Disparities in Hispanic Americans

New data on multiple myeloma in Hispanics from ASH 2022 

In this video filmed from the 64th American Society of Hematology (ASH) Annual Meeting and Exposition, Dr. Kara Cicero presents a study on the impact of Hispanic ethnicity on disease characteristics in multiple myeloma.

Furthermore, a systematic review on Health Disparities Experienced by Hispanic Americans with Multiple Myeloma published in Clinical Hematology International sheds light on “growing evidence that Hispanic Americans with multiple myeloma are facing a multitude of disparities that require immediate attention and solutions.”¹ 

To conduct the review, several publications describing health disparities relevant to Hispanic Americans with multiple myeloma were explored through December 2021. All original studies that compared incidence, treatment and/or outcomes of Hispanic Americans with other ethnicities were explored, with 22 out of 868 articles included in the systematic review. 

Key findings of the review

• The incidence of multiple myeloma among Hispanics is higher with median age at presentation 5 years younger than non-Hispanic whites. 
• A few prior studies suggested that there is no difference in incidence of multiple myeloma between Hispanics and non-Hispanic whites. 
• A higher proportion of Hispanic Americans live in zip codes with lower socio-economic status (SES) and in zip codes with low education levels. 
• Hispanic Americans received less myeloma maintenance therapy and less supportive therapies such as bisphosphonates. 
• A longer time from diagnosis to novel therapy initiation was more prevalent among Hispanic Americans compared to non-Hispanic whites. 
• Hispanic Americans receive less ASCT as compared to non-Hispanic whites and had the lowest rates of ASCT compared to all other ethnic groups. 
• Enrollment in clinical trials was lower in Hispanic Americans. 
• Rate of in-hospital mortality was higher in Hispanic Americans compared to other ethnic groups. 
• Hispanic Americans were found to be at higher risk of death, which may be related to having lower socio-economic status. 
• Despite improved therapy options, improvement in survival was least pronounced in Hispanic Americans. 
• Many Hispanic patients face financial, structural and personal barriers to healthcare and are least likely to have health insurance as compared to other major ethnic groups. 
• When given equal access to therapy, chances for survival among Hispanic Americans can be similar to non-Hispanic whites and African Americans. 
• Hispanic patients might not experience similar benefits from the introduction of novel therapies (even standard treatment) as their outcomes are worse than non-Hispanic whites and, in some cases, worse than other ethnic groups partly because they receive novel therapies much later as compared to non-Hispanic whites. 
• Gender-dependent differences may influence the primary genetic events of multiple myeloma, with women having poor prognosis with higher prevalence of immunoglobulin heavy chain gene translocations—often associated with inferior overall survival.  
• No obvious differences in significant measures of genomic variation were found in Hispanic Americans compared to non-Hispanic whites. 
• Hispanic patients continue to be the smallest proportion of patients on trials utilizing novel therapeutic agents in multiple myeloma. 
• Cancer is the leading cause of death among Hispanic Americans but only 1.3 percent of eligible Hispanic cancer patients participate in cancer-related clinical trials. 
• Hispanic Americans make up about 15 percent of the U.S. population but only 5.8 percent of active physicians are Hispanic; Hispanic doctors only make up 3.3 percent of awardees from the seven major Hematology-Oncology societies. 
• The highest number of studies pertaining to disparities in Hispanic Americans with multiple myeloma were published in 2021 (at 32 percent).  
• Studies from Latin America suggested a poor progression-free survival (PFS) among patients with relapsed/refractory multiple myeloma and a slower uptake of newer therapies in public clinics. 
• The systematic review has some limitations—while a rigorous, scoping review of existing literature was conducted, no assessment on the quality of the included studies was made (some published literature may have been missed; others may have been misclassified; included studies may also have varied their definition of “Hispanics,” e.g., Hispanic Whites or Hispanic Blacks) 
• Nevertheless, the study summarizes the current scope of health disparities experienced by Hispanic Americans and highlights areas that require immediate attention. 

Disparities in the Use of Novel Therapies in Hispanic Americans 

The study "Racial and ethnic differences in clinical outcomes among patients with multiple myeloma treated with CAR T-cell therapy," published on January 9, 2024, provides some insights into how Hispanic populations respond to CAR T-cell therapy². 

Key Takeaways

• Hispanic patients with relapsed/refractory multiple myeloma (RRMM) had inferior responses to ide-cel, but racial and ethnic differences in survival were not observed.  
• Hispanic patients were more likely to have inferior ide-cel responses. 
• In this study, Hispanic patients had inferior responses to ide-cel compared with non-Hispanic Black and non-Hispanic White patients.
• The reason for inferior response among Hispanic patients with RRMM in this study is unclear. It is possible that this finding was a product of the small number of Hispanic patients in our study, unmeasured confounders, or could point to biologic differences across race and ethnicity.
• Despite lower ide-cel response among Hispanic patients, we did not observe differences in OS or PFS based on race and ethnicity among patients with RRMM treated with standard-of-care ide-cel.

Furthermore, this commentary³ on the above study states, "From an access perspective, the time from diagnosis to initiation of treatment in Non-Hispanic Black patients and Hispanics is much longer compared to Non-Hispanic White patients. Besides, they are less likely to receive the 'triple-threat therapies for myeloma' that have clearly changed the myeloma therapeutic landscape: triplets, transplant, and CART. The myeloma disparities are further complicated by underrepresentation of Non-Hispanic Black and Hispanic patients in the clinical trials leading to the approval of effective myeloma drugs in the United States."

Looking Toward the Future: Improving Care for Hispanic American Multiple Myeloma Patients 

Patient education on clinical trials and materials in Spanish can improve enrollment. 

It would be of public interest to diversify the medical workforce. BIPOC patients are more likely to choose a BIPOC physician and are more satisfied with their care when provided by a BIPOC physician.