Clinical Scorecard: Comparable Survival Rates for Black Americans with Multiple Myeloma When Properly Matched to White Americans

At a Glance

Key Highlights

• Black Americans have approximately twice the incidence and mortality rates of multiple myeloma compared to White Americans.
• When rigorously matched for age, sex, molecular risk (GEP70), disease extent (PET/MRI), transplant type, and maintenance therapy, survival outcomes between Black and White Americans are comparable.
• Black Americans in the matched cohort were younger, more frequently female, had higher obesity rates, and lower hemoglobin levels, but these differences did not impact survival when treatment was standardized.

Guideline-Based Recommendations

Diagnosis

• Use advanced imaging (PET/MRI) to assess extent of disease at diagnosis.
• Perform molecular risk stratification using 70-gene expression profiling (GEP70) to guide prognosis.

Management

• Administer autologous stem cell transplantation (ASCT) within 12 months of induction therapy for eligible patients.
• Implement maintenance therapy post-transplant with immunomodulatory drugs (IMiDs) and/or proteasome inhibitors (PIs) to improve outcomes.
• Prioritize equitable access to timely and optimal treatment regardless of racial background.

Monitoring & Follow-up

• Conduct standardized follow-up for at least seven years post-transplant to monitor survival and event-free survival.
• Monitor hemoglobin and obesity status as part of comprehensive patient assessment.

Risks

• Recognize that lack of post-transplant maintenance therapy is associated with inferior progression-free and overall survival.
• Consider physiological variations such as lower hemoglobin levels in Black Americans that do not necessarily indicate worse prognosis.

Patient & Prescribing Data

Newly diagnosed multiple myeloma patients undergoing autologous stem cell transplantation, including Black and White Americans

Maintenance therapy regimens including IMiDs and PIs are more frequently used in Black Americans in recent treatment eras, contributing to comparable survival outcomes when treatment is matched.

Clinical Best Practices

• Employ propensity score matching or similar rigorous methods to balance demographic, molecular, disease extent, and treatment variables when comparing outcomes across racial groups.
• Focus on ensuring equitable treatment access and standardized post-transplant maintenance therapy to reduce racial disparities in multiple myeloma outcomes.
• Use continuous molecular risk scoring (GEP70) and detailed imaging assessments to capture full risk spectrum rather than categorical high-risk subsets.

References

• SEER Cancer Statistics Review, 1975-2018
• Cornell et al. Analysis of Post-Transplant Therapy Impact on Myeloma Outcomes
• 70-Gene Expression Profiling in Multiple Myeloma Prognosis