Comparable Survival Rates for Black and White Americans with Multiple Myeloma
Overview
This study demonstrates that when Black Americans (BA) and White Americans (WA) with newly diagnosed multiple myeloma (NDMM) are rigorously matched for clinical, molecular, and treatment factors, their survival outcomes are comparable. Propensity score matching accounted for age, molecular risk, disease extent, and treatment variables, revealing no significant survival disparities attributable to biological differences.
Background
Multiple myeloma (MM) disproportionately affects Black Americans, who experience roughly twice the incidence and mortality rates compared to White Americans. Previous studies have suggested that disparities in survival may be driven by inequities in access to timely and optimal treatment, but the role of biological or genetic factors remains unclear. Prior analyses were limited by incomplete treatment matching and potential confounding. This study leverages a large institutional database with strict inclusion criteria and comprehensive risk assessment to evaluate racial differences in survival independent of treatment disparities.
Data Highlights
Characteristic
Black Americans (n=131)
White Americans (n=376)
Odds Ratio (95% CI)
p-value
Age ≥65 years
10%
16%
–
–
Female sex
52%
37%
–
–
Obesity prevalence
45%
27%
2.23 (1.39–3.58)
0.001
Low hemoglobin
50%
40%
1.54 (1.03–2.30)
0.043
GEP70 molecular risk distribution
Comparable
Comparable
SMD = 0.013
–
Maintenance therapy (PI+IMiD)
More frequent
Less frequent
–
–
Key Findings
Black Americans with NDMM were younger and more often female compared to White Americans.
Baseline prognostic factors including molecular risk (GEP70) and disease extent by PET/MRI were similar between racial groups after matching.
Black Americans had higher rates of obesity and lower hemoglobin levels, consistent with known physiological and epidemiological differences.
Survival analyses showed comparable overall survival (OS) and event-free survival (EFS) between Black and White Americans when matched for key clinical and treatment factors.
Clinical Implications
These findings suggest that racial disparities in multiple myeloma survival are largely attributable to differences in access to and receipt of optimal treatment rather than inherent biological differences. Ensuring equitable access to standardized treatment protocols, including autologous stem cell transplantation and maintenance therapy, may mitigate survival disparities. Clinicians should be aware of demographic and physiological differences such as hemoglobin levels and obesity prevalence when managing patients but focus on delivering uniform, evidence-based care.
Conclusion
When Black and White Americans with newly diagnosed multiple myeloma are rigorously matched for clinical, molecular, and treatment factors, survival outcomes are comparable. This underscores the critical role of equitable treatment access in addressing racial disparities in multiple myeloma outcomes.
References
National Cancer Institute SEER Data 2021 -- Multiple Myeloma Incidence and Mortality
Cornell et al. 2019 -- Impact of Post-Transplant Therapy on Myeloma Outcomes
Shaughnessy et al. 2007 -- GEP70 Molecular Risk Score in Multiple Myeloma
by David E. Mery, Guido Tricot, Samer Al Hadidi, Yihao Zhan, Cody Ashby, Clyde Bailey, Eric R. Siegel, Daisy V. Alapat, Hongwei Xu, Sandra Mattox, Caroline Schinke, Maurizio Zangari, Sharmilan Thanendrarajan, Qing Yi, Robert Z. Orlowski, Frits van Rhee, John D. Shaughnessy, Fenghuang Zhan
