No Differences in Stem Cell Transplantation Utilization Rates (STUR) by Ethnicity after Referral to a Transplant Center for Multiple Myeloma (MM): Implications for Improving Stur Rates in Minorities

ASCT remains the standard of care for newly diagnosed MM. Recent studies have demonstrated that although STUR is improving across all ethnicities, it remains lowest in Black (B) and Hispanic (H) populations relative to Caucasians(C). New data suggests that the differences in utilization are not secondary to differences in outcome among different ethnicities. We reviewed our data on all patients seen in consult for a potential first transplant for MM, to attempt to understand why and where patients fail to undergo transplantation. From Nov 2011 to June 2016 we assessed 388 patients for consideration of an initial transplant for MM, 264 of whom (68%) proceeded to ASCT. Table 1 shows the transplant rate by ethnicity: 69% C, 72% H, 57% B, and 50% of Native Americans (NA) and the reasons for not proceeding to transplant. There is no obvious difference across groups. Table 2 shows the age and disease states for patients who underwent ASCT and for those who did not proceed. Although the numbers are small it does appear that a substantial number of the C patients who do not proceed are >70 years of age. For those who did proceed to transplant there also appears to be substantially more patients >70 in the C group.Table 1Reasons for Not Undergoing Transplant by Ethnicity (%)Ethnicity% Transplanted% Not Undergoing TransplantEarly DiseaseMedical Contra-IndicationProgressive DiseasePatient ChoiceNot SpecifiedCaucasian (n = 289)69 (n = 200)31 (n = 89)202116358Hispanic (n = 54)72 (n = 39)28 (n = 15)141426406Black (n = 35)57 (n = 20)43 (n = 15)401320270Native American (n = 10)50 (n = 5)50 (n = 5)02040400 Open table in a new tab Table 2Patient Characteristics: Proceeding to Transplant [T] versus Not Proceeding to Transplant [NT]EthnicityMedian Age (Range)% >70 y/oDisease Stages% Smoldering/1% 2A/2B% 3A% 3BTNTTNTTNTTNTTNTTNTCaucasian63 (33-80)68 (28-82)24421323221250511414Hispanic57.5 (39-74)63 (38-74)7131420141349532313Black60 (44-73)65 (31-80)152054015060472013Native American55 (51-56)57 (54-76)020000010010000 Open table in a new tab Our results suggest that once patients are seen at a transplant center, that there are no differences based on ethnicity regarding who proceeds to transplant. Additionally, there appears to be a tendency to see more C patients over the age of 70 for consideration of ASCT but the numbers for the comparison groups are small and make generalizations difficult. If these results can be verified at other centers, then the different STUR rates previously reported in minorities are more likely due to a referral bias or social factors rather than issues at the transplant center. Educational programs to overcome such obstacles, should be aimed at the primary oncologist to understand the differences in referral patterns across ethnicities and how to address these including referring more minorities over the age of 70 for consideration of transplant.