Hematopoietic stem cell transplant in multiple myeloma: An analysis of mortality, costs, and patient characteristics.

Abstract

e19556 Background: Multiple myeloma (MM) is a clonal plasma cell neoplasm projected to affect approximately 36,000 people and result in 12,000 deaths in the United States in 2025, according to the American Cancer Society. While advancements in treatment options have revolutionized care in recent years, hematopoietic stem cell transplant (HSCT) remains a cornerstone of therapy. This study aimed to analyze differences in patient characteristics, in-hospital mortality rates, comorbidity prevalence, hospital length of stay, and total charges between multiple myeloma patients with and without HSCT. Methods: We used the 2019–2020 National Inpatient Sample (NIS) database to identify all patients admitted with a primary diagnosis of Multiple myeloma (based on relevant ICD-10 codes), categorizing them by receiving HSCT to analyze their epidemiological differences, demographic characteristics, mortality rates, and associated healthcare burdens. Results: The epidemiological characteristics of the patient populations are summarized in the table below. A total of 41,280 patients met the inclusion criteria, of which 18,076 (43.79%) were female, and 10,260 (24.85%) underwent HSCT. The transplant group had significantly longer hospital stays (12.94 vs. 10.76 days, p < 0.001) and higher total charges ($170,529 vs. $138,484, p < 0.001). In-hospital mortality rates were also higher in the HSCT group (5.95% vs. 4.25%, p = 0.0022). However, multivariate regression analysis adjusting for confounding factors did not find HSCT to be a significant risk factor for mortality (OR: 1.14, p = 0.270). Regional trends showed that most MM patients undergoing HSCT were hospitalized in the South (38.4%) and Northeast (28.51%), whereas patients not receiving HSCT were predominantly hospitalized in the South (37.89%) and Midwest (24.55%). Conclusions: While HSCT is a complex procedure associated with high risks of infection and significant costs in the treatment of MM, our study did not demonstrate a statistically significant increase in in-hospital mortality for transplant patients after adjusting for confounding factors. The mean ages between the transplant and non-transplant groups were comparable, suggesting that age was not a primary determinant for undergoing HSCT. Despite the longer hospital stays and higher total charges observed in the HSCT group, the findings underscore the need for further research to optimize patient selection criteria and improve cost-effectiveness in MM management. Variables MM patients with HSCT (24.85%) MM patients without HSCT (75.15%) p values Total number of patients 10, 260 31, 020 Age (years) 65.92 65.68 0.4542 Gender (Female) 45.32% 43.28% 0.0944 Race < 0.001  -White 52.58% 60.56%  -Black 26.75% 21.71%  -Hispanic 10.09% 9.72%  -Asian/Native American and others 10.58% 8.01% Primary Insurance 0.2648  -Medicare 52.12% 52.73%  -Medicaid 9.26% 8.26%  -Private insurance 34.28% 33.47%  -Other 4.34% 5.54% Household income(quartile) 0.0908  -1 st 26.16% 26.49%  -2 nd 23.15% 23.7%  -3 rd 24.04% 26.01%  -4 th 26.66% 23.8% Obesity 12.77% 12.99% 0.8157 DM 24.12% 21.86% 0.0490 COPD 7.31% 6.33% 0.1456 CHF 15.64% 12.52% 0.0007 Smoking 21.3% 23.66% 0.0317 CKD 34.26% 29.11% 0.0001 Age> 80 11.11% 11.9% 0.3892 Sepsis 7.6% 5.3% 0.0020