Effect of diabetes on multiple myeloma outcomes varies by race
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Key takeaways:
- White patients with multiple myeloma and diabetes experienced worse OS compared with their Black counterparts.
- Black patients with obesity experienced better OS compared with white patients.
Patients with both multiple myeloma and diabetes experienced reduced OS compared with those without diabetes, according to study results published in Blood Advances.
Of note, results of a subgroup analysis specifically showed worse OS among white patients with multiple myeloma and diabetes compared with Black study participants.
Rationale and methodology
“We knew from prior studies that patients with multiple myeloma and diabetes have lower survival rates,” Urvi Shah, MD, a multiple myeloma specialist at Memorial Sloan Kettering Cancer Center, said in a press release. “But what we did not know is how these outcomes differ between races. Diabetes is much more common in Black individuals vs. white individuals, and we wanted to understand whether this difference may play a role in health outcomes among patients with both conditions.”
Shah and colleagues conducted a retrospective study including 5,383 patients with multiple myeloma receiving care at Memorial Sloan Kettering Cancer Center and Icahn School of Medicine at Mount Sinai. Overall, 15% of study participants also had diabetes, including 25% of Black patients and 12% of white patients.
Researchers used Kaplan-Meier tests to estimate distributions of OS, and log-rank tests to compare OS distributions according to diabetes status. They also used multivariable Cox proportional hazards regression models to estimate HRs for the association between diabetes and OS, and adjusted center-specific models for race, gender, age and BMI for the overall cohort.
Findings
At a median follow-up of 4.2 years, results of the multivariate analysis showed worse OS among patients with multiple myeloma and diabetes compared with those without diabetes (multivariate HR = 1.27; 95% CI, 1.11-1.47).
Researchers additionally found that increased OS appeared driven by a significant difference in OS between white (multivariate HR = 1.35; 95% CI, 1.15-1.59) vs. Black patients (multivariate HR = 1.08; 95% CI, 0.81-1.44).
“What we did not expect to see here was that diabetes was actually associated with worse survival outcomes among white individuals with myeloma, but not Black individuals,” Shah said in the release.
Moreover, results showed that Black patients with obesity experienced better OS compared with white patients.
Investiators also noted an association between elevated BMI abd increased OS among Black (HR = 0.62; 95% CI, 0.46-0.83) but not white patients (HR = 0.88; 95% CI, 0.76-1.02).
Other predictors of decreased OS included age — with those aged older than 60 years in the overall cohort having experienced worse OS — as well as among Black vs. white patients separately, researchers noted.
Researchers acknowledged study limitations, including the retrospective design, which may not account for how the quality-of-care patients with diabetes received impacts survival outcomes. In addition, race was self-reported and limited to the academic centers where patients received care.
Looking ahead
Shah and colleagues hope to identify therapies that stop both the development of multiple myeloma and the overactive insulin signaling pathway they believe may be prevalent in patients with multiple myeloma and diabetes, according to the press release.
Other aims of research include how the altering of modifiable risk factors, such as the microbiome and diet, may affect cancer outcomes.
“While drugs are important, as oncologists, we need to also look at comorbidities and modifiable risk factors to improve patient survival outcomes,” Shah said in the release. “Therapies and lifestyle changes can go hand in hand.”
References:
- Diabetes may accelerate blood cancer growth, yet survival outcomes differ by race (press release). Available at: https://www.mountsinai.org/about/newsroom/2023/diabetes-may-accelerate-blood-cancer-growth-yet-survival-outcomes-differ-by-race. Published Sept. 29, 2023. Accessed Oct. 6, 2023.
- Shah UA, et al. Blood Adv. 2023;doi:10.1182/bloodadvances.2023010815.
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