factor, and disparity is a factor of also the genetics of the disease.
The treatments that these patients receive prior to transplantation, the measurable residual disease before transplantation was it was a profound was a MRD positive disease.
And also were these patients post-transplant on maintenance therapies.

In this study, one of the things that we looked at, key components that we looked into in both univariate, their multivariate analysis was the presence of renal dysfunction that may have been present even before the disease was occurring.
And what we found was in Hispanic patients, interestingly, renal dysfunction was a bit more so present.
And there was a significant difference between the groups.

Although the creatinine values when we looked closely kind of were similar.
But the outcome and the impact of the renal function actually affected the overall survival in the end.
So we do think that, baseline comorbidities do have a significant impact.
What can we do to address those comorbidities comes down to screening early on and early years and and more education to patients into the importance of diet and good health screening.

That has nothing to do necessarily with an myeloma diagnosis, but that could, in fact, impact that end organ damage from myeloma long term and affect those outcomes.

So I don't have objective data to say that this patient's a lot of them were not necessarily treated at MD Anderson.
Right.
They came from outside oncology offices and then pursue transplantation through our division.

There is a large possibility that could be occurring because myeloma, amyloidosis is plasma discreations tend to be harder to diagnose upfront, right.
So patients go to a general doctor's office and they see a little bit of anemia.
While they might be thinking it’s anemia not chronic disease and they see a little bit, of creatinine dysfunction or renal dysfunction,
but they're not necessarily putting all of these puzzle pieces together early on until the presentation is a little bit later in the diagnosis.

So it is a very high likelihood that that could be occurring.
One way we can do this is by, educating the community about myeloma.
It is a lower, that is prevalent disease in malignant hematology.
But it is a disease that has a chronicity.
And, and the body of the patient is a chronic illness that currently is considered incurable.
I'm hopeful that it will be cured will one day,
but that affects our patients in such a way.
The burden of the economical burden, right.
The burden of the disease itself and the family on the patient that the earlier we diagnose it and the more we can attack this disease
so that the patient has a better quality of life,
I think would be one of the key components.

I think the outlook in myeloma nowadays is very promising.
I am very excited to see more inclusiveness of patients of under served minority backgrounds being included in the clinical trials.
And I exhort every single patient to when they go to their doctor's office, ask if they have knowledge of clinical trials,
or visit ClinicalTrials.gov and see what trials are available
that might be close to them in a cancer center,
because that's probably their best upfront option.
If they're newly diagnosed.
And it will be the best way to move the needle forward in this disease process.