Studies cite the following reasons:
- There is a documented, higher incidence of myeloma in Africa.1
- “A family history of blood cancers is also associated with increased risk that is stronger among Black people than White people.”2
- “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.3 Furthermore, African Americans are younger at diagnosis by about 5 years.4
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:5
- 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.6 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).5
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.
Two studies published in Blood in 2026 examined the immune environment in the bone marrow, where myeloma cells develop. One analyzed samples from 128 people with MGUS, smoldering myeloma, or myeloma, or without a plasma cell disorder.7 The other analyzed 320 patients with newly diagnosed myeloma.8
Researchers found differences associated with self-identified Black race and African genetic similarity, including greater proportions of certain specialized T cells and lower activity in some gene pathways linked to inflammation. The larger study also identified differences in natural killer cells, which help the body respond to abnormal cells.
Race and genetic ancestry describe different things. Race includes social identity and experiences, while genetic ancestry reflects inherited patterns in DNA. These studies offer new directions for research, but they do not establish why myeloma is more common in Black Americans or show that the observed immune differences improve treatment responses or survival
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.9
Importantly, the Mikhael et al. 2024 systematic review found that when treatment access barriers are removed and data are adjusted for socioeconomic factors, this survival disadvantage is eliminated. One analysis demonstrated that adding health access variables to the statistical model shifted outcomes from favoring White patients to significantly favoring Black patients (HR: 0.91; 95% CI: 0.85–0.97), highlighting that the 12% increased risk of death is a consequence of unequal care, not of biology.6
A 2026 study in Blood Cancer Journal examined outcomes in 1,209 patients, including 275 Black patients, diagnosed between 2017 and 2023 at Cleveland Clinic facilities.10 Black and White patients had similar use of three- or four-drug treatment combinations within one year of diagnosis and comparable five-year survival. A separate analysis that accounted for differences in patient characteristics and treatment found a lower hazard of death among Black patients. However, transplant use remained lower: 22.5% of Black patients received a stem cell transplant during follow-up, compared with 38.5% of White patients. These findings support efforts to improve access while showing that treatment gaps can persist. The study covered one health system, so its results may not apply to every care setting.
Genetic studies are ongoing to better understand how myeloma may be different in African Americans.3
Further research is needed to determine whether the observed immune differences affect myeloma development, progression from precursor conditions, or treatment response.
Larger studies that include more Black participants and follow changes over time can help researchers examine the roles of genetic ancestry, environmental exposures, and immune function. The current findings do not establish a need for different screening or treatment based on race or genetic ancestry.
- Acquah ME, Hsing AW, McGuire V, Wang S, Birmann B, Dei-Adomakoh Y. "Presentation and survival of multiple myeloma patients in Ghana: a review of 169 cases." Ghana Med J. 2019 Mar;53(1):52-58. doi: 10.4314/gmj.v53i1.8. PMID: 31138944; PMCID: PMC6527826.
- “Myeloma.” American Cancer Society, Cancer Statistics Center, 2018, https://cancerstatisticscenter.cancer.org/?_ga=2.206522640.2020590099.1664383872-1499661037.1664383871#!/cancer-site/Myeloma
- Bhutani M, Lonial S, Mikhael J. Disparities in multiple myeloma among African Americans. J Natl Med Assoc. 2022 Dec 22;S0027-9684(22)00167-5. doi:10.1016/j.jnma.2022.10.001)
- Baker, Angela et al. “Uncovering the biology of multiple myeloma among African Americans: a comprehensive genomics approach.” Lymphoid Neoplasia, April 18, 2013,
- Mikhael, J. “M-Power Facebook Live: Studies on Disparities in Myeloma Presented at ASH.” Myeloma Today, Winter 2022. /resource-library/myeloma-today-winter-2022
- Mikhael J, Cichewicz A, Mearns E ...Overall Survival in Patients With Multiple Myeloma in the U.S.: A Systematic Literature Review of Racial Disparities. Clinical Lymphoma, Myeloma and Leukemia, 2023; 24, e1-e12
- Hongwei Tang, William C Pilcher, Huihuang Yan, Annamalai Sivasankar, Jinzhuang Dou, Suganti Shivaram, Mariam Khanfar, Neeraj Sharma, Stacey J. Lehman, Shulan Tian, Surendra Dasari, Cinthya J Zepeda-Mendoza, Mahek Bai, Joselle Cook, Nadine Abdallah, Abiola Bolarinwa, Emilie I Anderson, Taxiarchis V. Kourelis, S Vincent Rajkumar, Shaji K. Kumar, Megan Weivoda, Felicia Gomez, Manoj Bhasin, Linda B Baughn; Enriched Adaptive Immunity and Reduced Inflammatory Response in Plasma Cell Disorders of Self-Identified Black Patients. Blood 2026; blood.2026033998. doi: https://doi.org/10.1182/blood.2026033998
- William C Pilcher, Hongwei Tang, Katherine Ferguson, Steven M Foltz, Marina E Michaud, Sarthak Satpathy, Nishi Nilesh Shah, Yuxin Jin, Denis Ohlstrom, Mojtaba Bakhtiari, Chaitanya R Acharya, Immune Atlas Consortium, Alexander M Gout, Jonathan Keats, Madhav V. Dhodapkar, David E. Avigan, Ravi Vij, Shaji K. Kumar, Hearn Jay Cho, Ioannis S Vlachos, Li Ding, Sacha Gnjatic, Craig Emmitt Cole, Ajay K. Nooka, Sagar Lonial, John Carpten, George Mulligan, Linda B Baughn, Manoj Bhasin; African Genetic Similarity Is Associated with Reduced Inflammation and Enhanced Adaptive Immunity in Multiple Myeloma. Blood 2026; blood.2026033999. doi: https://doi.org/10.1182/blood.2026033999
- Sikander Ailawadhi, Kejal Parikh, Safiya Abouzaid, Zhou Zhou, Wenxi Tang, Zoe Clancy, Claudia Cheung, Zheng-Yi Zhou, Jipan Xie; Racial disparities in treatment patterns and outcomes among patients with multiple myeloma: a SEER-Medicare analysis. Blood Adv 2019; 3 (20): 2986–2994. doi: https://doi.org/10.1182/bloodadvances.2019000308
- Gasoyan, H., Raza, S., Rothberg, M.B. et al. Overall survival of Black patients with newly diagnosed multiple myeloma in the era of triplet and quadruplet therapies. Blood Cancer J. 16, 173 (2026). https://doi.org/10.1038/s41408-026-01645-1
With support from:
AbbVie, Amgen, Bristol Myers Squibb, Genentech , GSK, Johnson & Johnson, Karyopharm Therapeutics, Kite, and Sanofi
The International Myeloma Foundation medical and editorial content team
Comprised of leading medical researchers, hematologists, oncologists, oncology-certified nurses, medical editors, and medical journalists, our team has extensive knowledge of the multiple myeloma treatment and care landscape.
Additionally, the content on this page is medically reviewed by myeloma physicians and healthcare professionals.
Last medical content review: October 30, 2026
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.
