African-American Multiple Myeloma Patients Exhibit Less Bone Disease Compared to Other Racial/Ethnic Groups

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4994-4994
Author(s):  
Eric W. Dean ◽  
Elad Ziv

Abstract Abstract 4994 Background: Bone destruction remains one of the major complications in Multiple Myeloma (MM) leading to morbidity and mortality. African-Americans have a higher incidence of MM but exhibit longer survivals compared to Caucasians. We analyzed bone involvement in a cohort of patients with MM to determine if non African American (non AA) vs. African American (AA) race predicts the presence and severity of bone disease at presentation. Methods: Clinical data was gathered on 197 (176 non AA and 21 AA) MM patients at the University of California, San Francisco. Each patient had a skeletal survey at diagnosis and identified as having 0 lytic lesions, 1–2 lytic lesions or 3 or more lytic lesions. The presence of compression fractures was also documented for each patient as was age and sex. Results: The presence of compression fractures strongly correlated with the number of lytic lesions in both the non AA and AA groups, with no compression fractures observed in the patients with zero lytic lesions (p<0.001). Among the AA group, there were fewer (6 of 15) patients with compression fractures compared with patients from the non AA group (92 of 161) (p=0.02). There was also a trend towards fewer lytic lesions among the AA group (p=0.053). No significant difference was observed between the extent of bone disease and age or sex between the two groups. Conclusions: Within this cohort of patients, there is a significantly lower rate of compression fractures among African-Americans. These data supports the idea that African-American patients present with less bone disease which confers a survival advantage compared to other racial/ethnic groups. Disclosures: No relevant conflicts of interest to declare.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3518-3518
Author(s):  
Martin Kaiser ◽  
Maren Mieth ◽  
Peter Liebisch ◽  
Susanne Rötzer ◽  
Christian Jakob ◽  
...  

Abstract Objectives: Lytic bone disease is a hallmark of multiple myeloma (MM) and is caused by osteoclast activation and osteoblast inhibition. Secretion of Dickkopf (DKK)-1 by myeloma cells was reported to cause inhibition of osteoblast precursors. DKK-1 is an inhibitor of the Wnt/β-catenin signaling, which is a critical signaling pathway for the differentiation of mesenchymal stem cells into osteoblasts. So far there is no study showing a significant difference in serum DKK-1 levels in MM patients with or without lytic bone lesions. Methods: DKK-1 serum levels were quantified in 184 previously untreated MM patients and 33 MGUS patients by ELISA, using a monoclonal anti-DKK-1 antibody. For the evaluation of bone disease, skeletal X-rays were performed. Results: Serum DKK-1 was elevated in MM as compared to MGUS (mean 11,963 pg/mL versus 1993 pg/mL, P < 0.05). Serum DKK-1 levels significantly correlated with myeloma stage according to Durie and Salmon (mean 2223 pg/mL versus 15,209 pg/mL in stage I and II/III, respectively; P = 0.005). Importantly, myeloma patients without lytic lesions in conventional radiography had significantly lower DKK-1 levels than patients with lytic bone disease (mean 3114 pg/mL versus 17,915 pg/mL; P = 0.003). Of interest, serum DKK-1 correlated with the number of bone lesions (0 vs. 1–3 vs. >3 lesions: mean 3114 pg/mL vs. 3559 pg/mL vs. 24,068 pg/mL; P = 0.002). Conclusion: This is the largest study of DKK-1 serum levels in multiple myeloma patients and data show for the first time a correlation between DKK-1 serum concentration and the amount of lytic bone disease, suggesting that DKK1 is an important factor for the extent of bone disease and supporting the hypothesis of DKK-1 as a therapeutic target in myeloma bone disease.


Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4876-4876
Author(s):  
Ola Landgren ◽  
Vincent Rajkumar ◽  
Ruth Pfeiffer ◽  
Robert Kyle ◽  
Jerry Katzmann ◽  
...  

Abstract Abstract 4876 Background Recent studies have found obesity to be associated with a 1.5- to 2-fold elevated risk of developing multiple myeloma. This is of particular interest given that elevated levels of the pro-inflammatory cytokine interleukin (IL)-6 have been found in obese persons, and, at the same time, IL-6 has well-known proliferative and anti-apoptotic effects on monoclonal plasma-cells. Also insulin-like growth factors (IGFs) have been proposed to play a role since obesity often causes insulin resistance, which in turn modulates the bioavailability of IGF-1 Similar to IL-6, prior studies have found IGF-1 to have both growth and survival effects on monoclonal plasma-cells. Based on these facts, we have speculated that obesity might increase the risk of the multiple myeloma precursor monoclonal gammopathy of undetermined significance (MGUS), or, alternatively, that obesity may increase the risk for transformation from MGUS to multiple myeloma. We conducted the first large screening study designed to assess the association between obesity and MGUS among almost 2,000 African-American and Caucasian women. Methods We included 1000 African-American and 996 Caucasian women (age 40-79, median 48 years) from the Southern Community Cohort Study to assess MGUS risk in relation to obesity. Per our sampling strategy, about 50% of the participants were obese. Medical record-abstracted weight and height (measured on the day of study enrollment) and self-reported values had very high concordance (Pearson correlation >0.95). Serum samples from all subjects were analyzed by electrophoresis performed on agarose gel; samples with a discrete or localized band were subjected to immunofixation. Using logistic regression models, we estimated odds ratios (ORs) as measures of risk. Results Among all study participants, 39 (3.9%) African-Americans and 21 (2.1%) Caucasians were found to have MGUS, yielding a 1.9-fold (95%CI 1.1-2.3; p=0.021) higher risk of MGUS among African-Americans (vs. Caucasians). On multivariate analysis, we found obesity (OR=1.8, 95%CI 1.03-3.1; p=0.039), African-American race (OR=1.8, 95%CI 1.04-3.1; p=0.037), and increasing age (quartiles: ≥55 vs. <43 years) (OR=2.5, 95%CI 1.1-5.7; p=0.028) to be independently associated with an excess risk of MGUS. Another interesting finding was that the distribution of the monoclonal immunoglobulin isotype usage among African-American and Caucasian women was significantly different (p=0.007). Their respective rates were: IgG in 79.5% and 71.3 %; IgA in 7.7% and 0%; IgM in 7.7% and 19%; biclonal in 5.1% and 4.7%; and triclonal in 0% and 4.7%. The distribution of serum light-chain types between the two races was also significantly different (P=0.003, chi-square test): kappa in 53.8% and 47.6%; lambda in 43.6% and 42.8%; biclonal 2.6% and 4.7%; and triclonal in 0% and 4.7%. Conclusions Our finding that MGUS is twice as common among obese (vs. non-obese) women, and independent of race, supports the hypothesis that obesity is etiologically linked to myelomagenesis and may have public health impact. The observed 2-fold excess of MGUS among African-Americans (vs. Caucasians) of similar socio-economic status, coupled with other recent studies supports a role for susceptibility genes as the cause for racial disparity in the prevalence of MGUS. Disclosures No relevant conflicts of interest to declare.


Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4866-4866
Author(s):  
Luciana Correa Oliveira de Oliveira ◽  
Juliana Alves Uzuelli ◽  
Ana Paula Alencar de Lima Lange ◽  
Barbara Amelia Aparecida Santana-Lemos ◽  
Marcia Sueli Baggio ◽  
...  

Abstract Abstract 4866 Background Multiple myeloma (MM) is an incurable malignant disease, characterized by increased angiogenesis in the bone marrow (BM) microenvironment and aberrant BM metabolism. Matrix metalloproteinases (MMP) are a family of zinc-dependent endopeptidases implicated in tumour progression, invasion, metastasis and angiogenesis, via proteolytic degradation of extracellular matrix. MMPs are inhibited by tissue inhibitors of metalloproteinase (TIMP). Although recent studies have implicated MMP 9 in MM bone disease, little is known about the role of the TIMPs. Objectives a) to compare levels of sRANKL, OPG, MMP-2, MMP-9, TIMP-1, TIMP-2, VEGF, bFGF, microvessel density (MVD) between newly diagnosed MM patients and healthy controls; b) to determine the association of these molecules with disease progression, bone disease and neoangiogenesis and c) to evaluate the impact of these variables on survival. Patients and Methods As of July 2009 38 newly diagnosed and untreated multiple myeloma patients were enrolled in the study. The median age was 61years-old (range 39-91) with 24 (63%) males. Patients were diagnosed and categorized according The International Myeloma Working Group criteria and ISS, respectively. Bone involvement was graded according to standard X-ray: patients with no lesions, or with one/ two bones involved or diffuse osteoporosis were classified as low score, whereas patients with lesions in more than two bones or presence of bone fracture were classified as high score. MMP-2 and MMP-9 were determined by PAGE gelatin zymography from plasma as previously described. MMP-9, TIMP-1 and TIMP-2, OPG and sRANKL concentrations were measured by ELISA. The levels of VEGF, bFGF were obtained using cytometric bead array. Ten healthy volunteers were used as controls. Bone marrow MVD measured in hotspots was evaluated in 26 out of 38 patients at diagnosis and 15 patients with Hodgkin Lymphoma stage IA and IIA (used as controls) by staining immunohistochemically for CD34. Comparisons among groups were analyzed by ANOVA and the correlation by the Spearman's correlation coefficient. Cox regression were performed for overall survival (OS) analysis. Results Patients with MM had elevated TIMP-1, TIMP-2 and OPG values compared with controls. No significant difference was found between plasma sRANKL, pro-MMP2, pro-MMP9 and MMP-9 levels. We found that plasma TIMP-1 levels correlated positively with bFGF, VEGF, MVD, beta-2 microglobulin (B2M) and OPG (r: 0.514, p=0,001, r: 0.350, p=0,031; r: 0.610, p<0.0001; r: 0.760, p<0.0001 and r: 0.701, p<0.0001, respectively) and TIMP-2 levels with bFGF, DMV, B2M and OPG (r: 0.512, p=0.002; r: 0.595, p<0.0001; r: 0.587, p<0.0001 and r: 0.552, p<0.0001, respectively). TIMP-1 and TIMP-2 levels correlated with the ISS stage (p<0.0001, p=0.006, respectively). The only variables that correlated with clinical bone disease staging were hemoglobin, B2M and albumin levels, whereas TIMP-1, TIMP-2, bFGF, VEGF and OPG correlated with DMV. On the univariate analyses, age, gender, proMMP2, TIMP-1, TIMP-2, creatinine, B2M and MVD were significantly associated with overall survival. In Cox regression model, TIMP-1, TIMP-2 and B2M levels remained to be significantly associated with OS. In conclusion, our results suggest that TIMP-1 and TIMP-2 levels are strongly associated with neoangiogenesis and are independent prognostic factors in MM. Disclosures No relevant conflicts of interest to declare.


Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4631-4631
Author(s):  
Karen Sweiss ◽  
Annie L. Oh ◽  
Gregory S. Calip ◽  
Damiano Rondelli ◽  
Pritesh R. Patel

Abstract African Americans (AA) have a 2- to 3-fold higher incidence of multiple myeloma (MM) when compared to other racial groups. Evidence suggests that there may be differences in the biology of MM, which confer a more favorable prognosis in AA patients. Prior studies are conflicted as to whether AA patients achieve equal or improved outcomes compared to non-African American (non-AA) patients. Our purpose was to evaluate the impact of AA race on outcomes of MM patients undergoing ASCT at a single center in both the chemotherapy and novel agent era. One hundred and twenty-nine patients who received melphalan 200 mg/m2 and ASCT between 2000 and 2013 were included in the analysis. Sixty-one (47%) patients were African-American and 68 (53%) were non-AA. Baseline characteristics including age, FISH, cytogenetics, paraprotein subtype, median number of prior therapies and International Staging System (ISS) stage were similar between racial groups. Overall, 77 (60%) patients received any novel agent prior to transplant and 52 (40%) received only chemotherapy. More non-AA patients were male (59% vs. 38%, p=0.02), received initial induction with a proteasome inhibitor (59% vs. 28%, p=0.0007), and were treated with post-ASCT maintenance therapy (41% vs. 23%, p=0.008). Time from diagnosis to ASCT in AA patients was 10 (range: 4-144) versus 8 (range: 3-54) months in non-AA patients (p=0.01). The ASCT hospital course was similar between both groups with no significant differences in time to neutrophil and platelet engraftment as well as the duration of hospitalization. Additionally, there was no significant difference in the extra-hematologic toxicity between the two groups including the incidence of diarrhea, mucositis, and infection. Response was measured using the International Myeloma Working Group criteria and was assessed immediately prior to transplant and between 90 to 180 days after transplant. No differences were observed in pre-transplant (p=0.13) or post-transplant (p=0.28) response rates between the two groups. African American patients had a significantly improved median OS compared to non-AA patients (not reached vs. 108 months, p=0.03). We further stratified analyses of OS by those treated in the chemotherapy versus novel agent era. Improved OS was observed in both the chemotherapy (93 vs. 68 months, p=0.02) and novel agent (not reached vs. 79 months, p=0.01) treatment era. In a multivariate Cox proportional hazards model, AA race was associated with improved overall survival (adjusted HR 0.30, 95% CI 0.11 to 0.81; p=0.017). Multiple myeloma has one of the most apparent ethnic disparities in incidence and outcomes among cancers. In our study, AA patients had a longer time to transplant and received less proteasome inhibitor-based induction and post-ASCT maintenance suggesting disparities in access to care. Despite these differences in treatment, we observed improved overall survival after ASCT compared to non-AA patients. We demonstrated this improved OS in patients who had received either chemotherapy or novel agents prior to ASCT. These findings provide further evidence for more favorable outcomes among AA patients. One explanation could be a difference in disease biology that may result in a lower risk disease. Investigation of these biologic differences between AA and non-AA MM patients may increase our understanding of the pathogenesis and future treatments of myeloma. Disclosures No relevant conflicts of interest to declare.


Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5353-5353
Author(s):  
Angela Oranger ◽  
Rita Rizzi ◽  
Giacomina Brunetti ◽  
Bruna Daraia ◽  
Isabella Gigante ◽  
...  

Abstract Introduction Multiple myeloma (MM)-bone disease occurs in 70% to 80% of patients at MM diagnosis, and up to 90% at relapse; skeletal related events cause high morbidity and mortality. MM-bone disease is mostly consisting of lytic lesions arising as a consequence of an unbalanced bone remodelling due to activation of osteoclasts (OCs), and inactivation of osteoblasts. Osteoclastogenesis may be under immunoregulation by T-cells through the production of receptor activator of NF-kB ligand (RANKL), that is the OC differentiating molecule. Aim By means of an in vitro osteoclastogenesis model derived from peripheral blood mononuclear cells (PBMCs) of patients with MM-lytic bone disease, we purposed to evaluate OC formation and T-cell RANKL expression at diagnosis, and in the setting of frontline therapy. Methods PB was taken by venipuncture from 18 patients (7 men and 11 women), aged from 63 to 84, diagnosed as having symptomatic MM by International Myeloma Working Group (IMWG) criteria. In all of them, lytic lesions were demonstrated by skeleton standard radiography, and in some cases by nuclear magnetic resonance (NMR) too. On the basis of patients’ age and fitness, initial standard therapy consisting of proteasome inhibitor (Bortezomib) associated with Melphalan and Prednisone (VMP) was administered for nine cycles. The therapy response was assessed according to IMWG criteria. The controls included PB collected from 20 healthy donors, matched for age and sex with the patients. Controls and patients gave their written informed consent to the study, that was approved by the local Ethical Committee and performed according to the Declaration of Helsinki. PB was taken from the patients at diagnosis, and following the fourth and the ninth VMP cycles, respectively. OCs were obtained from unfractionated PBMC cultures either stimulated or not with the exogenous pro-osteoclastogenic cytokines [macrophage-colony stimulating factor (M-CSF) and RANKL]. Mature OCs were identified as multinucleated tartrate-resistant acid phosphatase (TRAP) positive cells. Freshly isolated T-cells from patients’ and controls’ PBMCs were lysed and analyzed by Western Blotting to evaluate RANKL expression. Results Spontaneous osteoclastogenesis was demonstrated in the cultures derived from PBMCs isolated at diagnosis. With particular regard to the patients achieving a deep treatment response, at the end of the culture period we found that PBMCs formed few small-sized OCs, when cultured in the absence of M-CSF and RANKL. Moreover, fresh T-cells purified after four and nine VMP cycles expressed progressively lower RANKL levels than fresh T-cells purified at diagnosis. Otherwise the cultures derived from non-responsive patients’ PBMCs, collected during and after treatment respectively, showed in vitro spontaneous formation of numerous and large OCs, overlapping the results at diagnosis. Fresh T-cells purified during or after treatment expressed comparable or even higher RANKL levels respect to diagnosis. Conclusions These findings show that in vitro spontaneous osteoclastogenesis and T-cell RANKL expression may be correlated with the response to treatment in patients with MM-lytic bone disease. However, further studies will be necessary to confirm these data, and to better translate them from a biologic to a clinical point of view. Disclosures: No relevant conflicts of interest to declare.


2016 ◽  
Vol 26 (1) ◽  
pp. 77 ◽  
Author(s):  
Jacob Warren ◽  
Bryant Smalley ◽  
Nikki Barefoot

<p><strong>Objectives:</strong> To examine the relationship between race/ethnicity and motivation for weight loss and motivation for exercise among patients with chronic disease.</p><p><strong>Design:</strong> Cross-sectional</p><p><strong>Setting</strong>: The current study took place within a network of federally qualified health centers (FQHCs) in the rural southern United States</p><p><strong>Patients</strong> <strong>or Participants</strong>: 463 active FQHC patients with diabetes and/or hypertension identifying as African American, White Hispanic, or non-Hispanic White participated in the current study.</p><p><strong><em>Main Outcome Measures</em>:</strong> Primary outcomes were assessed using standardized measures of motivation for a) weight loss; and b) hypertension per the Transtheoretical Model</p><p><strong>Results:</strong> Multivariate logistic regression revealed that, when controlling for age, sex, education status, employment status, poverty, comorbidity, and weight status, there were no significant differences in motivation for exercise among the different racial/ethnic groups (P=.361).  However, when controlling for the same factors, there was a significant difference in motivation for weight loss, with African American participants more than twice as likely as non-Hispanic White participants to be motivated to lose weight (ORAD)=2.430, P=.002).</p><p><strong><em>Conclusions</em>:</strong> Our study suggests that, among rural patients with obesity-related chronic disease, there is a significant variation in motivation to lose weight between racial/ethnic groups.  This underscores the importance of culturally tailoring interventions and in considering motivation for change when promoting weight loss behaviors.  Additional implications for intervention development and delivery are discussed.<em> Ethn</em> <em>Dis.</em> 2016;26(1):77-84; doi: 10.18865/ed.26.1.77</p>


Author(s):  
Khadijah Breathett ◽  
Larry A Allen ◽  
Laura Helmkamp ◽  
Kathyrn Colborn ◽  
Stacie L Daugherty ◽  
...  

Background: Rates of receipt of left ventricular assist devices (LVADs) are less than expected for racial/ethnic minorities. A major etiology of this disparity changed over the past few years with broader access to insurance. Thus, we hypothesized that changes in the census-adjusted rate of receipt of LVADs would be higher for racial/ethnic minorities than Caucasians independent of sex and age. Methods: Using the Interagency Registry of Mechanically Assisted Circulatory Support, we analyzed 10,795 patients (African-American 24.8%, Asian 1.5%, Caucasian 67.4%, Hispanic 6.3%, female 21.4%) who had an LVAD implanted between 2012-2015. Linear models were fit to annual census-adjusted rate of LVAD implantation, and the rate of change in receipt of LVADs was compared for each racial/ethnic minority to Caucasians, stratified by sex and age group. Results: Between 2012 and 2015, African-Americans had an increase in the census-adjusted annual rate of receipt of LVADs per 100,000 [+0.26 (95% CI: 0.17-0.34)], while others exhibited no significant changes [Caucasian: +0.06 (95%CI: -0.03-0.14); Hispanic: +0.04 (95%CI: -0.05-0.12); Asian: +0.04 (95%CI: -0.04-0.13)]. When stratified by sex, the observed increase in rate of receipt of LVAD for African-Americans relative to Caucasians was present for both sexes [African-American women: +0.14 (95%CI: 0.01-0.27); African-American men: +0.28 (95%CI: 0.15-0.41)]. No increase was observed in either sex among other racial/ethnic groups ( Figure 1a ). When stratified by age group, the observed increase in rate of receipt of LVAD for African-Americans relative to Caucasians was limited to those aged 40-59 years [African-Americans aged: 20-39: +0.09 (95%CI: -0.20-0.39); 40-49: +0.41 (95%CI: 0.11-0.70); 50-59: +0.31 (95%CI: 0.01-0.60); 60-69: +0.22 (95%CI: -0.08-0.51); 70+: +0.07 (95%CI: -0.23-0.36)]. No differences by age group were observed among other racial/ethnic groups compared to Caucasians ( Figure 1b) . Conclusions: From 2012-2015, rates of receipt of LVADs increased for African-Americans but not other racial/ethnic groups in comparison to Caucasians. Similar patterns were seen when stratified by sex. When stratified by age, the increase in rate was limited to middle-aged African-Americans.


2017 ◽  
Vol 8 (1) ◽  
pp. 1
Author(s):  
Ayodeji Daramola ◽  
Gbolahan S Osho

Today, criminologists, especially, Black criminologists, are thoroughly perplexed by the same problem of disproportionate minority confinement (DMC) most especially of Blacks in both the juvenile and criminal justice systems. Are African Americans more criminally minded than other races or ethnic groups? Do African Americans actually commit more crimes than others? These are the questions that the different deviant theories have tried to answer. The concept of social bonding arose from social control theory, which suggests that attachment to family and school, commitment to conventional pathways of achievements and beliefs in the legitimacy of social order are primary and important elements of establishing a social bond (Hirschi, 1969). In expounding his social control theory, Hirschi listed the elements of the bond as attachment, commitment, involvement, and belief. Does it mean that African Americans commit more crimes than other racial and ethnic groups? Or are African Americans genetically wired to be criminogenic? Is the society or the environment to blame for the perceived higher rate of crime among African Americans? Or are the criminal justice system, the judicial system, and the juvenile justice system, all together racially biased against Blacks, especially, Black males? Even though Hirschi (1969) did not mention attachment to religious beliefs as part of social control, but for the African American families, the church could play a significant role in helping to cement the bond of adolescents to their families. Any study of the African American family is not complete without the church. According to Work (1900), in all social study of the Negro, the church must be considered, for it is one of the greatest factors in his social life.


2017 ◽  
Vol 48 (4) ◽  
pp. 593-610 ◽  
Author(s):  
Jennifer Ramirez ◽  
Linda Oshin ◽  
Stephanie Milan

According to developmental niche theory, members of different cultural and ethnic groups often have distinct ideas about what children need to become well-adapted adults. These beliefs are reflected in parents’ long-term socialization goals for their children. In this study, we test whether specific themes that have been deemed important in literature on diverse families in the United States (e.g., Strong Black Woman [SBW], marianismo, familismo) are evident in mothers’ long-term socialization goals. Participants included 192 mothers of teenage daughters from a low-income city in the United States (58% Latina, 22% African American, and 20% European American [EA]/White). Socialization goals were assessed through a q-sort task on important traits for a woman to possess and content analysis of open-ended responses about what values mothers hoped they would transmit to their daughters as they become adults. Results from ANCOVAs and logistic regression indicate significant racial/ethnic differences on both tasks consistent with hypotheses. On the q-sort task, African American mothers put more importance on women possessing traits such as independence than mothers from other racial/ethnic groups. Similarly, they were more likely to emphasize self-confidence and strength in what they hoped to transmit to their daughters. Contrary to expectation, Latina mothers did not emphasize social traits on the q-sort; however, in open-ended responses, they were more likely to focus on the importance of motherhood, one aspect of marianismo and familismo. Overall, results suggest that these mothers’ long-term socialization goals incorporate culturally relevant values considered important for African American and Latino families.


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