Comparisons of the Response of Chemo/BMT Treatment and Survival Outcomes between African American and Caucasian Patients with Multiple Myeloma Open Access

Hu, Zheyu (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/tt44pn366?locale=en
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Abstract

This study aimed to investigate the racial disparity in patients' response to chemotherapy / bone marrow transplantation (BMT) and the survival outcome in multiple myeloma (MM) patients. A total of 370 white MM patients and 370 African American (AA) patients were treated with chemotherapy and BMT. The demographic and clinical information were recorded. Univariate and multivariate logistic regression analysis were performed to evaluate the racial disparity in pretransplant response, BMT response, and the improvement of response after BMT. The survivor functions for progression free survival (PFS) analysis and overall survival (OS) analysis in white and AA patients were estimated by the method of Kaplan and Meier. The log-rank test was used to test the difference. A COX model was employed to estimate the univariate effect of race and all other variables on PFS or OS as well as the adjusted effects of race by other factors on PFS or OS. We found that AA patients were younger with more female and have lower albumin and higher quantitated IgG level. AA patients were less likely to have anemia and hypertension, buy more likely to have lytic bone lesion. The usage of Melphalan, mobilization with growth factor and thalidomide maintenance were significantly higher in AA patients, while the usage of thalidomide and lenalidomide maintenance were significantly lower among them. As for the treatment response, we found that there was no significant racial disparity in pre-transplant response, treatment response at day 100 after BMT, and response improvement. In PFS analysis, we found that the hazard rate of progression or death among AA patients was significantly lower (only 0.783 [95% CI: 0.632 - 0.9696] folds) than white patients. ISS stage, the presence of lytic bone lesion, hypercalcemia, anemia, renal insufficiency, thalidomide, dexamethasone, etoposide, cytoxytan, carboplatin, growth factor mobilization and thalidomide maintenance were also shown to be significantly risk factors of PFS. We did not find racial disparity in OS. But, ISS stage, cytogenetics, the presence of lytic bone lesion, hypercalcemia, anemia, DM, renal insufficiency, velcade, thalidomide, dexamethasone, doxorubicin, cytoxytan, carboplatin, etoposide and bortezomib maintenance were found to be risk factors of OS.

Table of Contents

Table of Content

Chapter I

Introduction …………………………………………………………………. 1

Chapter II

Methods ………………………………………………………………………. 12

Chapter III

Results …………………………………………………………………………..1 5

Chapter IV

Discussion ……………………………………………………………………..2 2

References ……………………………………………………………………. 26

Appendix ………………………………………………………………………..3 1

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