Welcome to Study of the Week from Patient Worthy. In this segment, we select a study we posted about from the previous week that we think is of particular interest or importance and go more in-depth. In this story we will talk about the details of the study and explain why it’s important, who will be impacted, and more.
If you read our short form research stories and find yourself wanting to learn more, you’ve come to the right place.
This week’s study is…
Prevalence and impact of diabetes on survival of patients with multiple myeloma in different racial groups
We previously published about this research in a story titled “Impact of Diabetes on Multiple Myeloma Varies by Racial Background” which can be found here. The study was originally published in the scientific journal Blood Advances. You can read the abstract of the study here.
This research team was associated with the Memorial Sloan Kettering Cancer Center and Icahn School of Medicine at Mt. Sinai.
What Happened?
In multiple myeloma, having diabetes is a problem. Prior studies have found that myeloma patients with diabetes have lowered rate of survival in general. Prior studies have also shown a degree of correlation between the two diseases, with people of African ancestry being disproportionately impacted by diabetes and multiple myeloma. The goal of this study was to compare outcomes in patients of both European (white) and African (Black) ancestry who had diabetes and multiple myeloma.
This was a retrospective study looking at data from 5,383 patients with multiple myeloma. Of this group, a total of 15% had diabetes. This included 12% of white patients and 25% of Black patients. The research team utilized an approach called Kaplan-Meier testing in order to provide estimates of the distribution of overall survival (OS). Additionally, they used log-rank testing in order to evaluate the distributions of OS by diabetes status. Other methodology used during the study included multivariable Cox proportional hazards regression models, BMI (in the overall cohort), and adjusted center-specific models for variables such as age, race, and gender.
The median follow-up time was 4.2 years, and the analysis clearly showed that OS was worse in patients with diabetes. However, the data also found a meaningful difference in OS between Black and white patients in the diabetes group, with white patients having worse OS than Black patients. Another unexpected finding was that obese Black patients had better OS than white patients. Old age was also a predictor of worse OS, and this finding was true across both racial groups.
About Multiple Myeloma
Multiple myeloma, which is occasionally referred to as plasma cell myeloma, is a blood cancer that affects plasma cells. These are white blood cells that produce antibodies. The overall cause of multiple myeloma is not well understood; however, some risk factors have been identified. These include obesity, family history, smoldering myeloma, and monoclonal gammopathy of undetermined significance. These last two conditions have the potential to develop into multiple myeloma. Symptoms of this cancer include bone pain, infections, anemia, kidney failure, overly thick blood, confusion, fatigue, headaches, and amyloidosis. Treatment includes chemo, stem cell transplant, and other medications for relapsed disease, which is common. Five-year survival rate is 49 percent in the US. To learn more about multiple myeloma, click here.
Why Does it Matter?
The findings from this study revealed some unexpected results related to the impacts of diabetes in multiple myeloma, with diabetes having a stronger negative effect in people of European ancestry when compared to people of African ancestry. The greater OS in Black patients with obesity was also a surprise.
“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.” – Urvi Shah, MD, multiple myeloma specialist, Memorial Sloan Kettering Cancer Center
Future avenues of study will include investigating overactive insulin signaling pathways, which may be a common thread in people living with diabetes and multiple myeloma. The scientists also hope to investigate other risk factors that could be potentially modifiable, such as the diet and gut microbiome.
“While drugs are important, as oncologists, we need to also look at comorbidities and modifiable risk factors to improve patient survival outcomes.” – Shah
