Racial disparities in access to transplant for multiple myeloma:

reflections on the Brazilian healthcare system with local data

Authors

DOI:

https://doi.org/10.46311/2318-0579.62.eUJ4707

Keywords:

Multiple myeloma, Hematopoietic stem cell transplantation, Racial factors, Access to healthcare services

Abstract

Multiple myeloma (MM) is a neoplasia whose treatment may include hematopoietic stem cell transplantation (HSCT). The literature points to racial disparities in access to HSCT, but information on this issue is scarce in Brazil. This study aimed to analyze the racial composition of patients subjected to autologous HSCT for multiple myeloma in a single Brazilian center, discussing access to treatment. A retrospective review was conducted considering HSCTs performed between 2014 and 2022 at a Brazilian academic center. The categorization adopted by the IBGE was used for white, pardo, and black patients. Variables such as age at the time of transplant and region of origin were evaluated. Data were presented through descriptive statistics. A total of 130 patients were included: 106 white (81.5%), 10 pardo (7.7%), and 14 black (10.8%). 71 were men (54.6%) and 59 were women (45.4%), with no significant differences among racial groups. The median age was 60 years for white and 53 years for black and pardo patients. Among the subgroups, white individuals from the Southeast, Midwest, and Northeast regions represented 76.4%, 17%, and 2.8%, respectively, while black and pardo patients represented 62.5%, 12.5%, and 20.8%. This study identified a white majority among patients subjected to HSCT for MM management in a single center. A deeper analysis of these differences is essential, as these findings may reflect phenomena within the Brazilian healthcare system. Discussing this issue is crucial for better understanding access to transplantation in light of factors that contribute to inequality in this vulnerable patient group.

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References

Ailawadhi, S., Frank, R. D., Advani, P., Swaika, A., Temkit, M., Menghani, ... Chanan-Khan, A. A. (2017). Racial disparity in utilization of therapeutic modalities among multiple myeloma patients: a SEER-medicare analysis. Cancer Medicine, 6(12), 2876-2885. doi: 10.1002/cam4.1246 DOI: https://doi.org/10.1002/cam4.1246

Ailawadhi, S., Jacobus, S., Sexton, R., Stewart, A. K., Dispenzieri, A., Hussein, M. A., … Rajkumar, S. V. (2018). Disease and outcome disparities in multiple myeloma: exploring the role of race/ethnicity in the Cooperative Group clinical trials. Blood Cancer Journal, 8, 67. doi: 10.1038/s41408-018-0102-7 DOI: https://doi.org/10.1038/s41408-018-0102-7

Al Hadidi, S., Schinke, C., Thanendrarajan, S., Zangari, M., & van Rhee, F. (2022). Enrollment of Black Participants in Pivotal Clinical Trials Supporting US Food and Drug Administration Approval of Chimeric Antigen Receptor-T Cell Therapy for Hematological Malignant Neoplasms. The Journal of the American Medical Association, 5(4), e228161. DOI: https://doi.org/10.1001/jamanetworkopen.2022.8161

Assis, M. M., & Jesus, W. L. (2012). Acesso aos serviços de saúde: abordagens, conceitos, políticas e modelo de análise. Ciência & Saúde Coletiva, 17(11), 28652875. doi: 10.1590/s1413-81232012001100002 DOI: https://doi.org/10.1590/S1413-81232012001100002

Attal, M., Harousseau, J. L., Stoppa, A. M., Sotto, J. J., Fuzibet, J. G., Rossi, J. F. … Bataille, R. (1996). A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe

Francais du Myelome. The New England Journal of Medicine, 335(2), 91-97. doi: 10.1056/NEJM199607113350204 DOI: https://doi.org/10.1056/NEJM199607113350204

Brasil. (2017). Política Nacional de Saúde Integral da população negra: uma política do SUS (3rd ed.). Ministério da Saúde. Brasília, DF: Secretaria de Gestão Estratégica e Participativa. Departamento de Apoio à Gestão Participativa e ao Controle Social.

Brasil. (2022). Censo 2022. Instituto Brasileiro de Geografia e Estatística. Recovered from: https://www.ibge.gov.br/estatisticas/sociais/trabalho/22827censo-demografico-2022.html.

Brigle, K., & Rogers, B. (2017). Pathobiology and Diagnosis of Multiple Myeloma. Seminars in Oncology Nursing, 33(3), 225-236. doi: 10.1016/j.soncn.2017.05.012 DOI: https://doi.org/10.1016/j.soncn.2017.05.012

Derman, B. A., Jasielec, J., Langerman, S. S., Zhang, W., Jakubowiak, A. J., & Chiu, B. C. (2020). Racial differences in treatment and outcomes in multiple myeloma: a multiple myeloma research foundation analysis. Blood Cancer Journal, 10(8), 80. doi: 10.1038/s41408-020-00347-6 DOI: https://doi.org/10.1038/s41408-020-00347-6

Dong, J., Garacci, Z., Buradagunta, C. S., D’Souza, A., Mohan, M., Cunningham, A., … Hari, P. (2022). Black patients with multiple myeloma have better survival than white patients when treated equally: a matched cohort study. Blood Cancer Journal, 12(2), 34-34. doi: 10.1038/s41408-022-00633-5 DOI: https://doi.org/10.1038/s41408-022-00633-5

Estrela, C. S., Santos, I. R.; Lima, R. R. T. (2021). O quesito raça/cor e a equidade no Sistema Único de Saúde: critérios atravessados pelo contexto racial brasileiro. In Barbosa, I. R., Aiquoc, K. M., Souza, T. A. (Org.). Raça e Saúde: múltiplos olhares sobre a população negra no Brasil (p. 49-62). Natal, RN: EDUFRN.

Fakhri, B., Fiala, M. A., Tuchman, S. A., & Wildes, T. M. (2018). Undertreatment of older patients with newly diagnosed multiple myeloma in the era of novel therapies. Clinical Lymphoma, Myeloma and Leukemia, 18(3), 219-224. doi: 10.1016/j.clml.2018.01.005 DOI: https://doi.org/10.1016/j.clml.2018.01.005

Fossum, C. C., Navarro, S., Farias, A. J., & Ballas, L. K. (2021). Racial disparities in the use of palliative radiotherapy for black patients with multiple myeloma in the United States. Leukemia & Lymphoma, 62(13), 3235-3243. doi: 10.1080/10428194.2021.1953012 DOI: https://doi.org/10.1080/10428194.2021.1953012

Geraldo, R. M., Oliveira, J. C., Alexandre, L. S. C., Aguiar, M. R. A., Vieira, A. F. S., & Germani, A. (2022). Preenchimento do quesito raça/cor na identificação dos pacientes: aspectos da implementação em um hospital universitário. Revista Ciência & Saúde Coletiva, 27(10), 3871-3880. doi: 10.1590/1413812320222710.08822022 DOI: https://doi.org/10.1590/1413-812320222710.08822022en

Goes, E. F., & Nascimento, E. R. (2013). Mulheres negras e brancas e os níveis de acesso aos serviços preventivos de saúde: uma análise sobre as desigualdades. Saúde em Debate, 37(99), 571-579. doi: 10.1590/s0103-11042013000400004 DOI: https://doi.org/10.1590/S0103-11042013000400004

Gomes, S. M., Meira, K. C.; Silva, M. F. S. (2021). Interseccionalidades da atenção à saúde da população negra. In Barbosa, I. R., Aiquoc, K. M., Souza, T. A. (Org.). Raça e Saúde: Múltiplos olhares sobre a saúde da população negra no Brasil (p. 77). Natal, RN: EDUFRN.

James, S. A. (2017). The strangest of all encounters: racial and ethnic discrimination in US health care. Cadernos de Saúde Pública, 33(Suppl 1). doi:10.1590/0102-311X00104416 DOI: https://doi.org/10.1590/0102-311x00104416

Kazandjian, D. (2016). Multiple myeloma epidemiology and survival: A unique malignancy. Seminars in Oncology, 43(6), 676-681. doi: 10.1053/j.seminoncol.2016.11.004 DOI: https://doi.org/10.1053/j.seminoncol.2016.11.004

Kristinsson, S. Y., Landgren, O., Dickman, P. W., Derolf, A. R., & Bjorkholm, M. (2007). Patterns of survival in multiple myeloma: a population-based study of patients diagnosed in Sweden from 1973 to 2003. Journal of Clinical Oncology, 25(15), 1993-1999. doi: 10.1200/JCO.2006.09.0100 DOI: https://doi.org/10.1200/JCO.2006.09.0100

Oliveira, L. A. V., Morais, A. A., Damasceno, A. R. P., & Bezerra, S. G. S. (2023). Análise epidemiológica dos diagnósticos de mieloma múltiplo no Brasil no período 2013-2022. Hematology, Transfusion and Cell Therapy, 45 (Supp. 4). doi: 10.1016/j.htct.2023.09.800 DOI: https://doi.org/10.1016/j.htct.2023.09.800

Palumbo, A., & Anderson, K. (2011). Multiple myeloma. The New England Journal of Medicine, 364(11), 1046-1060. doi: 10.1056/NEJMra1011442 DOI: https://doi.org/10.1056/NEJMra1011442

Pan, D., Coltoff, A., Ozbek, U., Lin, J.-Y., Afshar, S., Galitzeck, Z., & Steinberg, A. (2021). Evaluating race and time to transplantation in multiple myeloma: the Mount Sinai Hospital Experience. Clinical Lymphoma, Myeloma & Leukemia, 21(7), 439-443. doi: 10.1016/j.clml.2021.02.003 DOI: https://doi.org/10.1016/j.clml.2021.02.003

Sanchez, R. M., & Ciconelli, R. M. (2012). The concepts of health access. Revista Panamericana de Salud Publica, 31(3), 260-268. doi: 10.1590/s102049892012000300012 DOI: https://doi.org/10.1590/S1020-49892012000300012

Shavers, V. L., & Brown, M. L. (2002). Racial and ethnic disparities in the receipt of cancer treatment. Journal of the National Cancer Institute, 94(5), 334-357. doi: 10.1093/jnci/94.5.334 DOI: https://doi.org/10.1093/jnci/94.5.334

Silveira, R., Rosa, R., Fogaça, G., Santos, L., Nardi, H., Alves, M., & Bairros, F. (2021). Reflexões sobre a coleta do quesito raça/cor na Atenção Básica (SUS) no Sul do Brasil. Saúde e Sociedade, 30(2). doi: 10.1590/s0104-12902021200414 DOI: https://doi.org/10.1590/s0104-12902021200414

Travassos, C., & Martins, M. (2004). A review of concepts in health services access and utilization. Cadernos de Saúde Pública, 20 (Suppl 2), S190-198. doi: 10.1590/s0102-311x2004000800014 DOI: https://doi.org/10.1590/S0102-311X2004000800014

Turesson, I., Velez, R., Kristinsson, S. Y., & Landgren, O. (2010). Patterns of improved survival in patients with multiple myeloma in the twenty-first century: a population-based study. Journal of Clinical Oncology, 28(5), 830-834. doi: 10.1200/JCO.2009.25.4177 DOI: https://doi.org/10.1200/JCO.2009.25.4177

Viacava, F., Oliveira, R. A. D., Carvalho, C. C., Laguardia, J., & Bellido, J. G. (2018). SUS: supply, access to and use of health services over the last 30 years. Ciência e Saúde Coletiva, 23(6), 1751-1762. doi: 10.1590/141381232018236.06022018 DOI: https://doi.org/10.1590/1413-81232018236.06022018

Wang, R., Neparidze, N., Ma, X., Colditz, G. A., Chang, S. H., & Wang, S. Y. (2024). Racial differences in treatment and survival among older patients with multiple myeloma. Cancer Medicine, 13(3), e6915. doi: 10.1002/cam4.6915 DOI: https://doi.org/10.1002/cam4.6915

Waxman, A. J., Mink, P. J., Devesa, S. S., Anderson, W. F., Weiss, B. M., Kristinsson, S. Y., … Landgren, O. (2010). Racial disparities in incidence and outcome in multiple myeloma: a population-based study. Blood, 116(25), 55015506. doi: 10.1182/blood-2010-07-298760 DOI: https://doi.org/10.1182/blood-2010-07-298760

Published

24-06-2025

How to Cite

Alves Pereira, C., Carvalho Barbosa Neves, G., Carolina de Oliveira, I., Macedo, T., Silva Bruno Barbosa, G., Savi, G., & Victor Piccolo Feliciano, J. (2025). Racial disparities in access to transplant for multiple myeloma: : reflections on the Brazilian healthcare system with local data. Revista Uningá, 62, eUJ4707. https://doi.org/10.46311/2318-0579.62.eUJ4707

Issue

Section

Health Sciences