Disparities in Care and Outcomes in the African American Population
Survival With Multiple Myeloma Has Improved
We have seen a series of treatments approved for multiple myeloma over the years and have been fortunate to see this translate into improved patient survival. This graph depicts estimated median overall survival for multiple myeloma patients based on a retrospective analysis from Surveillance, Epidemiology, and End Results (SEER).1
African Americans Have Had a Smaller Improvement in Survival Compared With Whites2
Data from one study demonstrate that community-dwelling older African Americans had 4 times the risk of dying from multiple myeloma compared to Whites.3* This disparity in survival may be due to the lack of access to the same therapies as Whites.2
*All other factors controlled.3
According to guidelines outlined by the American Society of Clinical Oncology (ASCO), the general newly diagnosed multiple myeloma population should receive the standard of care and have their patient eligibility be based on age, frailty, the ability to tolerate, and other factors.5
Guidelines outline standard of care as:
- Autologous hematopoietic stem-cell transplant5
- Triplet combinations5
While stem cell transplants are recommended, they are performed at disparate rates5
While African Americans experience disparities in stem cell transplant treatment for multiple myeloma and are underrepresented in clinical trials, studies have found that African Americans who gain access to treatment and trials have similar overall survival and progression-free survival.2,8
After stem cell transplant, African Americans achieved similar outcomes as Whites
A large, single-institution retrospective study of stem cell transplant in 453 patients included 174 African American and 279 White patients and showed that while African American patients experienced a delay in time from diagnosis to transplantation, they still had similar overall survival and progression-free survival rates to White patients.9
African Americans enrolled in trials do as well as Whites
An analysis of patient-level data from 9 ECOG-ACRIN/SWOG clinical trials in newly diagnosed multiple myeloma patients (N=3026) examined clinical trial outcomes by race. No significant differences in overall survival by race in patients who participated in clinical trials were seen.8
- Based on a SEER database study of patients. 46,328 patients were available in the SEER-Medicare database. N=20,916 patients included in the analyses sample; n=17,574 Whites, n=3342 Blacks.7
- P<.0001. After controlling for overall health and potential access barriers, median household income, Medicaid, urban/rural status.7
ECOG=Eastern Cooperative Oncology Group.
ACRIN=American College of Radiology Imaging Network.
SWOG=Southwest Oncology Group.
With equal access to care, African Americans have similar outcomes to Whites2,8
References: 1. Drawid A, et al. Impact of novel therapies on multiple myeloma survival–current and future outcomes. Poster presented at: 20th Congress of the European Hematology Association (EHA). 2015. #E1233. 2. Marinac CR. Blood Cancer J. 2020;10:19. 3. Marron MM, et al. J Am Geriatr. Soc. 2018;66:1980-1986. 4. Ailawadhi S, et al. Br J Haematol. 2012;158:91-98. 5. Mikhael J, et al. J Clin Oncol. 2019;7(14):1228-1263. 6. Schriber JR, et al. Cancer. 2017;123:3141-3149. 7. Fiala MA, et al. Cancer. 2017;123(9):1590-1596. 8. Ailawadhi S, et al. Blood Cancer J. 2018;8:67-74. 9. Bhatnagar V, et al. Cancer. 2015;121(7):1064-1070.