Black patients with primary myelofibrosis (PMF) were diagnosed at an earlier age and experienced shorter survival compared with White patients, according to an analysis of the Surveillance, Epidemiology, and End Results (SEER) database.
Additional factors associated with worse survival included older age, male sex, and married status, according to the results of a study presented at the SOHO 2023 Annual Meeting.
The retrospective study analyzed data from 5403 patients with PMF from the SEER 2000-2019 database to determine if socioracial characteristics affected survival outcomes. An additional cohort of 51 patients with PMF from Montefiore Medical Center were included to compare with the study’s findings from the SEER database.
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The median age of the SEER cohort was 69 years at diagnosis and 82% of patients were White, 8.4% were Black, and 7.7% were Asian/Pacific Islander. The overall age-adjusted incidence of PMF was 0.32 per 100,000 person-years with an annual percentage increase of 1.3% (P <.05).
Black patients were more likely to be female, unmarried, and have an annual income of less than $70,000 compared with non-Black patients (all P <.001). However, there was no significant difference in the receipt of radiotherapy (P =.607) or chemotherapy (P =.546).
Black race was significantly associated with shorter overall survival (OS) compared with non-Black race (hazard ratio [HR], 1.202; 95% CI, 1.016-1.422; P <.032). The 2- and 5-year OS were 69% and 41%, respectively, and the median OS was 47 months among Black patients.
Other variables that were significantly associated with worse survival included older age (HR, 1.042; 95% CI, 1.038-1.046; P <.001) and male sex (HR, 1.399; 95% CI, 1.277-1.533; P <.001). In contrast, married status appeared protective against all-cause mortality (HR, 0.969; 95% CI, 0.885-1.062; P <.502), according to M. Bakri Hammami, MD, of Albert Einstein Medical Center in New York.
In the Montefiore cohort, the median age at diagnosis was 66 and 35% of patients were White, 20% were Black, 10% were Asian, and 35% were other or unknown. The 2- and 5-year OS were 92% and 63%, respectively, for the entire cohort.
In this cohort, there was no significant difference in the treatment of PMF between Black and non-Black patients. The most commonly used agent was ruxolitinib, which was used among 50% of Black patients and 43.9% of non-Black patients, followed by hydroxyurea, which was used among 20% and 19.5%, respectively, and enrollment in a clinical trial, which occurred among 10% and 14.6% of patients, respectively.
There was also no difference in the rates of evaluated genetic mutations between Black and non-Black patients. The most common gene that was mutated was JAK2, which was present among 70% of Black patients and 78% of non-Black patients. CALR was also commonly mutated, with mutations present among 20% and 16% of patients.
“We were able to tell with fair certainty that there is a real role for social factors in terms of survival, especially in terms of Black versus non-Black patients,” Dr Hammami concluded. He also noted that social factors may play a larger role than biological differences.
Reference
Hammami MB, Vegivinti C, Thakur R, et al. Examining racial disparities in primary myelofibrosis incidence and survival rates: A SEER database analysis from 2000–2019. Presented at: the Eleventh Annual Meeting of the Society of Hematologic Oncology (SOHO); September 6-9, 2023. MPN-470.
