Exploring why racial and ethnic background significantly influences chances of surviving multiple myeloma, even when we all have the same blood cells.
Meet Robert, a 58-year-old African American man who began experiencing persistent back pain and overwhelming fatigue. When his doctor finally ordered the blood tests that revealed multiple myeloma, a cancer of plasma cells in the bone marrow, Robert joined a startling statistic: he was twice as likely to develop this disease than his White neighbors, yet less likely to survive it. This paradox lies at the heart of one of oncology's most pressing puzzles—why do your racial and ethnic background significantly influence your chances of surviving multiple myeloma, even when we all have the same blood cells?
For decades, researchers have documented persistent survival gaps in multiple myeloma across racial and ethnic groups. While overall survival for this cancer has improved dramatically with new treatments, these advances haven't benefited all populations equally. African Americans experience the highest incidence of multiple myeloma globally yet often face the shortest survival, while Hispanic patients are typically diagnosed at younger ages with worse outcomes.
What explains these divides? Are they rooted in biology, access to care, or deeper systemic issues within our healthcare system? This article explores the complex interplay of factors determining multiple myeloma outcomes and reveals how a landmark study is reshaping our understanding of race, treatment, and survival.
Multiple myeloma represents approximately 2% of all cancers, but it places a disproportionate burden on communities of color. The numbers reveal a stark reality:
African Americans develop multiple myeloma at more than twice the rate of White Americans
Despite representing only 14% of the U.S. population, African Americans constitute 20% of all myeloma patients
Hispanic Americans are diagnosed at the youngest average age (64-65 years) 8
Incidence per 100,000 people and early mortality odds compared to White Americans
These disparities extend beyond incidence to survival outcomes. Research drawing from national data spanning 2000-2019 reveals that non-Hispanic Black and Hispanic patients have significantly higher odds of early mortality—defined as death within two years of diagnosis 5 . This early mortality persists even when accounting for income differences, suggesting that financial resources alone don't explain the survival gap 5 .
| Metric | African Americans | White Americans | Hispanic Americans |
|---|---|---|---|
| Incidence (per 100,000) | 15.8 4 7 | 6.9 | Data Not Available |
| Median Age at Diagnosis | 65-66 years | 69-70 years | 64-65 years 8 |
| Early Mortality Odds | Increased 5 | Reference Group | Increased 5 |
| 2-Year Survival Trend | Improving but gap persists | Improving | Improving but gap persists |
Table 1: Multiple Myeloma Disparities at a Glance
For years, the conventional wisdom attributed survival disparities primarily to biological differences. Then, a groundbreaking analysis published in Blood Cancer Journal in 2018 challenged this assumption by asking a simple but profound question: What happens when patients from different racial and ethnic backgrounds receive exactly the same treatments? 1 3
Researchers pooled data from nine national clinical trials conducted between 1988-2011, encompassing 2,896 patients with newly diagnosed multiple myeloma 1 3 . These cooperative group trials—including studies by the Eastern Cooperative Oncology Group (ECOG-ACRIN) and South West Oncology Group (SWOG)—provided a unique opportunity to observe outcomes under standardized conditions where treatment protocols were identical regardless of race.
The research team categorized patients into four mutually exclusive groups: non-Hispanic Whites, non-Hispanic African Americans, non-Hispanic Others, and Hispanics. They then analyzed how these groups differed across key metrics including baseline disease characteristics, access to clinical trials featuring novel therapeutic agents, objective response rates to treatment, progression-free survival, and overall survival.
The analysis exposed significant underrepresentation of minority groups in clinical trials. Among the 2,896 patients, only 18% were non-White, and enrollment of minorities actually decreased in the most recent years of the study (2002-2011) 1 3 . This shortage of diverse participants makes it difficult to generalize trial results to all populations.
African American patients presented with distinct disease characteristics—they were younger at diagnosis and had more frequent poor-risk markers, including anemia and elevated lactate dehydrogenase 1 3 . Hispanics had the smallest proportion of patients participating in trials that utilized novel therapeutic agents, suggesting disparities in access to cutting-edge treatments even within the research setting 6 .
| Factor | Non-Hispanic Whites | Non-Hispanic African Americans | Hispanics |
|---|---|---|---|
| Representation in Trials | 81.9% | 13.5% | 2.6% |
| Novel Agent Trial Access | Reference Group | Comparable | Lowest Access |
| Median Progression-Free Survival | No Significant Differences Across Groups | ||
| Median Overall Survival | No Significant Differences Across Groups | ||
Table 2: Key Findings from the Cooperative Group Trial Analysis
If outcomes can be equal with equal treatment, why do disparities persist in the general population? The answer lies in a complex web of biological, social, and systemic factors that create what some researchers term an "invisible divide" in myeloma care 2 .
The underrepresentation of minority groups in clinical trials has far-reaching consequences. A separate analysis of 19 global trials supporting FDA drug approvals between 2006-2019 revealed that among 10,157 patients, White participants comprised 84%, while Black patients represented only 4% and Hispanics just 4% 4 . This disparity exists despite the higher disease burden in Black communities.
When certain populations are underrepresented in clinical trials, researchers cannot fully understand how new treatments will work for those groups. This creates an evidence gap that can perpetuate disparities if treatments are less effective or have different side effects in underrepresented populations.
Beyond clinical trials, real-world treatment patterns reveal consistent disparities in care:
Recent survey data reveals the human impact of these barriers: 60% of Black adults report preparing for possible insults from healthcare providers and feeling they must be careful about their appearance to receive fair treatment, compared to 33% of White adults .
Biology does play a role in myeloma disparities, but not in the ways traditionally assumed. Research presented at the 2022 American Society of Hematology meeting revealed that:
African Americans actually have a more favorable cytogenetic profile with lower incidence of high-risk abnormalities like deletion 17p 8 .
Despite this biological advantage, which should lead to better outcomes, real-world survival remains worse for minority groups 8 .
African American and Hispanic patients experience different side effects from treatments, including higher rates of cytokine release syndrome after CAR T-cell therapy and increased peripheral neuropathy from bortezomib 8 .
| Treatment Modality | Disparity Observed | Potential Impact |
|---|---|---|
| Stem Cell Transplantation | Lower utilization in African American and Hispanic patients | Reduced long-term survival |
| Novel Drug Combinations | Delayed access and lower usage | Inferior disease control |
| Clinical Trial Participation | Significant underrepresentation | Limited data on efficacy across populations |
| CAR T-Cell Therapy | Reduced access and different side effect profile | Limited benefit from cutting-edge treatment |
Table 3: Treatment Access Disparities in Multiple Myeloma
Addressing myeloma disparities requires a multi-faceted approach that targets both clinical practice and social determinants of health. Promising strategies emerging from recent research include:
Research highlights the importance of cultural tailoring in lifestyle interventions aimed at reducing myeloma risk factors like obesity 7 . Successful programs such as the Eat for Life trial and Body & Soul intervention demonstrate the effectiveness of this approach 7 .
A study presented at ASH 2022 revealed differences in how White and African American patients experience communication with their healthcare teams 8 . Implementing training in unconscious bias and shared decision-making can help bridge these divides.
Trained navigators can assist patients with insurance enrollment, transportation, appointment scheduling, and financial assistance programs—addressing practical barriers that disproportionately affect minority communities 8 .
| Research Tool | Function | Role in Disparities Research |
|---|---|---|
| SEER Database | National cancer registry collecting incidence, survival, and mortality data | Identifies population-level disparities and trends over time |
| Pooled Clinical Trial Data | Combined analysis of multiple therapeutic studies | Controls for treatment variables to isolate effect of race/ethnicity |
| Social Vulnerability Index (SVI) | Measures community resilience to stressors | Correlates socioeconomic factors with health outcomes |
| Cytogenetic Profiling | Analyzes chromosomal abnormalities in myeloma cells | Determines biological differences across racial groups |
| Patient-Reported Outcome Measures | Captures patient experiences directly | Reveals disparities in symptom burden and quality of life |
Table 4: Essential Tools in Myeloma Disparities Research
The compelling evidence from cooperative group trials delivers a powerful message: with equal access to effective treatments, survival disparities in multiple myeloma can be eliminated.
As the 2018 analysis demonstrated, when patients from different racial and ethnic backgrounds receive the same therapeutic approaches, their outcomes are comparable, and in some cases, even better for minority groups 1 3 .
This revelation transforms our understanding of myeloma disparities—shifting the focus from what's different in patients' biology to what's unequal in their care. The higher incidence of myeloma in African Americans coupled with their potentially superior survival under equal conditions creates what researchers call a "double disparity" 8 —not only are they affected more often, but they also benefit less from advances in treatment.
As research continues to unravel the complex interplay of biology, access, and social determinants, one truth becomes increasingly clear: achieving equity in myeloma outcomes requires addressing the systemic barriers that limit access to optimal care for all patients.
Through concerted efforts to diversify clinical trials, improve cultural competence in care, and address practical barriers to treatment, the myeloma community can work toward a future where survival is determined not by race or ethnicity, but by the quality of care received.
The story of multiple myeloma disparities is still being written, and with continued research and commitment to equity, its next chapter could be one of hope and healing for all patients, regardless of their background.