Why Are Myeloma Rates Higher in African Americans?

Studies cite the following reasons:

1.  There is a documented, higher incidence of myeloma in Africa.¹
2.  “A family history of blood cancers is also associated with increased risk that is stronger among Black people than White people.”2
3. “Higher rates of obesity among Black people may contribute to the racial disparity for myeloma, especially among women.”²   

Some evidence suggests the biology of myeloma may be different in African Americans when compared to white Americans.⁴  Furthermore, African Americans are younger at diagnosis by about 5 years.⁵ 

In the in the 2022 Winter Edition of Myeloma Today, Dr. Mikhael pointed to three abstracts from the ASH 2021 meeting that identified three biological differences of how myeloma presents in African Americans:⁶

• ASH abstract 152 (the PROMISE clinical trial) was a large screening study that showed us that 10% of African Americans over the age of 40 have monoclonal gammopathy of undetermined significance (MGUS), and the percentage may be even higher with more sophisticated testing techniques.  
• Abstract 402 noted differences in mutation profiles in African Americans.   
• Abstract 4121 proposed that historical risk stratification with cytogenetics may not be as influential in African American patients.  

A study on “Disparities in multiple myeloma among African Americans” conducted by a group of top myeloma researchers, including IMF Medical Advisor Dr. Joseph Mikhael “sought to further investigate the source and impact of disparities in multiple myeloma for [African] Americans and potential solutions for improvement,” according to the Journal of National Medical Association.³

Here are some key findings of this study: 

• “Due to higher prevalence among African Americans, [multiple myeloma] ranks as the number one hematologic malignancy in this population.” 
• “From 2011 to 2034, new cases of multiple myeloma will increase by 65 percent in men and 61 percent in women. Consequently, the future distribution of new multiple myeloma cases is expected to include significant proportion of African American patients.” 

In this systematic review of racial disparities, led by IMF Medical Advisor Dr. Joseph Mikhael, researchers aimed to examine disparities in overall survival (OS) between Black and white patients with multiple myeloma (MM) in the U.S. The study concluded that "When data are adjusted for important confounders, Black patients exhibit better or equal survival to White patients, indicating that similarities in patient populations and equal access to treatment can bridge the disparity in patient outcomes between races." 

A 2024 systematic literature review published in Clinical Lymphoma, Myeloma and Leukemia, led by Dr. Joseph Mikhael, analyzed 33 U.S. real-world studies comprising more than 410,000 patients (approximately 21.5% Black, 78.5% White).  

The review found that unadjusted data often showed worse outcomes for Black patients. However, in the nine studies rated highest quality — those that controlled for prognostic factors, treatment type, and socioeconomic status — Black patients demonstrated survival outcomes equal to or better than White patients. This indicates that disparities in survival are driven primarily by unequal access to treatment and socioeconomic barriers, not by underlying disease biology. In fact, Black patients tend to have a lower prevalence of high-risk cytogenetic markers such as deletion 17p and TP53 mutations, which may confer a biological advantage when treatment access is equalized. 

A SEER-Medicare analysis on “Racial disparities in treatment patterns and outcomes among patients with multiple myeloma” discovered that: 

• The median time from diagnosis to the beginning of novel therapy treatment took longer for African Americans (5.2 months) and Hispanics (4.6 months) as compared to white patients (2.7 months) 
• African Americans are 37 percent less likely undergo autologous stem cell transplant (ASCT) and 21 percent less likely to receive bortezomib for treatment. 
• Underuse of these treatments have been associated with a 12 percent increase in risk of death for African American patients. 
• There is a lack of African American patients in clinical trials. Of 2,896 patients enrolled in nine national cooperative group clinical trials for newly diagnosed multiple myeloma, only 18 percent were non-white. 
• Only 4.5 percent of all patients participating in drug trials are African Americans. These trials are pivotal in securing regulatory approval of drugs in the U.S.⁶ 

Genetic studies are ongoing to better understand how myeloma may be different in African Americans.³ 

Explore the IMF's M-Power Project. Partnered with cities across the U.S., this project aims to eliminate health disparities and create better and more equitable access to healthcare for all.