School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Middlemore Hospital, Auckland, New Zealand.
Clin Lymphoma Myeloma Leuk. 2022 Aug;22(8):e762-e769. doi: 10.1016/j.clml.2022.04.004. Epub 2022 Apr 8.
Māori and Pacific peoples (MPP) in New Zealand (NZ) have poorer health outcomes than other ethnicities. However, this has not been clinically investigated in multiple myeloma (MM). Using data from the Australian and NZ Myeloma and Related Diseases Registry for all participating centers in NZ, we compared MPP demographics, clinical characteristics, diagnostics, treatment, and outcomes to non-MPP.
MPP were defined as having ≥1 grandparent of this heritage. We tested ethnicity as a predictor of overall survival (OS) with multivariable Cox regression.
Of 568 NZ patients with MM (September 2012 to April 2021) and ethnicity data, 138 were MPP. They were diagnosed younger than non-MPP (median age 63 [IQR: 57-72] vs. 70y [62-77], P < .001). Obesity (53 vs. 27%, P < .001), diabetes (24 vs. 8%, P < .001), renal insufficiency (28 vs. 17%, P = .005), pulmonary disease (10 vs. 5%, P = .02) and FISH abnormalities (54 vs. 42%, P = .04) were more common in MPP, and a lower proportion received first-line drug therapy (88 vs. 94%, P = .03) and autologous stem cell transplant (ASCT) (age <70y: 56 vs. 70%, P = .03). OS for MPP was shorter than non-MPP even after adjusting for age, comorbidities, disease stage, performance status, FISH abnormalities and treatment (HR 1.58 [1.04-2.39], P = .03).
MPP with MM in NZ were younger, a greater proportion had comorbidities and FISH abnormalities at diagnosis, fewer received first-line treatment and/or ASCT, and they had poorer OS than non-MPP. Investigation of modifiable factors to improve outcomes and discern why MM occurs at a younger age in MPP is needed.
新西兰（NZ）的毛利人和太平洋岛民（MPP）的健康状况不如其他族裔。然而，这在多发性骨髓瘤（MM）中尚未得到临床研究。利用来自澳大利亚和 NZ 骨髓瘤和相关疾病登记处的所有参与 NZ 中心的数据，我们将 MPP 的人口统计学、临床特征、诊断、治疗和结局与非 MPP 进行了比较。
MPP 被定义为有≥1 位具有这种传统的祖辈。我们使用多变量 Cox 回归来检验种族是否为总生存期（OS）的预测因子。
在 568 名 NZ 多发性骨髓瘤患者（2012 年 9 月至 2021 年 4 月）中，有 138 名是 MPP。他们的诊断年龄比非 MPP 年轻（中位数年龄 63 [IQR：57-72] 岁比 70 岁 [62-77]，P<.001）。肥胖症（53%比 27%，P<.001）、糖尿病（24%比 8%，P<.001）、肾功能不全（28%比 17%，P=.005）、肺部疾病（10%比 5%，P=.02）和 FISH 异常（54%比 42%，P=.04）在 MPP 中更为常见，而接受一线药物治疗（88%比 94%，P=.03）和自体干细胞移植（ASCT）的比例较低（年龄<70 岁：56%比 70%，P=.03）。即使在调整了年龄、合并症、疾病分期、表现状态、FISH 异常和治疗后，MPP 的 MM 患者的 OS 也短于非 MPP（HR 1.58 [1.04-2.39]，P=.03）。
在 NZ，患有 MM 的 MPP 更年轻，在诊断时更有可能出现合并症和 FISH 异常，更少接受一线治疗和/或 ASCT，OS 比非 MPP 差。需要研究可改变的因素以改善结果，并探讨为什么 MPP 中的 MM 发生在更年轻的年龄。
