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Disparities in utilization of autologous hematopoietic cell transplantation for treatment of multiple myeloma. Biol Blood Marrow Transplant 2015 Apr;21(4):701-6 PMID: 25555447 PMCID: PMC4361014

Pubmed ID

25555447

Abstract

Autologous hematopoietic cell transplantation (AHCT) is an established therapy for multiple myeloma (MM), with an impact on quality of remission and survival. We analyzed the role of race, ethnicity, sex, and age disparities in AHCT utilization in the United States. We combined MM incidence derived from the Surveillance, Epidemiology and End Results program with transplantation activity reported to the Center for International Blood and Marrow Transplant Research for the period of 2005 to 2009 to assess the impact of disparities in AHCT. Utilization (number of transplantations/new cases) was compared between groups using the relative utilization ratio (RUR), defined as [utilization for a given category]/[utilization for the entire population]. Data were obtained from 22,462 actual MM cases and 13,311 AHCT. The age-adjusted RUR was 1.17 (95% confidence interval [CI], 1.15 to 1.19) among non-Hispanic Whites (NHW), higher than in non-Hispanic Blacks (NHB) (age-adjusted RUR, .69; 95% CI, .67 to .72; P < .0002), Hispanics (age-adjusted RUR, .64; 95% CI, .60 to .69; P < .002), and Asians (age-adjusted RUR, .65; 95% CI, .58 to .73; P < .0002]. AHCT utilization was higher in men than in women among Hispanics (age-adjusted RUR .72 versus .56, P = .007), but not among NHW, NHB, or Asians. Sex disparity prevents 1.3% of potential AHCTs in patients with MM (10.4% among Hispanics). Racial-ethnic disparities prevent 13.8% of AHCTs (44.7% in Hispanic and Asians, 39.9% in NHBs). Race-ethnicity disparity greatly affects AHCT utilization in MM. Sex disparity plays a lesser role, except among Hispanics. The ongoing decrease in age disparity will continue to drive major increase of AHCT activity. Two-year and 5-year increases in the age of the AHCT population would result in 12% and 32% increases, respectively, in volume of AHCT.

Author List

Costa LJ, Huang JX, Hari PN

Author

Parameswaran Hari MD Chief, Professor in the Medicine department at Medical College of Wisconsin




Scopus

2-s2.0-84924233017   15 Citations

MESH terms used to index this publication - Major topics in bold

Age Factors
Aged
Autografts
Female
Hematopoietic Stem Cell Transplantation
Humans
Male
Middle Aged
Multiple Myeloma
Registries
jenkins-FCD Prod-297 dff1a717c492f00bf6291286365f1f4fe95208f1