Racial and ethnic differences in clonal hematopoiesis, tumor markers, and outcomes of patients with multiple myeloma

• Published in: Blood advances Vol. 6; no. 12; pp. 3767 - 3778
• Main Authors: Peres, Lauren C., Colin-Leitzinger, Christelle M., Teng, Mingxiang, Dutil, Julie, Alugubelli, Raghunandan R., DeAvila, Gabriel, Teer, Jamie K., Du, Dongliang, Mo, Qianxing, Siegel, Erin M., Hampton, Oliver A., Alsina, Melissa, Brayer, Jason, Blue, Brandon, Baz, Rachid, Silva, Ariosto S., Nishihori, Taiga, Shain, Kenneth H., Gillis, Nancy
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 28.06.2022
• ISSN: 2473-9529; 2473-9537
• DOI: 10.1182/bloodadvances.2021006652

Multiple myeloma (MM) incidence, mortality, and survival varies by race and ethnicity but the causes of these differences remain unclear. We investigated demographic, clinical, and molecular features of diverse MM patients to elucidate mechanisms driving clinical disparities. This study included 495 MM patients (self-reported Hispanic, n=45; non-Hispanic Black, n=52; non-Hispanic White, n=398). Hispanic and non-Hispanic Black individuals had an earlier age of onset than non-Hispanic White individuals (53 and 57 versus 63 years, respectively, p<0.001). There were no differences in treatment received by race and ethnicity groups, but non-Hispanic Black patients had a longer time to hematopoietic cell transplant than non-Hispanic White patients (376 days versus 248 days, p=0.01). Overall survival (OS) was improved for non-Hispanic Black compared to non-Hispanic White patients (HR 0.50, 95% CI 0.31-0.81, p=0.005), although this association was attenuated after adjusting for clinical features (HR 0.62, 95% CI 0.37-1.03, p=0.06). Tumor mutations in IRF4 were most common in Hispanic patients, and mutations in SP140, AUTS2, and SETD2 were most common in non-Hispanic Black patients. Differences in tumor expression of BCL7A, SPEF2, and ANKRD26 were observed by race and ethnicity. Clonal hematopoiesis was observed in 12% of patients and associated with inferior OS in non-Hispanic Black patients compared to patients without clonal hematopoiesis (HR 4.36, 95% CI 1.36-14.00), although this association was attenuated after adjusting for prognostic factors. This study provides insight into differences in molecular features that may drive clinical disparities in MM patients receiving comparable treatment, with the novel inclusion of Hispanic individuals.