Black and African American individuals face a stark reality: they are more than twice as likely to develop multiple myeloma compared to white Americans, and often at a younger age. This disparity, while well-documented, remains not fully understood.
“We know the disparity is real, but we don’t yet fully understand why it exists,” said Leslie Popplewell, MD, a hematologist and chief of hematology at City of Hope Cancer Center Atlanta. “Black Americans are more than twice as likely as White Americans to develop multiple myeloma, and they also tend to be diagnosed at a younger age.”
Unraveling the Reasons Behind the Disparity
Several factors are under investigation. Biology and genetics may play a role, including differences in inherited susceptibility. Obesity is another potential risk factor being studied.
“We know that Black Americans are diagnosed with multiple myeloma at higher rates than other racial groups, but there is likely no single explanation,” said Tulio Rodriguez, MD, a hematologist-oncologist and director of the Bone Marrow Transplant and Cellular Therapy Program at City of Hope Cancer Center Chicago.
Another factor is monoclonal gammopathy of undetermined significance (MGUS), a condition preceding multiple myeloma. Research indicates MGUS is more common in Black individuals, potentially contributing to higher myeloma rates.
MGUS often shows no symptoms, but a small percentage of those with it develop multiple myeloma.
Recognizing Symptoms and Seeking Diagnosis
There are no routine screening guidelines for multiple myeloma or MGUS in healthy individuals. This makes it key to recognize symptoms like fatigue, bone pain, and anemia.
Dr. Joseph Mikhael, a hematologist, professor at the Translational Genomics Research Institute (TGen), and medical advisor to the International Myeloma Foundation, stated, “When any of these exist without a clear explanation, especially in higher-risk populations, such as African Americans, the diagnosis of myeloma should at least be considered.”
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While family history can influence risk, most people with multiple myeloma have no family history of the disease. Dr. Mikhael notes that a family history can double an individual’s risk, but overall risk remains low.
Treatment and Prognosis for Black Americans
However, Dr. Popplewell stresses that being Black does not inherently mean a worse outcome.
Dr. She explained, “Studies in settings where access to care is more equal have found that Black patients can have outcomes similar to, and in some studies better than, White patients.” Historically, Black patients have faced barriers in receiving key treatments, including triplet therapies and stem cell transplantation, and remain underrepresented in clinical trials.
Researchers have identified possible biological differences among racial groups, but Dr. Rodriguez emphasizes that race alone cannot predict multiple myeloma’s course. Dr. Rodriguez stated, “Treatment decisions must always be based on the individual’s disease characteristics, genetics, and overall health rather than race alone.”
Clinical Trial Participation and Barriers for Black Patients
Black patients remain underrepresented in myeloma clinical trials due to several factors, including historical mistrust stemming from past medical research abuses, such as the Tuskegee trials. Dr. Mikhael explained, “The terrible history of trials such as Tuskegee, where Black patients were horribly treated in the context of clinical trials, has produced several generations of mistrust of the medical system in general and specifically for clinical trials.”
Current Treatment Options and Challenges
Multiple myeloma treatment often starts with a combination of three or four medications targeting the disease in different ways. For those eligible for a stem cell transplant, guidelines recommend a regimen of four drugs: an anti-CD38 antibody, bortezomib, lenalidomide, and dexamethasone.
After initial treatment, patients may undergo an autologous stem cell transplant, followed by maintenance therapy to control the disease. For relapsed myeloma, options include antibody-based treatments, bispecific antibodies, and CAR T-cell therapy.