Flatiron Health Inc, New York, NY, USA.
Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
Blood Cancer J. 2022 Apr 19;12(4):65. doi: 10.1038/s41408-022-00665-x.
This retrospective observational study evaluated racial disparities among Black and White patients with multiple myeloma (MM). We included patients from a longitudinal de-identified EHR-derived database who had ≥2 visits recorded on or after 1/1/2011, documented treatment, and race listed as White or Black. Black patients (n = 1172) were more likely female (54.8%/42.9%) and younger (<65 years, 40.8%/30.8%) than White patients (n = 4637). Unadjusted median real-world overall survival (rwOS) indexed to first-line of therapy (LOT) was 64.6 months (95% CI: 57.8-74.0) for Blacks and 54.5 months (95% CI: 50.9-56.2) for Whites. Adjusted rwOS estimates (for sex, age at index date, and practice type) to either first- (aHR = 0.94; 95% CI: 0.84-1.06) or second-LOT (aHR = 0.90; 95% CI: 0.77-1.05) were similar. Unadjusted derived response rate (dRR) during first-LOT was 84.8% (95% CI: 80.7-88.1) for Blacks and 86.9% (95% CI: 85.0-88.5) for Whites (odds ratio [OR] = 0.78 [95% CI: 0.57-1.10]); in second-LOT, 67.2% (95% CI: 58.4-75.0) for Blacks and 72.4% (95% CI: 68.1-76.3) for Whites (OR = 0.72 [95% CI: 0.46-1.13]). High representation of Black patients enabled this robust analysis, albeit with limitations inherent to the observational data source, the retrospective design, and the analytic use of newly derived endpoints requiring further validation.
这项回顾性观察研究评估了多发性骨髓瘤（MM）黑人和白人患者之间的种族差异。我们纳入了来自纵向去识别电子健康记录（EHR）衍生数据库的患者，这些患者在 2011 年 1 月 1 日或之后至少有 2 次就诊记录，记录了治疗情况，并列出了白种人或黑种人种族。黑人患者（n=1172）比白人患者（n=4637）更有可能为女性（54.8%/42.9%）和年轻（<65 岁，40.8%/30.8%）。未调整的真实世界总生存期（rwOS）指数到一线治疗（LOT），黑人患者为 64.6 个月（95%CI：57.8-74.0），白人患者为 54.5 个月（95%CI：50.9-56.2）。调整后的 rwOS 估计值（性别、指数日期年龄和实践类型）与一线治疗（aHR=0.94；95%CI：0.84-1.06）或二线治疗（aHR=0.90；95%CI：0.77-1.05）相似。一线治疗期间未经调整的衍生缓解率（dRR），黑人患者为 84.8%（95%CI：80.7-88.1），白人患者为 86.9%（95%CI：85.0-88.5）（比值比[OR]=0.78[95%CI：0.57-1.10]）；二线治疗时，黑人患者为 67.2%（95%CI：58.4-75.0），白人患者为 72.4%（95%CI：68.1-76.3）（OR=0.72[95%CI：0.46-1.13]）。黑人患者的高代表性使这项研究结果可靠，尽管存在观察性数据源固有的局限性、回顾性设计和新衍生终点的分析使用，需要进一步验证。
