Survival of ethnic and racial minority patients with multiple myeloma treated with newer medications

Abstract

Key Points Patients of minority race with myeloma have had less increase in population-level survival in the early 21st century than white patients. Data from clinical trials show that mortality is similar for minorities, suggesting the population-level difference is due to utilization.

Racial differences in treatment and outcomes in multiple myeloma: a multiple myeloma research foundation analysis

“…In a retrospective analysis of 15,717 patients with MM in the Veterans Association (VA) health care system with equal access to care between 2000 and 2017, Fillmore et al 13 found that Blacks had better overall survival (OS) compared with Whites, even after adjusting for age, sex, rurality, income, stage, transplantation, and induction therapies. A similar superior survival in Black individuals with MM after ASCT was also reported by Sweiss et al 14 . In contrast, several studies have shown similar OS between Blacks and Whites, though this is despite later access to novel therapies or ASCT 9,[15][16][17][18] .…”

Dissecting racial disparities in multiple myeloma

“…For example, in an analysis of 174 Black and 279 White MM patients who underwent autologous stem cell transplantation between 2000 and 2013, Bhatnagar et al 39 found that Black patients had better overall survival compared with White patients when survival time was measured from the time of diagnosis to death (median survival time 7.7 years in Blacks vs. 6.1 years in Whites; p = 0.03). Conversely, several secondary analyses of clinical trials in the US suggest minimal differences in survival among Black and White MM patients enrolled in MM treatment trials [40][41][42] , although it is notable that the enrollment of Black and other minority patients into MM clinical trials has been extremely low. The small numbers of Blacks enrolled in clinical trials not only limit the confidence in the reported results, but they raise questions as to whether the trends observed in the Black patients who did enroll are generalizable to broader patient populations.…”

“…The causes of these treatment-related disparities are not well understood. They may stem from systemic distrust in the medical community 56 , poor accrual of Blacks to clinical research studies 42 , or differences in healthcare access and delivery, geographic location or insurance coverage 57 . Understanding and targeting the causes of these treatment-related disparities in MM is critical to achieve more equitable treatment delivery and outcome for all MM patients.…”

African American patients may or may not have poorer response rates after monoclonal antibody treatment: Overreliance on P values in underpowered studies

“…A recent article by Chehab et al analyzed racial disparities in response to monoclonal antibodies (MoAbs) for the treatment of multiple myeloma (MM) . Studies have shown that African American patients with MM respond as well, if not better, to therapies including autologous stem cell transplantation, proteasome inhibitors, and immunomodulatory drugs compared with their white peers . However, they receive these treatments at lower rates and, as a result, have poorer outcomes at the population level …”

“…1 Studies have shown that African American patients with MM respond as well, if not better, to therapies including autologous stem cell transplantation, proteasome inhibitors, and immunomodulatory drugs compared with their white peers. [2][3][4] However, they receive these treatments at lower rates and, as a result, have poorer outcomes at the population level. 5 Theoretically, differences in immune response among racial/ethnic subgroups after treatment with MoAbs may result in outcome disparities.…”