How is myeloma different in African Americans?
Myeloma Is Different in African Americans
Like many patients who are diagnosed with the disease, you may have never heard of multiple myeloma. Here are some key facts about how myeloma affects African Americans:
- African Americans have an average earlier age of onset of myeloma1.
- The pre-myeloma condition, monoclonal gammopathy of undetermined significance (MGUS), is more common in African Americans. Studies in Africa have also shown this increased incidence2.
- MGUS is twice as common in African Americans than white Americans3
The IMF is educating the multiple myeloma community to ensure that African Americans can be diagnosed earlier. Earlier diagnoses are linked to better outcomes.
Wait: Now What’s That Good News Again?
Some evidence suggests the biology of myeloma may be different in African Americans when compared to white Americans.4 Genetic studies are ongoing to better understand how myeloma may be different in African Americans. We do know, for example, that when African-American patients are in clinical trials, they fare as well as white patients.5
African Americans and Multiple Myeloma Treatments
We know that African Americans tend to have a better prognosis with multiple myeloma. Yet, other patient populations have greater improvement in survival rates than the African-American population.6
The medical community and the African-American community are working together to understand why this is happening. We do know that longer survival is a result of
- autologous stem cell transplant
- newer drugs
- using these newer drugs in combination
Unfortunately, many African-American patients may not be presented with these care options.6 The IMF believes patients of all races and ethnicities should have knowledge of the best treatment options available.
African Americans and Access to Clinical Trials
While African Americans make up 20% of the people living with myeloma in the U.S., they only account for 6% of all patients in clinical trials.7. Experts say this disparity exists for the following reasons:8-10
- Unwillingness to refer patients for trials
- Fear that clinical trials create a financial or administrative burden to the practice
- Lack of clinical trial availability
- Few minority investigators
- Lack of knowledge
- Cultural differences
- Mistrust of the medical or research systems
- Perceived risk of harm
- Lack of transportation
- Lack of education about clinical trials
- Time commitment and conflicts
- Fear of clinical procedures
- Family issues
How can these treatment disparities be overcome? First, the IMF encourages health-care providers and patients to learn about clinical trials that provide new drugs and new approaches to care.
Secondly, as we know, there are few clinical investigators who are minorities.11 Perhaps this may affect the comfort level in patient/doctor or patient/nurse relationships. For that reason, we encourage collaboration among many health-care professionals. As reported by Kaiser Health News, black pharmacists in the U.S. are helping to close the cultural gap.12
We encourage you to involve your whole health-care team in your care plan.
Take a Deeper Dive: Latest Research on Racial and Ethnic Disparities in Myeloma
From the New England Journal of Medicine. https://www.nejm.org/race-and-medicine
ASH Abstract 902. The Global State of Hematopoietic Stem Cell Transplantation for Multiple Myeloma: An Analysis of the Worldwide Network of Blood and Marrow Transplantation (WBMT) Database and the Global Burden of Disease Study
ASH Abstract 903. Outcomes in Multiple Myeloma Based on Comorbidities and Race
1. American Cancer Society. Cancer Facts and Figures for African Americans 2019-2021. Atlanta: American Cancer Society, 2019. Available at: www.cancer.org. Accessed April 19, 2019.
2. Landgren O, et al. Racial disparities in the prevalence of monoclonal gammopathies: a population-based study of 12,482 persons from the National Health and Nutritional Examination Survey. Leukemia 2014; 28(7):1537-1542.
3. Landgren O, et al. Prevalence of myeloma precursor state monoclonal gammopathy of undetermined significance in 12372 individuals 10–49 years old: a population-based study from the National Health and Nutrition Examination Survey. Blood Cancer J. 2017 Oct 20;7(10)e618.
4. Baker A, et al. Uncovering the biology of multiple myeloma among African Americans: a comprehensive genomics approach. Blood. 2013;12(16):3147-3152.
5. Ailawadhi S, et al. Disease and outcome disparities in multiple myeloma: exploring the role of race/ethnicity in the Cooperative Group clinical trials. Blood Cancer J. 2018 Jul 6;8(7):67-75.
6. Schriber JR, et al. Hispanics have the lowest stem cell transplant utilization rate for autologous hematopoietic cell transplantation for multiple myeloma in the United States: A CIBMTR report. Cancer. 2017;123(16):3141-3149.
7. U.S. Census Bureau. U.S. Census Bureau Quick Facts. Available at: www.census.gov/quickfacts. Accessed April 22, 2019.
8. Duma N, et al. Representation of minorities and elderly patients in multiple myeloma clinical trials. Oncologist. 2018 Sep;23(9):1076-1078.
9. Banda DR, et al. A critical review of the enrollment of black patients in cancer clinical trials. Am Soc Clin Oncol Educ Book. 2012:153-157.
10. Ford JG, et al. Barriers to recruiting underrepresented populations to cancer clinical trials: a systematic review. Cancer. 2008;112(2):228-242.
11. Iammarino NK, Gribble JG. The Intercultural Cancer Council's Fact Sheet series: a tool for public and professional education. J Cancer Educ. 2009;24(2 Suppl):S7-9.
12. Anthony C. Kaiser Health News. "How Black Pharmacists Are Closing The Cultural Gap In Health Care." June 27, 2019.
With educational support from:
Amgen, Bristol-Myers Squibb, Genentech, GlaxoSmithKline, Janssen, Karyopharm Therapeutics, Oncopeptides, Sanofi, Takeda Oncology and The Binding Site