Lack of racial disparity in outcome of African American (AA) and Caucasian patients with symptomatic multiple myeloma (MM) at the Veterans Affairs (VA) hospitals.

Abstract BACKGROUND: Multiple myeloma (MM) is the most common hematologic malignancy in the African American (AA) population with an incidence more than 2-3 times higher than Caucasians [Landgren O et al Blood 2006]. In the pre-novel therapy era, SEER data [1975-2008] indicated better survival outcomes for AA patients with MM. However, with the recent advent of novel drugs for treatment of MM, the survival gap for Caucasian patients with MM has closed [Ailawadhi S et al Br J Haematol 2012]. A recent pooled analysis of diagnostic cytogenetics in 292 AA MM patients [Greenberg et al Blood Cancer J 2015] reported on differences in commonly observed baseline cytogenetic abnormalities (CA) between AA and Caucasian MM patients. The large and diverse population of patients with MM at our institution prompted us to examine diagnostic cytogenetics in our MM patients along with other clinical features. PATIENTS & METHODS: The MM database was interrogated for all patients presenting with MM between January 2012 and February 2016. Baseline clinical and pathology variables were compared between the AA and Caucasian cohorts. Continuous variables were compared using nonparametric rank tests, while incidences and proportions (e.g. CAs including t(11;14), t(4;14), t(14;16), t(14:20), amplification 1q21, monosomy13/del13q and del17p) were compared using Fisher's exact tests. RESULTS: A total of 398 patients were identified for the analysis (African Americans n = 168, Caucasian n = 230). The median age of AA MM patients was significantly younger than Caucasian MM patients (median age 63 years vs. 68 years, p<0.0001), with a similar sex distribution. There was no significant difference in the degree of anemia, renal insufficiency, serum LDH levels, bone marrow flow cytometry, bone marrow cellularity or plasmacytosis in the two cohorts. Although there was a trend toward more ISS I amongst Caucasian MM patients, there was no statistical difference in ISS stages (p = 0.126) and no significant difference in R-ISS stage between the cohorts (p = 0.361). There was 72.7% agreement between the ISS and R-ISS staging (88 of 121 evaluable subjects had the same stage by ISS and R-ISS staging criteria), while 27.3% of the patients were upstaged from Stage I or II by ISS criteria to Stage III by R-ISS criteria. Of those upstaged, 19 patients were in the Caucasian cohort and 14 were in the AA cohort. The magnitude of this upstaging was significant when evaluated with a Generalized McNemar's test (p < 0.001). Additionally, there was a similar incidence of common FISH abnormalities in the AA cohort compared to the Caucasian cohort [Table 1]. CONCLUSIONS: This is the largest single institution report of FISH data in AA MM patients. Unlike previous reports, we show similar clinical, pathological, and cytogenetic features between AA and Caucasian patients with MM at presentation. It is possible that molecular abnormalities not detectable by FISH in our patient cohort could account for differences in our data and the published literature. Table 1 FISH Abnormalities Table 1. FISH Abnormalities Disclosures Bhutani: Prothena: Research Funding; Takeda Oncology: Research Funding, Speakers Bureau; Bristol-Myers Squibb: Speakers Bureau; Onyx, an Amgen subsidiary: Speakers Bureau. Symanowski:Eli Lilly & Co: Consultancy; Ra Pharma: Consultancy; Caris Life Sciences: Consultancy; Endocyte: Consultancy. Avalos:Seattle Genetics: Membership on an entity's Board of Directors or advisory committees. Usmani:Onyx: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Skyline: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Britsol-Myers Squibb: Consultancy, Research Funding; Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Sanofi: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Millenium: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Array: Research Funding; Pharmacyclics: Research Funding; BioPharma: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Consultancy, Research Funding, Speakers Bureau; Novartis: Speakers Bureau.

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Survival Disparities Between African-American and Caucasian Patients with Multiple Myeloma Are Blunted in the Era of Novel Therapeutics and Autologous Stem Cell Transplantation.

Blood ◽

10.1182/blood.v114.22.1395.1395 ◽

2009 ◽

Vol 114 (22) ◽

pp. 1395-1395 ◽

Cited By ~ 1

Author(s):

Nina Shah ◽

Donna M Weber ◽

Michael Wang ◽

Sheeba Thomas ◽

Jatin Shah ◽

...

Keyword(s):

Multiple Myeloma ◽

Overall Survival ◽

African American ◽

Stem Cell ◽

Median Overall Survival ◽

Stage I ◽

Single Center ◽

Novel Therapeutics ◽

Caucasian Patients

Abstract Abstract 1395 Poster Board I-417 Background: Multiple myeloma accounts for approximately 10% of hematologic malignancies diagnosed annually in the U.S. It is well documented that the African-American population is disproportionately affected by multiple myeloma in incidence and mortality. Survival data from the SEER database from 2001-2005 demonstrated higher mortality in African-American patients compared to Caucasian patients. However, more recent retrospective reviews in the era of autologous stem cell transplant (ASCT) did not support this finding. Thus the persistence of racial survival disparities in the era of ASCT and novel therapeutics is an evolving question. Methods: We performed a retrospective review of 170 African-American multiple myeloma patients and 170 age and gender-matched Caucasian patients initially seen at the M.D. Anderson Cancer Center from 1/1/2002 to 12/31/2008. Results: Three hundred forty previously untreated patients were analyzed. Median age at diagnosis was 57 years for both groups. For evaluable patients, the International Staging System at diagnosis was determined. The percentage of stage I, II and III patients in the African-American group was 53%, 28% and 19% respectively. The percentage of stage I, II and III patients in the Caucasian group was 40%, 30% and 29% respectively. These staging data were not significantly different between racial groups. In both groups, 89% of patients received a novel therapeutic (thalidomide, lenalidomide or bortezomib) during their treatment course. We found a statistically significant difference in the percentage of African-American and Caucasian patients who received high dose chemotherapy and ASCT (65% and 76%, respectively, p=0.04). There was no difference observed in the number of second transplants performed in the two groups (19 in both groups). Response to therapy is detailed in Table 1. There was no difference in overall response to any therapy of evaluable patients between the two groups. With a median follow-up time of 35 months, the median overall survival from diagnosis has not been reached in either group. Kaplan-Meir analysis shows that there is no difference in overall survival between black and white patients (p =0.1) Conclusions: In this single-center, retrospective study of multiple myeloma patients treated predominately with novel agents, with or without ASCT, no survival difference was observed between African-American and Caucasian patients. To our knowledge, this is the largest number of African-American myeloma patients analyzed for survival in a single-center study. Recognizing the potential disparities in healthcare access, this may not represent outcomes for all African-American patients with myeloma. Since median overall survival has not been reached in this data, it is possible that survival differences will become apparent in the future, and further follow-up is needed. However, this review suggests that in the era of novel therapeutics and ASCT resulting in improved overall response rates, survival in African-American patients may be equivalent to Caucasian patients. Further efforts are needed to enroll African-American patients on clinical trials to validate this observation prospectively. Disclosures: No relevant conflicts of interest to declare.

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Survival Disparities Between African-American and Caucasian Patients Treated with Autologous Stem Cell Transplantation for Multiple Myeloma Are Eliminated in the Era of Novel Therapeutics

Blood ◽

10.1182/blood.v118.21.2017.2017 ◽

2011 ◽

Vol 118 (21) ◽

pp. 2017-2017

Author(s):

Sairah Ahmed ◽

Yvonne T Dinh ◽

Sofia Qureshi ◽

Gabriela Rondon ◽

Qaiser Bashir ◽

...

Keyword(s):

Multiple Myeloma ◽

African American ◽

Stem Cell ◽

African Americans ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Autologous Stem Cell Transplantation ◽

Progression Free Survival ◽

Novel Agents ◽

Caucasian Patients

Abstract Abstract 2017 Background: Multiple myeloma (MM) remains an incurable disease and is the most common hematologic malignancy among African-Americans. In the United States, MM and its precursor monoclonal gammopathy of undetermined significance (MGUS) are twice as common in African Americans (Hari et al 2010). Analysis of the Surveillance Epidemiology and End Results (SEER) database from 1969 to 2003 demonstrated African-Americans have twice the mortality from MM compared to Caucasians. However this may be a function of the considerable difference in incidence of MM between Caucasian and African-American populations. Retrospective data from Southwest Oncology Group showed comparable outcomes between groups before the advent of autologous stem cell transplantation (auto-HCT). Recently Hari et al. determined that African-American and Caucasians have similar outcomes after auto-HCT for MM. In the age of novel therapy, Waxman et al addressed racial disparity in population based query of SEER and found disease specific survival was greater for African-Americans than Caucasians; and over time, survival improvement was much less pronounced among African-Americans than Caucasians. Nevertheless transplant specific data is sparse in the contemporary era with novel treatment options. Methods: We performed a retrospective review of 196 African-American multiple myeloma patients (pts) and 806 Caucasian patients initially seen at the M.D. Anderson Cancer Center from 1/1/2002 to 12/31/2010 who underwent autologous transplantation after high dose chemotherapy. The year 2002 was used to incorporate patients who had been exposed to novel agents. Results: A total of 1002 patients were analyzed, 196 African American and 806 Caucasian pts with multiple myeloma who underwent an autologous transplant. Median age at diagnosis was 59 years for both cohorts. Initial response prior to transplant was fairly evenly matched between groups (TABLE 1) as well as final response after transplant. 25% of Caucasian pts and 21% of African-American pts achieved a very good partial response (VGPR) while 28% of Caucasian and 21% of African-American pts achieved a complete response (CR). For evaluable patients, the International Staging System (ISS) at diagnosis was determined. The percentage of stage I, II and III patients in the African-American group was 27%, 20% and 17% respectively. The percentage of stage I, II and III patients in the Caucasian group was 26%, 19% and 17% respectively. Importantly 133/806 of Caucasians and 33/196 of African Americans were diagnosed at ISS stage III (p value=0.91). There was no measurable difference in progression free survival (figure 1) or overall survival (figure 1figure 2) with a maximum follow-up of >100 months. Conclusion: In this retrospective single-center study we demonstrated no difference in progression free survival or overall survival between African-American and Caucasian patients with MM treated in the era of novel agents and autologous stem cell transplantation. These findings concur with previous studies showing no difference in response to treatment between racial groups. In light of older SEER data this may be an effect of novel agents, improved access of care for African Americans or a combination of both. Disclosures: No relevant conflicts of interest to declare.

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LACK of ASSOCIATION BETWEEN Race and Probability of TRANSPLANT AMONG PATIENTS Referred for Hematopoietic CELL TRANSPLANTATION (HCT) for MULTIPLE Myeloma

Blood ◽

10.1182/blood.v118.21.3129.3129 ◽

2011 ◽

Vol 118 (21) ◽

pp. 3129-3129

Author(s):

Manish Sharma ◽

Michael Bromberg ◽

Thomas R. Klumpp ◽

Patricia Kropf ◽

Mary Ellen Martin ◽

...

Keyword(s):

Multiple Myeloma ◽

African American ◽

Hematopoietic Cell Transplantation ◽

Conflicts Of Interest ◽

P Value ◽

Initial Visit ◽

Transplant Center ◽

Caucasian Patients ◽

Race 4 ◽

Median Interval

Abstract Abstract 3129 Background: As documented in recently published large database reviews, race appears to be a barrier to the access to HCT. Hypotheses as to why this may be the case include (but are not limited to): 1. patient preference; 2. delayed time to referral from community physicians to transplant centers; 3. delays in transplant once evaluated by a transplant center; 4. Possible increased prevalence of comorbidities among racial minorities referred for transplant. We attempt to address some of these issues by reviewing our 20-year experience with transplantation for multiple myeloma. Methods: We queried our core clinical database for potential associations between race and the following parameters: 1. Median interval between date of diagnosis and date of referral; 2. Median interval between date of initial visit and date of transplant 3. Probability of actually receiving a transplant following formal evaluation by a transplant physician by race; 4. Type of transplant recommended 5. Reasons for not receiving a transplant. Results: Between January 1990 and June 2011, 441 patients with multiple myeloma were referred to our center for consideration of HCT, of whom 293 (66%) were Caucasian, 94 (21%) were African American (AA), 27 (6%) were of unknown race, and 27 (6%) were of other races. The median interval from diagnosis to referral for transplant for AA patients was 145 days, versus 137 days for Caucasian patients (p=0.32). Fifty-three of the 94 AA patients (56%), versus 157 of the 293 Caucasian patients (54%) have received at least one transplant to date (p=0.72). The median interval between the date of the initial visit to our transplant center and the occurrence of an initial transplant was 120 days for AA, versus 150 days for Caucasians (p=0.39). The probability of being transplanted on an allogeneic or hybrid (auto-allo) initial transplant protocol was 0% for AA making it to transplant vs 6% for Caucasions making it to transplant (p=0.07). Reasons for not receiving a transplant are indicated in Table 1 (global p-value = 0.94). Conclusions: African American and Caucasian patients with myeloma have similar intervals from diagnosis to referral, similar intervals from referral to transplant, and are equally likely to actually receive a transplant once referral to the transplant center took place. Therefore, the reported barrier to transplantation for myeloma patients appears to be prior to referral to the transplant center. Disclosures: No relevant conflicts of interest to declare.

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Analysis of Racial Differences in the Incidence of a Targetable Biomarker, t(11;14), in Patients with Multiple Myeloma

Blood ◽

10.1182/blood-2020-140133 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 1-2

Author(s):

Fang Liu ◽

Jeries Kort ◽

Shashirekha Shetty ◽

Ravikumar Kyasaram ◽

John Shanahan ◽

...

Keyword(s):

Multiple Myeloma ◽

African American ◽

Racial Differences ◽

Racial Disparity ◽

Categorical Variables ◽

Female Ratio ◽

Cytogenetic Abnormalities ◽

Blood Cancer ◽

Chromosome 13 ◽

Monoclonal Gammopathies

Introduction Compared with Caucasian Americans (CA), African Americans (AA) have an increased incidence of multiple myeloma (MM), earlier age at diagnosis, and overall better prognosis [1]. The molecular mechanisms underlying such racial disparity are not well understood. Using targeted next generation sequencing assay or traditional fluorescence in situ hybridization (FISH) methods, previous studies reported that t(11;14) is more common in AA compared with CA with MM and monoclonal gammopathies [2,3]. However, the number of AA cases studied were small and conflicting data exists. Clinical trials in relapsed or refractory MM indicate that t(11;14) is a biomarker which may be used to predict response to a therapeutic agent (venetoclax) which targets BCL-2 [4,5]. Identifying racial differences in molecular biomarkers would be helpful in our understanding of the known racial disparities of incidence in MM and in the development of therapeutic trials. Methods 737 patients with newly diagnosed MM or smoldering myeloma (SM) at University Hospitals Seidman Cancer Center between 2009 and 2020 were identified. All had myeloma FISH panel sent at diagnosis, which included trisomy of chromosomes 3, 7, or 11, deletion 13q14.3 or loss of chromosome 13, deletion 17p13.1, 1q21 (CKS1B) amplification, and 14q32.3 rearrangements. IGH/CCND1 [t(11;14)(q13;q32)] dual fusion probe was used prior to 2018. Extra signal would trigger reflex test for IGH/FGFR3 [t(4;14)(p16.3;q32)] and IGH/MAF [t(14;16)(q32;q23)]. IGH break apart probe was used since 2018. IGH rearrangement would trigger reflex testing for translocation partners as listed above. Between-group differences were assessed with T-test for continuous variables, and Chi-square / Fisher's exact test for categorical variables. Results Of the 737 patients (661 MM, 76 SM), 502 (68.1%) were self-reported as CA, 213 (28.9%) were AA, and 22 (3.0%) were of other races or listed as unknown. Median age was 71 among CA and 70 among AA (p=0.67). The male-female ratio was 291/211 (58% male) among CA and 101/112 (47% male) among AA (p=0.0095). Overall t(11;14) was detected in 4.5% of cases, 5.2% CA and 2.8% AA (p=0.165); among 661 MM, t(11;14) was tested positive in 30/656 (4.57%), including 23 (5.1%) CAs, 6 (3.1%) AAs, and 1 others (p= 0.80); among 76 SM, t(11;14) was tested positive in 3/76 (3.95%), all were CAs. The percentages of patients who tested positive for other cytogenetic abnormalities were as follows: trisomy 3,7, or 11 was detected in 35.6% CA and 32.4% AA (p=0.42); 1q21 amplification was detected in 25.5% CA and 23.9% AA (p=0.72); deletion 13q14.3 or loss of chromosome 13 was detected in 16.5% CA and 10.7% AA (p=0.08); deletion 17p13.1 was detected in 6.4% CA and 5.2% AA (p=0.54); t(4;14) was detected in 2.8% CA and 1.4% AA (p=0.27); t(14;16) was detected in 0.4% CA and 0.5% AA (p=0.89) Conclusions This retrospective series of 737 MM and SM patients did not find an increased incidence of the targetable biomarker t(11;14) in AA patients. The overall percentage of t(11;14) cases was lower than expected. The lack of our finding a racial difference differs from some other reports, perhaps due to a fairly enriched AA population. There were also no significant racial differences found in other cytogenetic abnormalities. Further investigation at the molecular level should be performed to elucidate the mechanisms of racial disparity in MM. References [1]. Landgren O, Devesa S, Mink P, et al. African-American multiple myeloma patients have a better survival than Caucasian patients: a population-based study including 28,636 patients. Blood. 2009;114:1832. [2]. Kzandjian D, Hill E, Hultcrantz M, et al. Molecular underpinnings of clinical disparity patterns in African American vs. Caucasian American multiple myeloma patients. Blood Cancer J. 2019;9(2):15. [3]. Baughn LB, Pearce K, Larson D, et al. Differences in genomic abnormalities among African individuals with monoclonal gammopathies using calculated ancestry. Blood Cancer J. 2018;8(10):96. [4]. Kortüm KM, Einsele H. First targeted therapy in multiple myeloma. Blood. 2017;130(22):2359-2360. [5]. Kumar S, Harrison S, Cavo M, et al. A phase 3 study of venetoclax or placebo in combination with bortezomib and dexamethasone in patients with relapsed/refractory multiple myeloma. EHA Library. Abstract LB2601. Disclosures No relevant conflicts of interest to declare.

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African-American Multiple Myeloma Patients Have a Better Survival Than Caucasian Patients: a Population-Based Study Including 28,636 Patients.

Blood ◽

10.1182/blood.v114.22.1832.1832 ◽

2009 ◽

Vol 114 (22) ◽

pp. 1832-1832 ◽

Cited By ~ 1

Author(s):

Ola Landgren ◽

Susan Devesa ◽

Pamela Mink ◽

William F Anderson ◽

Brendan Weiss ◽

...

Keyword(s):

Multiple Myeloma ◽

African American ◽

African Americans ◽

Excess Mortality ◽

Survival Rates ◽

Population Based ◽

Age Group ◽

Population Based Study ◽

Caucasian Patients ◽

Survival Patterns

Abstract Abstract 1832 Poster Board I-858 Background Multiple myeloma is the most common hematologic malignancy in African-Americans with twice the incidence of Caucasians. Prior single center studies have reported poorer survival among African-American multiple myeloma patients. In contrast, recent data based on multiple myeloma patients who received autologous transplantation in an equal access health care system, showed comparable survival between African-Americans and Caucasians, suggesting that the reportedly poorer outcome for African-Americans may be due to inequalities in access to care. Also, based on publicly available cancer registry data, several publications have reported excess mortality rates for African-American multiple myeloma patients. We conducted a large population-based study including almost 30,000 multiple myeloma patients to evaluate survival patterns by race. Methods. Patient information was obtained from the Surveillance, Epidemiology and End Results (SEER) cancer registries of the National Cancer Institute. Data were drawn from the original nine SEER registries (Atlanta, Connecticut, Detroit, Hawaii, Iowa, New Mexico, San Francisco-Oakland, Seattle-Puget Sound, and Utah), which collectively cover approximately 10% of the U.S. population. Using the SEER*Stat statistical software package, we calculated 1-, 5-, and 10-year relative survival rates (RSR) of multiple myeloma patients diagnosed 1973-2004. We applied four calendar periods (1973-1979, 1980-1986, 1987-1993, and 1994-2004), follow-up through 2005 was included, and age at diagnosis was grouped into three strata (<50, 50-64, and 65+ years). Results We identified a total of 28,636 multiple myeloma patients (4,855 African-American; 23,781 Caucasian); 64% were 65 years or greater at diagnosis. When we included all patients, a comparison of survival rates in African-American and Caucasian males showed that African-American males had significantly better 5-year (32.2% vs. 28.7%) and 10-year (16.4% vs. 11.5%) RSRs (p<0.05). Similarly, African-American females had significantly better 1-year (73.3% vs. 70.2%) and 5-year (31.1% vs. 27.7%) RSRs than Caucasian females (p<0.05). When we examined survival patterns by calendar period (between 1973-1979 and 1994-2004), we found Caucasian patients to have significant improvements in the 1-year (from 67.1 to 72.4%), 5-year (from 24.1% to 31.7%), and 10-year RSR (from 9.9% to 14.9%). African-Americans also showed significantly improved 1-year RSRs (from 68.5% in 1973-1979 to 74.9% in 1994-2004) but the improvements in 5- and 10-year RSRs were not significant. When we examined survival patterns by age group, in the youngest age group (<50 years), both African-Americans and Caucasians improved 5- and 10-year RSRs, while 1-year RSR was improved for Caucasians only (from 80.9% to 84.9%). For patients 50-64 years, Caucasians had significantly improved 1-, 5-, and 10-year RSR; for African-Americans only 1-year RSR improvement was significant. Among patients 65+, there was no significant improved survival for African-Americans while Caucasians had improved 1-year (from 61.4% to 66.9%) and 5-year (from 19.6% to 24.7%) RSRs. Conclusions This large study of almost 30,000 patients found African-American multiple myeloma patients to have a significantly better prognosis than Caucasian patients, suggesting there is disease heterogeneity by race. After the introduction of newer therapies (autologous transplant, IMiDs, and bortezomib), Caucasian multiple myeloma patients showed a more pronounced survival benefit which might reflect inequalities in access to modern care; however, still African-Americans showed similar/better survival compared to Caucasians. Clinicians should be aware that the excess mortality rates for multiple myeloma among African-Americans, to a major degree, is a reflection of the fact that multiple myeloma is 2- to 3-fold more common among African-Americans. Future studies are needed to improve our understanding of the molecular basis for racial disparity patterns in multiple myeloma. Ultimately, such efforts will facilitate an improved understanding regarding disease subtype-specific benefits for individual agents, as well as mechanistic insights into drug sensitivity and resistance. Disclosures Weiss: The Binding Site, Inc.: Research Funding.

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Social determinants of health affecting treatment of pediatric brain tumors

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.4.peds18594 ◽

2019 ◽

Vol 24 (2) ◽

pp. 159-165

Author(s):

Jillian M. Berkman ◽

Jonathan Dallas ◽

Jaims Lim ◽

Ritwik Bhatia ◽

Amber Gaulden ◽

...

Keyword(s):

African American ◽

Health Disparities ◽

Brain Tumors ◽

Social Determinants Of Health ◽

Social Determinants ◽

Determinants Of Health ◽

Cns Tumor ◽

Initial Symptoms ◽

Caucasian Patients

OBJECTIVELittle is understood about the role that health disparities play in the treatment and management of brain tumors in children. The purpose of this study was to determine if health disparities impact the timing of initial and follow-up care of patients, as well as overall survival.METHODSThe authors conducted a retrospective study of pediatric patients (< 18 years of age) previously diagnosed with, and initially treated for, a primary CNS tumor between 2005 and 2012 at Monroe Carell Jr. Children’s Hospital at Vanderbilt. Primary outcomes included time from symptom presentation to initial neurosurgery consultation and percentage of missed follow-up visits for ancillary or core services (defined as no-show visits). Core services were defined as healthcare interactions directly involved with CNS tumor management, whereas ancillary services were appointments that might be related to overall care of the patient but not directly focused on treatment of the tumor. Statistical analysis included Pearson’s chi-square test, nonparametric univariable tests, and multivariable linear regression. Statistical significance was set a priori at p < 0.05.RESULTSThe analysis included 198 patients. The median time from symptom onset to initial presentation was 30.0 days. A mean of 7.45% of all core visits were missed. When comparing African American and Caucasian patients, there was no significant difference in age at diagnosis, timing of initial symptoms, or tumor grade. African American patients missed significantly more core visits than Caucasian patients (p = 0.007); this became even more significant when controlling for other factors in the multivariable analysis (p < 0.001). African American patients were more likely to have public insurance, while Caucasian patients were more likely to have private insurance (p = 0.025). When evaluating survival, no health disparities were identified.CONCLUSIONSNo significant health disparities were identified when evaluating the timing of presentation and survival. A racial disparity was noted when evaluating missed follow-up visits. Future work should focus on identifying reasons for differences and whether social determinants of health affect other aspects of treatment.

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African American Unemployment and the Disparity in Periviable Births

Journal of Racial and Ethnic Health Disparities ◽

10.1007/s40615-021-01022-7 ◽

2021 ◽

Author(s):

Ralph Catalano ◽

Deborah Karasek ◽

Tim Bruckner ◽

Joan A. Casey ◽

Katherine Saxton ◽

...

Keyword(s):

African American ◽

African American Women ◽

Unemployment Rate ◽

Racial Disparity ◽

Live Births ◽

Percentage Point Increase ◽

Point Increase ◽

The Us ◽

Race Ethnicity ◽

Hispanic White

AbstractPeriviable infants (i.e., born before 26 complete weeks of gestation) represent fewer than .5% of births in the US but account for 40% of infant mortality and 20% of billed hospital obstetric costs. African American women contribute about 14% of live births in the US, but these include nearly a third of the country’s periviable births. Consistent with theory and with periviable births among other race/ethnicity groups, males predominate among African American periviable births in stressed populations. We test the hypothesis that the disparity in periviable male births among African American and non-Hispanic white populations responds to the African American unemployment rate because that indicator not only traces, but also contributes to, the prevalence of stress in the population. We use time-series methods that control for autocorrelation including secular trends, seasonality, and the tendency to remain elevated or depressed after high or low values. The racial disparity in male periviable birth increases by 4.45% for each percentage point increase in the unemployment rate of African Americans above its expected value. We infer that unemployment—a population stressor over which our institutions exercise considerable control—affects the disparity between African American and non-Hispanic white periviable births in the US.

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223 Racial differences in outcomes for metastatic renal cell carcinoma (mRCC) patients managed on immune-checkpoint inhibitor (ICI) therapy

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-sitc2020.0223 ◽

2020 ◽

Vol 8 (Suppl 3) ◽

pp. A242-A242

Author(s):

T Anders Olsen ◽

Dylan Martini ◽

Subir Goyal ◽

Yuan Liu ◽

Sean Evans ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

African American ◽

Retrospective Study ◽

Cell Carcinoma ◽

Clinical Outcomes ◽

Immune Checkpoint ◽

Renal Cell ◽

Clear Cell ◽

Emory University ◽

Caucasian Patients

BackgroundImmune checkpoint inhibitors (ICIs) have increased in prevalence for the treatment of metastatic clear-cell renal cell carcinoma (mccRCC) in recent years given their efficacy and favorable toxicity profile. However, there has been insufficient investigation in the literature of how clinical outcomes differ on the basis of race. In this paper, we investigated differences in clinical outcomes between African American (AA) and Caucasian mRCC patients treated with ICI therapy.MethodsWe performed a retrospective study of 198 patients with mRCC who received ICI at the Emory Winship Cancer Institute from 2015–2020. Clinical outcomes were measured by overall survival (OS), progression-free survival (PFS), and clinical benefit (CB). OS and PFS were calculated from ICI-initiation to date of death and radiographic or clinical progression, respectively. CB was defined as a best radiographic response of complete response, partial response, or stable disease maintained for at least 6 months per response evaluation criteria in solid tumors version 1.1. The association of self-identified race with OS and PFS was generally modeled by Cox proportional hazards model. Univariable and multivariable logistic regression models were used for binary outcomes of CB. The univariate association of immune-related adverse events (irAEs) and non-clear-cell RCC (nccRCC) with race was assessed using Chi-square test.ResultsOur cohort was made up of 38 AA (19%) and 160 Caucasian (81%) patients. Most of the patients were diagnosed with ccRCC (78%) and more than half received PD-1 monotherapy (57%). Most patients were international mRCC database consortium (IMDC) intermediate (57%) or poor-risk (25%) groups. AA patients displayed significantly shorter PFS (HR=1.52, 95% CI: 1.01–2.3, p=0.045) and trended towards decreased CB (OR=0.51, 95% CI: 0.22–1.17, p=0.111) in MVA (table 1). There was no difference in OS (HR=1.09, 95% CI: 0.61–1.95, p=0.778) between the two racial groups in MVA (table 1). On Kaplan-Meier method, AA patients had shorter median OS (17 vs 25 months, p=0.3676) and median PFS (3.1 vs 4.4 months, p=0.0676) relative to Caucasian patients (figure 1). Additionally, AA patients more commonly had nccRCC compared to Caucasian patients (41.7% vs 17.5% nccRCC, p-0.002). AA patients also trended towards a lower incidence of irAEs compared to Caucasian patients in UVA (23.7% vs 35.8%, p=0.153).Abstract 223 Table 1*MVA controlled for age, race, gender, IMDC risk group, number of prior lines of therapy, PD-1 monotherapy, and ccRCC**statistical significance at alpha < 0.05Abstract 223 Figure 1African-American (black) and Caucasian (white) for OS (left panel) and PFS (right panel)ConclusionsIn this group of mRCC patients treated with ICI, African American patients had significantly shorter PFS compared to Caucasian patients. These findings suggest race could play a role in the management of late-stage mRCC. Larger, prospective studies are needed to validate these findings.AcknowledgementsResearch reported in this publication was supported in part by the Breen Foundation and the Biostatistics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.Trial RegistrationNot applicable.Ethics ApprovalThis retrospective study was approved by the Emory University Institutional Review Board.ConsentNot applicable.ReferencesNot applicable

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