Outcome Disparities In Multiple Myeloma: A SEER-Based Comparative Analysis of Hispanic Patients

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 396-396
Author(s):  
Sikander Ailawadhi ◽  
Dongyun Yang ◽  
Edmund Ho ◽  
Pedram Razavi ◽  
Asher A. Chanan-Khan
Keyword(s):  
Multiple Myeloma ◽  
Ethnic Disparities ◽  
Age At Diagnosis ◽  
Younger Age ◽  
Specific Mortality ◽  
Hispanic Patients ◽  
Ethnic Subgroup ◽  
Race Ethnicity ◽  
Epidemiological Characteristics ◽  
Overall Mortality

Abstract Abstract 396 Background: Study of ethnic disparities in various malignancies has revealed variation in clinical outcomes. In multiple myeloma (MM) patients, such an analysis has not yet been undertaken for patients with Hispanics decent. Since this is the fastest growing ethnic subgroup in the United States, we sought to define the epidemiological characteristics as well as disease related outcome of Hispanics with MM. Methods: The Surveillance Epidemiology and End Results (SEER) 17 Registry data (1973-2007) was utilized. Patients with confirmed diagnosis of MM were eligible for this analysis. To avoid bias of under representation, analysis was restricted to adults (>18 yr) with a diagnosis date of 1992 or later. Cases that received a diagnosis at death certificate or autopsy, no follow-up records, as well as lacking documentation on age at diagnosis, sex, or race/ethnicity were excluded. Cox proportional hazards models, adjusted for confounding variables, were used to evaluate association between patient characteristics and survival. All statistical tests were two-sided with a significance level of 0.05. Analysis was performed utilizing the SAS software (v9.2). Results: The final analysis included 37,963 MM patients (20,498 males; 54%, 17,465 females; 46%). The studied age-group cohorts included: 18–44 yrs (1,453; 4%), 45–54 yrs (4,495; 12%), 55–64 yrs (7,974; 21%), 65–74 yrs (11,146; 29%), and ≥75 yrs (12,895; 34%). Patients were stratified by race/ethnicity: White (25,753; 68%), African-American (6,595; 17%), Hispanic (3,475; 9%), Asian (1,961; 5%), and Native American (179; 0.5%). For survival analysis, Native Americans were excluded due to their small numbers. Patients were also stratified based on year of diagnosis (before or after 2002) to study the impact of novel agents on MM treatment. To investigate the effect of geographical location on disease outcome, patients were stratified across regional registries within the SEER 17. Mean age at diagnosis for Hispanics was significantly younger than W (64.2 yr Vs. 69.3 yr; p<0.001). Within the Hispanics, males (53%) had a younger age at diagnosis (mean 63.4 yr) than females (47%) (mean 65 yr). Survival analysis revealed that for all patients, females had an overall reduced mortality than males (HR 0.905; CI 0.882, 0.929; p <0.001), although there was no gender difference in MM-specific mortality (p=0.1). Amongst the different age cohorts, overall as well as MM-specific mortality was highest in patients ≥75 yrs (p<0.001). Patients diagnosed after 2002 had a significantly lower overall (HR 0.9; CI 0.874, 0.927; p<0.001) and MM-specific mortality (HR 0.845; CI 0.816, 0.875; p<0.001) than those diagnosed prior. Hispanics had higher overall mortality than all the other racial subgroups (HR 1.068; CI 1.019, 1.120; p=0.006), although the difference in MM-specific mortality was not significant (HR 1.039; CI 0.983, 1.097). In a multivariate model using gender, age, marital status, year of diagnosis and race, significant interactions were noted between race, age and survival showing that Hispanics ≥75 yr had higher overall and MM-specific mortality (p<0.001) than other age-stratified racial cohorts. There was no significant difference in mortality when comparing Hispanic patients in the different geographical regions. Conclusions: Studies of ethnic disparities are important for evaluating disease characteristics and management needs of specific patient populations as well as optimal triaging of healthcare resources. There is limited data to define MM characteristics and survival outcome in Hispanics. Here we present epidemiological characteristics and survival outcomes for MM in this fast growing ethnic subgroup. We observed significantly younger age at MM diagnosis for Hispanics. Hispanic MM patients had higher overall mortality than all other racial subgroups. Furthermore, we noted that the effect of race on survival depends on patient's age, with Hispanic patients ≥75 yrs having a significantly higher overall and MM-specific mortality. These results will help in better understanding of ethnic influences on disease biology and clinical behavior. Disclosures: No relevant conflicts of interest to declare.

Ethnic Disparities in Multiple Myeloma: A Comparative Analysis of Hispanic Patients.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4875-4875
Author(s):  
Michael Keng ◽  
Asher A. Chanan-Khan ◽  
Eddie Thara ◽  
Dongyun Yang ◽  
Ann Mohrbacher ◽  
...  
Keyword(s):  
Ethnic Disparities ◽  
Staging System ◽  
Treatment Patterns ◽  
Age At Diagnosis ◽  
Hispanic Population ◽  
Significant Difference ◽  
Plasma Cell Disorders ◽  
Hispanic Patients ◽  
Ethnic Subgroup ◽  
M Spike

Abstract Abstract 4875 Background Study of ethnic disparities in various malignancies has revealed variation in treatment patterns as well as clinical outcomes. In multiple myeloma (MM) patients, ethnic disparities and clinical variability has been recorded in Caucasian, African-American and Asian populations. Such an analysis has not yet been undertaken for patients with Hispanics decent. Since this is the fastest growing ethnic subgroup in USA, it is increasingly important to investigate the variations in disease that may specifically define this population from MM patients of other ethnic backgrounds. We studied a large cohort of MM patients with Hispanic decent seen at our institution and compared them with the Caucasians (the most predominantly reported MM patient population), to better define biological characteristics and survival in this subgroup. Methods Patients with plasma cell disorders seen at the University of Southern California were included in the analysis. Demographic, mortality and disease-related clinical characteristics at the time of diagnosis of active MM were evaluated. Chi-square test or Mann-Whitney U test were used where appropriate. A 0.05 nominal significance level was used in all hypothesis testing. Results Plasma cell disorders in 160 patients were studied. Among these, 140 had active MM at the time of diagnosis. Patients were divided into Hispanic (H; 54%), Caucasian (C; 21%), African-American (AA; 14%), Asian (A; 6%), and other (O; 5%) subgroups based on race. Median age at diagnosis amongst Hispanic patients was 57 yrs (range 20-85), with 49% males. Advanced stage (>stage 1) disease was observed in 87% and 55% of these patients based on the Durie Salmon (DS) staging system and the International Staging System (ISS), respectively. Renal dysfunction was noted at diagnosis in 9% patients. IgG disease was the most common MM subtype (57%) and kappa light chain involvement was more common than lambda light chain (61% vs. 39%). Presence of bone lesions was noted in 65% of the Hispanic patients, while 8% had non-secretory MM. Median serum M spike at diagnosis was 2.3 gm% (range 0-26.7) and median bone marrow (BM) plasmacytosis at diagnosis was 24.5% (range 1%-100%). Majority of Hispanic patients (89%) never received an autologous stem cell transplant (ASCT) and only 21% ever participated in a clinical trial. Immunomodulatory drugs (IMiDs) were used in 55% and proteasome inhibitors (PI) in 44% of the Hispanic patients over the course of their disease. Median overall survival (OS) amongst Hispanic MM patients was 4.1 yrs (95% CI 3.1, 8.1). Further investigation involved comparison of these characteristics between our Hispanic (n=75) and Caucasian (n=30) patients. Among the demographic parameters, we observed a statistically significant difference between the 2 ethnic groups with respect to median age at diagnosis (H; 57 vs. C; 64, p=0.01). Hispanics had 61% patients <70 yrs of age, while the Caucasians had only 38%. There was no statistically significant difference between the two subgroups with respect to gender, DS stage, ISS stage, M spike at diagnosis, renal dysfunction, MM subtype, presence of lytic lesions at diagnosis, secretor status or clinical trial participation. BM plasmacytosis at the time of diagnosis was significantly lower in the Hispanics (H; 20% vs. C; 40%, p=0.04). The Hispanic population was less likely to undergo ASCT (OR=0.21; 95% CI 0.07, 0.59). There was no significant difference amongst the two ethnic subgroups for median OS (p=0.56), or if OS was compared for type of treatment given; IMiDs (p=0.9) or PI (p=0.3). Conclusions Studies of ethnic disparities remain an important area of evaluating management needs of specific patient populations as well as optimal triaging of healthcare resources. There is limited information on biological parameters of disease, clinical management information and survival outcome of Hispanic patients with MM. Here we present disease characteristics and treatment outcomes in this fast growing ethnic subgroup. Although our experience is limited to a single center, it reflects the changing population demographics of USA. We observed important disparities in patient demographics such as young age at diagnosis, as well as variable treatment patterns such as decreased ASCT in Hispanic population. Although several parameters may influence these patterns, our initial indications warrant systematic evaluation in larger patient cohorts. These studies are timely and will help in better understanding of ethnic influences on disease biology and clinical behavior. Disclosures No relevant conflicts of interest to declare.

Improved Prognosis in Multiple Myeloma-a Population Based Study on 13,376 Patients Diagnosed in Sweden 1973–2001.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2408-2408
Author(s):  
Sigurdur Y. Kristinsson ◽  
Ola Landgren ◽  
Paul Dickman ◽  
Asa Derolf ◽  
Magnus Bjorkholm
Keyword(s):  
Multiple Myeloma ◽  
Excess Mortality ◽  
Relative Survival ◽  
Population Based ◽  
Age At Diagnosis ◽  
University Hospital ◽  
Calendar Period ◽  
Population Based Study ◽  
Younger Age ◽  
One Year

Abstract Background: Over the last decades there have been advances in the treatment of patients with multiple myeloma (MM) and prognosis has improved with the introduction of new treatment strategies. However, few studies have addressed the issue which patients benefit most from these therapeutic changes over the years. Aims: To evaluate relative survival in all diagnosed MM patients in Sweden 1973–2001 and relate the changes to age, sex and type of hospital where diagnosis was made. Methods: All patients with MM notified to the Swedish Cancer Register in 1973–2001 were followed up by record linkage to the nationwide Cause of Death Register. Survival analyses were performed by obtaining relative survival (RS) defined as the ratio of observed versus expected survival. The study period was divided arbitrarily to four calendar periods: 1973–1979, 1980–1986, 1987–1993, and 1994–2002. Patients were grouped according to age at diagnosis (0–40, 41–50, 51–60, 61–70, 71–80, and 80+), sex, and hospital category. RS was estimated using SAS (Cary, NC, USA) and excess mortality modelled using Poisson regression. Results: A total of 13,376 patients (7,114 males and 6,262 females, mean age 69.8 years, and 32% diagnosed at a university hospital) were diagnosed with MM in Sweden between January 1st 1973 and December 31st 2001. The overall one-year RS estimates were 73%, 78%, 80%, and 81%, respectively, for the four calendar periods. The overall five-year RS was 31%, 32%, 34%, and 36% and the ten-year RS remained stable at 12%, 11% 13% in the first three periods; ten-year RS could not be calculated for the last calendar period. The increase in one-year RS was observed in all age categories over the four calendar periods, while the increase in five-year RS was restricted to patients <70 years. Younger age at onset was associated with a superior survival in all calendar periods. Differences in survival by age at diagnosis and calendar period were highly statistically significant (p<0.0001). Females had a superior 1- (p=0.002), 5- (p=0.024), and 10-year RS (p=0.019) compared to males, after adjusting for age and period. Patients diagnosed at university hospitals had superior 5- and 10-year RS (p=0.007) but not 1-year RS. Summary/conclusions: The present study shows an improved prognosis over time in a population-based study including > 13,000 MM patients diagnosed during a 29-year period. Of interest is that even one-year RS has improved in all age groups over the whole study period. Increase in five-year RS was only observed in patients aged <70 years. The ten-year RS did not improve over the first 20 years and could not be estimated for patients diagnosed in the last period. Younger age at diagnosis was associated with superior one-, five- and ten-year RS in all calendar periods. Females had a significantly better survival than males. A significant difference in survival was seen according to type of hospital, with patients diagnosed at a university hospital surviving longer. In conclusion, the results show that survival of MM patients has improved during the study period. However, long-term survival has not improved significantly. Males, elderly patients and patients diagnosed during early calendar periods experienced higher excess mortality.

Ethnic Disparities and Their Association With Outcomes In Chronic Myeloid Leukemia

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2917-2917 ◽  
Author(s):  
Sikander Ailawadhi ◽  
Dongyun Yang ◽  
Wendy Cozen ◽  
Asher Chanan-Khan
Keyword(s):  
Survival Analysis ◽  
Chronic Myeloid Leukemia ◽  
Ethnic Minorities ◽  
Myeloid Leukemia ◽  
Significant Interaction ◽  
Age Groups ◽  
Age At Diagnosis ◽  
Investigational Product ◽  
Hispanic Patients ◽  
Race Ethnicity

Abstract Background Outcomes for patients with chronic myeloid leukemia (CML) have improved in recent years. Nonetheless, survival disparities persist between various patient subgroups. There have been limited reports of ethnic variations in CML outcomes, with limited data on ethnic minorities (Hispanics and Asians), who are the fastest growing ethnic subgroups in the Unites States. We undertook a large Surveillance Epidemiology and End Results (SEER) based analysis to describe outcome disparities in different subgroups of CML patients, with a specific focus on various ethnicities. Methods SEER 17 Registry data (1973-2010) was utilized. Adult (>18 years) patients with confirmed diagnosis of CML were eligible. To avoid bias of under representation by ethnic minorities, analysis was restricted to patients with a diagnosis date of 1992 or later (SEER expansion). Cases that received a diagnosis at death certificate/autopsy, no follow-up records, or lacking age at diagnosis, sex, or race/ethnicity documentation were excluded. Cox proportional hazards models, adjusted for confounding variables, were used to evaluate association between patient characteristics and overall survival (OS). All statistical tests were two-sided with a significance level of 0.05, utilizing the SAS software (v9.2). Results The final analysis included 10,356 CML patients (5,943 males; 57.4%, 4,413 females; 42.6%). Age group cohorts included: 18-44 years (2,592; 25%), 45-54 years (1,706; 16.5%), 55-64 years (1,817; 17.6%), 65-74 years (1,876; 18.1%), and ≥75 years (2,365; 22.8%). Patients were stratified by race/ethnicity: White (7,292; 70.4%), African-American (AA) (1,143; 11%), Hispanic (1,163; 11.2%), Asian (697; 6.7%), and Native American (61; 0.6%). For survival analysis, Native Americans were excluded due to their small numbers. Patients were also stratified based on year of diagnosis (1992-1999, 2000-2004 and 2005-2010) to study the impact of evolving therapeutics on CML outcomes. Median age at diagnosis was significantly different among ethnicities (p<0.001) with Hispanics the youngest (47 years) and Whites the oldest (63 years) (Figure 1). There were more Hispanic and AA CML patients reported in recent years in the database than those in 1992-1999 or 2000-2004 (p<0.001). Survival analysis revealed that for all patients, females had a significantly better median OS than males (7.8 years vs. 6.4 years; p<0.001). Among the different age cohorts, median OS got progressively worse with increasing age at diagnosis (p<0.001), with a median OS of 15+ years in 18-44 year cohort vs. 2.3 years in patients ≥75 years. Patients diagnosed more recently had a better median OS (1992-1999: 4.5 years vs. 2000-2004: 7.7 years vs. 2005-2010: 9.8 years; p<0.001). AA had the worst median OS among all ethnicities, which was significantly worse than Whites (reference) (5.8 years vs. 7.4 years; p<0.001). Asians had a median OS of 6.4 years and Hispanics 6 years. In a multivariate model using race, age at diagnosis, year of diagnosis, sex and marital status, a significant interaction was noted between year of diagnosis and race, with all racial subgroups showing improvement in 5-year survival in more recent time periods (p=0.001) (Figure 2). A significant interaction was also noted between year of diagnosis and age, with a progressive improvement in 5-year survival noted across all age groups in more recent years (p<0.001) (Figure 3). Conclusions We present a population-based study of outcomes in CML with the largest representation of ethnic minorities reported so far. We noted a higher number of AA and Hispanic patients reported to the SEER database in recent years. Hispanic patients had a significantly younger age at diagnosis, which could mean longer treatment duration over the lifetime of a patient. AA patients had the worst median OS among all ethnicities, although all ethnicities and age groups were noted to have progressive improvement in outcomes in more recent years of diagnosis. The incremental benefit in outcomes was seen most for Asians and least for Whites. These results will help in better understanding of ethnic influences on disease biology and clinical behavior as well as optimal triaging of healthcare resources. Disclosures: Off Label Use: The abstract shows scientific information on SAR245409 which is an investigational product developed by Sanofi. This investigational product is not approved by any health authority for any indication.

scholarly journals Racial and Ethnic Differences in Clonal Hematopoiesis, Tumor Markers, and Clinical Outcomes of Patients with Multiple Myeloma

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 402-402
Author(s):  
Nancy Gillis ◽  
Lauren C Peres ◽  
Christelle M Colin-Leitzinger ◽  
Mingxiang Teng ◽  
Raghunandan Reddy Alugubelli ◽  
...  
Keyword(s):  
Board Of Directors ◽  
Research Funding ◽  
Multivariable Analysis ◽  
Age At Diagnosis ◽  
Advisory Committees ◽  
Black Patients ◽  
Significant Difference ◽  
Hispanic Patients ◽  
Race Ethnicity ◽  
White Patients

Abstract Background: Multiple myeloma (MM) is twice as common in Blacks compared to Non-Hispanic (NH) Whites and Hispanics. While treatment and mortality differences have been reported for Black patients with MM compared to NH White patients, there is limited data on Hispanic populations. Furthermore, the factors driving observed differences in MM presentation and treatment responses by race and ethnicity are largely unknown. We investigated demographic, clinical, and molecular features, including tumor mutations and clonal hematopoiesis (CH), in a diverse population of patients with MM to elucidate mechanisms driving clinical disparities. Methods: Patients diagnosed with MM who consented to our institutional biorepository protocol were eligible for inclusion. Demographic and clinical data were obtained from cancer registry and abstracted from electronic medical records. MM tumor cells were purified from bone marrow aspirates by CD138 affinity chromatography. DNA was isolated from tumor cells and whole blood for each patient, and whole exome sequencing (WES) data was generated. Tumor somatic mutations were characterized using paired tumor-normal (blood) WES. CH was classified based on blood-derived somatic mutations, using paired tumors and reference populations as germline comparators. Outcomes included overall survival (OS; date of diagnosis to death/last contact) and progression-free survival (PFS; 1 st-line treatment start to 1 st disease progression/death). Results: A diverse group of MM patients (n=496) were included: NH White (80%), NH Black (10%) and Hispanic (9%). NH Black and Hispanic MM patients had a younger median age at diagnosis (57 and 53 yrs, respectively) compared to NH Whites (63 yrs, p = 0.0001; Fig A). There was no statistical difference in treatment categories received by race/ethnicity. NH Black patients had a longer time to hematopoietic cell transplant (HCT; 376 days) than NH White or Hispanic patients (248 and 270 days, respectively, p = 0.011). There was an improvement in OS for NH Black (HR 0.49, 95% CI 0.30-0.81) and Hispanic (HR 0.66, 95% CI 0.37-1.18) patients compared to NH White patients, but the association was not statistically significant in Hispanics. In univariable analysis, OS was also associated with age at diagnosis, International Staging System (ISS), treatment with HCT, and treatment regimen category. In multivariable analysis, after adjusting for age, ISS, HCT, and treatment category there was no longer a statistically significant association between OS and race/ethnicity. Although a worse PFS was present among Hispanic patients (adjusted HR 1.45, 95% CI 0.99-2.13), there was no statistically significant difference in PFS by race/ethnicity. The most mutated genes in MM tumors were KRAS (24%), NRAS (17%), TP53 (11%), DIS3 (9%), and BRAF (9%) (Fig B). Genes with significantly higher tumor mutation rates in Black compared to NH White patients were SP140 (12% v 4%, p = 0.026), AUTS2 (8% v 2%, p = 0.04), and SETD2 (6% v 1%, p = 0.037). IRF4 was most commonly mutated in Hispanics (11% v 3% in NH White and 0% in Black, p = 0.019). We identified CH using WES in 60 (12%) patients. The most CH mutations were in ASXL1, DNMT3A, and TET2. There was no difference in the prevalence of CH by race/ethnicity (p=0.8). There was a statistically significant difference in OS by race/ethnicity and CH status (Fig C). For NH Black patients, CH (HR 4.36, 95% CI 1.36-14.0) and age at diagnosis (HR 1.08, 95% CI 1.03-1.14) were associated with inferior OS (Fig C). After adjusting for age in multivariable analysis, the positive association with CH status among Black patients was no longer statistically significant (HR 2.72, 95% CI 0.48-15.4). A positive, but not statistically significant, association for PFS in NH White patients with CH was also noted (adjusted HR 1.38, 95% CI 0.95-2.0). Conclusions: This is the first study to examine differences in tumor mutation profiles, CH, and treatment among different racial and ethnic groups of patients diagnosed with MM. Our data suggest that age at diagnosis, tumor mutations, and CH may all contribute to clinical disparities observed in patients with MM. Efforts to expand our cohort and incorporate additional molecular biomarkers, epidemiologic characteristics, and clinical parameters are ongoing with the ultimate goal of elucidating targetable biological mechanisms to personalize management and optimize outcomes for diverse patients diagnosed with MM. Figure 1 Figure 1. Disclosures Hampton: M2Gen: Current Employment. Blue: WebMD: Consultancy; Janssen Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees. Siqueira Silva: AbbVie Inc.: Research Funding; Karyopharm Therapeutics Inc.: Research Funding. Baz: GlaxoSmithKline: Consultancy, Honoraria; BMS, sanofi, Karyopharm, Janssen, AbbVie: Consultancy, Research Funding; Oncopeptides: Consultancy; Merck: Research Funding. Nishihori: Novartis: Research Funding; Karyopharm: Research Funding. Shain: Janssen oncology: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Karyopharm Therapeutics Inc.: Honoraria, Research Funding; Sanofi Genzyme: Consultancy, Speakers Bureau; Novartis Pharmaceuticals Corporation: Consultancy; GlaxoSmithLine, LLC: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; BMS: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Amgen Inc: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Adaptive Biotechnologies Corporation: Consultancy, Speakers Bureau; AbbVie: Membership on an entity's Board of Directors or advisory committees, Research Funding.

Obesity In Young Adulthood Is Associated With Early Onset Multiple Myeloma In African Americans

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1872-1872
Author(s):  
Amie E. Hwang ◽  
Sikander Ailawadhi ◽  
Leon Bernal-Mizrachi ◽  
Todd M Zimmerman ◽  
Christopher Haiman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
African American ◽  
African Americans ◽  
Board Of Directors ◽  
Research Funding ◽  
Clinical Characteristics ◽  
Age At Diagnosis ◽  
Advisory Committees ◽  
Younger Age

Abstract Introduction African-American ethnicity, male sex, older age and obesity are accepted risk factors for multiple myeloma (MM). Obesity early in life is a risk factor for many cancers, including MM; most studies have focused on populations of European origin. African-Americans have a higher prevalence of obesity than other populations, and may have a distinct genetic contribution to this condition. We established a multi-center collaborative study to investigate possible explanations for the excess risk of MM among African-Americans. The aim of the present case-case analysis was to determine whether body mass index (BMI) was associated with risk factors and clinical characteristics at presentation in African-American MM patients. Methods Patients diagnosed with active MM since January 1, 2009 were recruited from nine outpatient centers and three Surveillance, Epidemiology, End-Results Program (SEER) population-based cancer registries. Information on weight and height at 20 years of age and at 5 years prior to diagnosis was obtained from questionnaires. Clinical information collected included age at diagnosis, stage, percent plasmacytosis on bone marrow biopsy, β2 microglobulin level, Ig serotype, light vs. heavy chain disease, and presence of lytic bone lesions. BMI (ht/wt2) was categorized into 3 levels (normal <25, overweight 25-29, obese >30) according to World Health Organization standard. The Pearson chi-square test was used to test the association between BMI category, and risk factors and clinical characteristics. Mean ages at diagnosis across BMI categories were compared using linear regression and a t-test for trend calculated. Results To date, 1,044 African-American MM patients have been enrolled and of those, 1,014 provided a DNA sample. At present, 970 patients have completed a questionnaire, clinical records have been abstracted for 823 patients, and 509 patients have some information on gender, age at diagnosis, weight, height and clinical characteristics.The mean age at diagnosis was 59. Increasing BMI at age 20 was associated with younger age at diagnosis (p= 0.0004), whereas BMI at 5 years prior to diagnosis was not associated with age at diagnosis (p=0.9477). Among men, mean age at diagnosis decreased with increasing BMI at age 20 (p= 0.0125) (Table 1a) and at 5 years prior to diagnosis (p=0.0252) (Table 1b). Among women, the trend was signficant at age 20 (p=0.0018) (Table 1a) but not at 5 years prior to diagnosis (p= 0.7094) (Table 1b). Increasing BMI was not significantly associated with any other clinical characteristics. Conclusion/Discussion In a large collection of African-American MM patients, we observed a strong association between increasing BMI at age 20 and younger age at diagnosis. A similar trend was observed in men only at 5 years prior to diagnosis, consistent with previous reports. Obesity is one of the few known potentially modifiable risk factors for MM. Younger age at diagnosis reflects an earlier accumulation of either or both genetic and environmental risk factors. Obesity at an early age may influence MM risk through shared biological pathways such as interleukin-6 and insulin-like growth factor, by contributing to chronic B-cell activation, thereby increasing susceptibilty for MM later in life. The significance of the gender difference for the association closer to diagnosis is unclear and requires additional study. Disclosures: Terebelo: Amgen: Honoraria; Millennium: Honoraria. Mehta:Celgene: Speakers Bureau; Millennium: Speakers Bureau. Zonder:Skyline: Consultancy. Orlowski:Bristol-Myers Squibb: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding; Celgene: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding; Millennium: The Takeda Oncology Company: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding; Onyx: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding; Resverlogix: Research Funding; Array Biopharma: Honoraria, Membership on an entity’s Board of Directors or advisory committees; Genentech: Honoraria, Membership on an entity’s Board of Directors or advisory committees; Merck: Membership on an entity’s Board of Directors or advisory committees. Lonial:Celgene Corporation: Consultancy; Millennium: Consultancy; Novartis: Consultancy; Bristol Myers Squibb: Consultancy; Sanofi: Consultancy; Onyx: Consultancy.

Comparison of Age at Diagnosis, Cytogenetic Risk, and Overall Survival Between Acute Myeloid Leukemia Patients of White and South Asian Race/Ethnicity in the United States

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3753-3753
Author(s):  
Tao Zou ◽  
Ashley M. Perry ◽  
Andrew M. Brunner ◽  
Chepsy C Philip ◽  
Donna S. Neuberg ◽  
...  
Keyword(s):  
Old Age ◽  
South Asian ◽  
South Asians ◽  
Age Distribution ◽  
Age At Diagnosis ◽  
Age Group ◽  
Asian Populations ◽  
Younger Age ◽  
The Us ◽  
Race Ethnicity

Abstract Introduction: Acute myeloid leukemia (AML) is more frequent among older patients in the United States (US), with a median age at diagnosis of 67 years old. A recent case series of AML patients from India reported a median age at diagnosis of 40 years old, suggesting that the pathogenesis of AML may differ between these populations (British Journal of Haematology 2015;170:110). In this study, we examined whether differences exist in the age at diagnosis, cytogenetic risk, and overall survival (OS) of White and South Asian patients diagnosed with AML in the US. Methods: We used the 1973-2012 Surveillance, Epidemiology, and End Results Program (SEER) database to identify adults, age 20 years or older, diagnosed with AML between 2000 and 2012. We included patients with documented race/ethnicity and known age at diagnosis. We compared age at diagnosis, cytogenetic risk, and OS according to White or South Asian race/ethnicity, based on patient surname as defined by SEER. We stratified age at diagnosis into age groups, defined as 20-24, 25-34, 35-44, 45-54, 55-64, and >65 years old, to compare the White and South Asian populations. Using the 2012 US Census population age distributions, we directly standardized the distribution of age at diagnosis of AML in SEER, weighted according to the age distribution of the total White and South Asian populations in the US. We categorized SEER-reported cytogenetic profiles as having favorable or adverse prognosis based on accepted definitions. We compared cytogenetic risk and OS between White and South Asian populations according to stratified age group at diagnosis. Differences in age at diagnosis were calculated using the Mann-Whitney test. OS was compared by the Log-rank test and estimated by the method of Kaplan and Meier. P-values <0.05 were considered significant. Results: 39,192 patients, age 20 years old and above, were diagnosed with AML from 2000 to 2012 and had documented race/ethnicity at diagnosis in the SEER database. South Asian patients in the US were diagnosed with AML at a significantly younger age compared to White patients (Figure 1A, median age at diagnosis of 57 vs. 69.5 years old for South Asians (n=265) vs. Whites (n=33,419), p=<0.0001). Along with younger age at diagnosis, South Asians had a greater reported frequency of favorable cytogenetic risk (17.7% vs. 9.7% favorable cytogenetic risk for South Asians vs. Whites). Analysis of the demographics of the US population also showed that the South Asian population was significantly younger than the White population (median age of 40 vs. 50 years old for South Asians (n=2,447,009) vs. Whites (n=172,366,410), p=<0.0001). Direct standardization of the age at AML diagnosis with the age distributions of White and South Asian census populations in the US abrogated the differences in age at diagnosis between these groups (Figure 1B, p=0.8718). Standardization by age distribution also narrowed the difference in favorable cytogenetic risk between Whites and South Asians (17.9 vs. 19.1 cases per one million people, respectively). OS was not different between Whites and South Asians in the 20-49 year old age group (median OS: 46 vs. 60 months for Whites (n=5,272) vs. South Asians (n=96), p=0.4986), the 50-64 year old age group (median OS: 13.5 vs. 16 months for Whites (n=6,066) vs. South Asians (n=62), p=0.5088), or the >65 year old age group (median OS: 3 vs. 4.5 months for Whites (n=13,692) vs. South Asians (n=66), p=0.8491). Conclusions: In the US, AML patients of South Asian descent are diagnosed at a younger age and have more favorable cytogenetic risk profiles as compared to their White counterparts, which is of epidemiologic importance. Nevertheless, these findings appear to reflect the younger age distribution of the entire South Asian population as compared to the total White population in the US, rather than a difference in the inherent biology or pathogenesis of AML. These data highlight the importance of directly standardizing age distributions in population outcomes research. Disclosures Fathi: Agios Pharmaceuticals: Other: Advisory Board participation; Merck: Other: Advisory Board participation; Seattle Genetics: Other: Advisory Board participation, Research Funding.

scholarly journals Race and ethnicity on MS presentation and disease course

2020 ◽  
Vol 26 (5) ◽  
pp. 561-567
Author(s):  
Lilyana Amezcua ◽  
Jacob L McCauley
Keyword(s):  
African Americans ◽  
Race And Ethnicity ◽  
Ethnic Disparities ◽  
European Ancestry ◽  
Mortality Trends ◽  
Ethnic Populations ◽  
Specific Mortality ◽  
Future Challenges ◽  
Race Ethnicity ◽  
Racial Ethnic

Multiple sclerosis (MS) has a strong racial and ethnic component and disproportionately affects whites of European background. Recent incidence reports suggest an increasing rate of MS among African Americans compared with whites. Despite this recent increase in MS in African Americans, Hispanics and Asians are significantly less likely to develop MS than whites of European ancestry. MS-specific mortality trends demonstrate distinctive disparities by race/ethnicity and age, suggesting that there is an unequal burden of disease. Inequalities in health along with differences in clinical characteristics that may be genetic, environmental, and social in origin may be contributing to disease variability and be suggestive of endophenotypes. The overarching goal of this review was to summarize the current understanding on the variability of disease that we observe in selected racial and ethnic populations: Hispanics and African Americans. Future challenges will be to unravel the genetic, environmental, and social determinants of the observed racial/ethnic disparities.

Epithelial ovarian cancer survival by race/ethnicity in an equal-access healthcare population.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18525-e18525
Author(s):  
Zhaohui Liao Arter ◽  
Daniel Desmond ◽  
Jeffrey L. Berenberg ◽  
Melissa A. Merritt
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Ethnic Disparities ◽  
Access To Healthcare ◽  
Age At Diagnosis ◽  
Equal Access ◽  
Chemotherapy Treatment ◽  
Study Population ◽  
Race Ethnicity ◽  
Racial Ethnic

e18525 Background: Previous studies in the general population have observed that compared with Non-Hispanic White (NHW) women, Pacific Islander (PI) and Non-Hispanic Black (NHB) women have higher age-adjusted mortality rates from epithelial ovarian cancer (EOC), while Asian Americans (AS) have lower mortality. It is unknown whether these patterns reflect biological differences, environmental exposure or perhaps access to care. Our objective was to investigate whether self-reported race/ethnicity is associated with differences in EOC survival in a Military population where patients have equal access to healthcare. Methods: The study population included women diagnosed with EOC (ovarian, fallopian tube and primary peritoneal cancers) among US Department of Defense beneficiaries reported in the Automated Central Tumor Registry Database (year of diagnosis range: 2001-18). Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models following participants from their date of diagnosis until last contact or censoring, whichever occurred first. Multivariable models were adjusted for covariates selected a priori because of their known influence on risk of EOC death; age at diagnosis (continuous), histology, stage and receipt of the first course of chemotherapy treatment. We adjusted for year of diagnosis (continuous) to account for possible changes in treatment over time. Results: The study population included 1151 patients diagnosed with EOC: 796 NHW, 111 NHB, 130 AS, 49 PI and 65 Hispanic (HS). All EOC patients had complete information on age at diagnosis, stage and chemotherapy treatment. During a median (interquartile range) follow-up of 3.5 years (1.8-6.7), 702 EOC patients (61%) died of all causes. When comparing crude EOC patient characteristics by racial/ethnic group, NHW had the highest frequency of EOC leading to death (58% vs. < 49% in other groups). There also were differences in histology; NHW and NHB had a higher frequency of serous tumors ( > 56% of EOCs vs. < 52% in other groups); PI had a high proportion of endometrioid histology (14% of EOCs vs. < 11% in others); 10% of EOCs among AS had clear cell histology (vs. < 9% in others). HS had a high percentage of local disease (23% vs. < 20% in others). In multivariable survival analysis adjusting for clinical factors, we observed that compared with NHW, there were no differences in EOC survival by race/ethnicity: AS, HR = 0.80 (95% CI = 0.61-1.05); NHB, HR = 0.96 (95% CI = 0.72-1.28); PI, HR = 0.92 (95% CI = 0.58-1.46); and HS, HR = 0.82 (95% CI = 0.56-1.21). Conclusions: We observed no racial/ethnic disparities in EOC survival in a Military equal access treatment environment. These results highlight the importance of studying how differences in access to healthcare may impact observed racial/ethnic disparities for EOC.

Racial and ethnic disparities in nasopharyngeal cancer with an emphasis among Asian Americans.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 118-118
Author(s):  
Qian Wang ◽  
Hui Xie ◽  
Changchuan Jiang ◽  
Yaning Zhang ◽  
Yannan Li ◽  
...  
Keyword(s):  
Sample Size ◽  
Asian Americans ◽  
Care Delivery ◽  
Nasopharyngeal Cancer ◽  
Ethnic Disparities ◽  
Racial Group ◽  
Japanese Americans ◽  
Low Grade ◽  
Specific Mortality ◽  
Race Ethnicity

118 Background: Nasopharyngeal cancer (NPC) is characterized by a distinct geographic distribution which reflects genetic predispositions, with highest incidence in Southeastern Asia and Southern China. It continues to cause a significant health burden among Asian Americans (AAs), which is a fast growing but understudied racial group. Prior studies investigating NPC combined all AA groups which may mask heterogeneities among AA subgroups. We aimed to examine the disparities in NPC by dividing AAs into four major ethnic groups - Chinese, Filipinos, Vietnamese, and Japanese Americans. Methods: NPC cases were identified from the Surveillance, Epidemiology, and End Result (SEER) 18 database from 1975-2016. Information regarding age, sex, race/ethnicity, education, income, % of foreign born, marital status, region of SEER registry, stage, histology, grade, surgery, chemotherapy, and radiation therapy were extracted. Multivariate-adjusted Cox proportional hazard regression and Fine-Gray sub-distribution hazard models were used to calculate overall and cause-specific mortality. SEER*Stat was used to calculated age-adjusted incidence. Results: Among a total of 11,737 NPC patients, 42.2% were non-Hispanic White (NHW), 10.7% non-Hispanic Black (NHB), 7.1% Hispanics, 18.9% Chinese, 7.6% Filipinos, 4.8% Vietnamese, 1.0% Japanese and 7.7% other Asians. AAs continue to have the highest NPC incidence among all racial groups despite of an overall decreasing trend. Japanese were significantly more likely to be diagnosed at localized stage, having low grade tumor and having keratinizing squamous cell carcinoma histology compared to other AAs. Compared to NHW, Filipino Americans had decreased mortality (HR = 0.90; 95%CI:0.84-0.98). Chinese (HR = 0.95; 95%CI: 0.90-1.01), and Vietnamese (HR = 0.94; 95%CI: 0.86-1.03) also observed marginally reduced mortality but not Japanese Americans (HR = 1.09; 95%CI: 0.90-1.32). No differences in NPC-specific mortality by race/ethnicity groups were found. In addition, Chinese, Filipino and Vietnamese Americans with NPC were less likely to die of other cancer and cardiovascular disease than NHW, but no such differences were observed among NHB, Hispanics or Japanese Americans. Conclusions: Asian Americans have been historically studied as one single racial group mostly due to limited sample size, despite that it is consistent of a diverse population with different genetic makeup, socioeconomic status, cultural background, health behaviors, and health care access. Our novel finding that significant disparities exist within AA NPC patients in regard to demographic and clinical features, overall and cause-specific mortality underlines the importance of adequate AA-subgroup specific sample size in future studies in order to understand the prognostic role of ethnicity in NPC, and advocates more ethnically and culturally tailored cancer care delivery.

Clinical Expression of Multiple Sclerosis in Hispanic Whites of Primarily Caribbean Ancestry

2015 ◽  
Vol 44 (4) ◽  
pp. 262-268 ◽  
Author(s):  
Athena Hadjixenofontos ◽  
Ashley H. Beecham ◽  
Clara P. Manrique ◽  
Margaret A. Pericak-Vance ◽  
Leticia Tornes ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Characteristics ◽  
The United States ◽  
Age At Diagnosis ◽  
Disease Characteristics ◽  
Age Related ◽  
Younger Age ◽  
Hispanic Patients ◽  
The Relationship ◽  
Hispanic White

Objective: The clinical characteristics of multiple sclerosis (MS) are not well defined in Hispanic populations. We hypothesized that disease presentation in Hispanic white (HW) patients will be different from non-Hispanic white (NHW) patients given their ancestral background and reported lower disease prevalence. This study was undertaken to compare HW of primarily Caribbean ancestry to NHW on clinical characteristics of MS. Methods: We assessed 312 HW and 312 NHW patients with definite MS for clinical disease characteristics obtained through consented review of medical records. In order to assess the relationship between age-related phenotypes and ethnicity, linear regression was used. Logistic regression was used to assess the relationship between ethnicity and descriptors of disease presentation and severity as well as presence of neurological symptoms. Results: We observed a significantly younger age at diagnosis (p = 1.38E-02) and age at exam (p = 2.36E-05) in HW. However, age at first symptom did not differ significantly between the two groups. Furthermore, within HW, the mean age at first symptom and age at diagnosis was significantly younger in those born in the United States (p < 1.00E-03 for both). Interestingly, we noted an increase in ambulatory disability in HW patients, primarily among those with relapsing disease (p = 4.18E-03). Conclusions: We found several differences in age-related phenotypes and disease severity between HW of primarily Caribbean origin and NHW patients. To our knowledge, this is the largest study to date that examined the clinical characteristics of MS in Hispanic patients of largely Caribbean origin.

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