Multiple myeloma is twice as common—and twice as deadly—in African Americans than in Caucasian Americans. Additionally, the incidence of conditions associated with the development of myeloma (including monoclonal gammopathy of undetermined significance or MGUS) is high in African Americans. Finally, although myeloma treatment has advanced significantly in recent years, survival rates for African American myeloma patients have not kept pace with survival rates of other myeloma patient populations. The reasons for these racial disparities are not known, but it is believed that the presence of some biological factors in African Americans may be the cause.
In the MMRF CoMMpass Study, researchers discovered important differences in key cancer genes between African American and Caucasian myeloma patients. African American myeloma patients were shown to have a lower-risk genetic profile and thus should achieve treatment results equal to—or even better than—those seen in other myeloma patient populations. But barriers to appropriate treatment and lack of awareness of the disease (on the part of both patients and community health care providers) contribute to treatment approaches inconsistent with current recommended practice. To overcome these barriers and more effectively manage their disease, African American patients need to stay informed about these unique disease and management considerations.
Certain genetic defects are believed to occur more frequently in African American myeloma patients. The increased frequency of multiple myeloma in African American patients seemed to be driven specifically by the higher frequency of t(11;14), t(14;16), and t(14;20)—three forms of a specific type of mutation called a translocation. The likelihood of having these translocations increased with every 10% increase in the extent of African ancestry. The t(11;14) subtype has a favorable prognosis compared with other subtypes, whereas t(14;16) and t(14;20) are considered high-risk but are significantly rarer.
As determined in several studies, clinical aspects of myeloma also differ by race. For example, compared with Caucasian Americans, African Americans tend to have an earlier average age at diagnosis—by 5 to 10 years. Factors associated with high-risk myeloma, such as anemia (lower hemoglobin levels) and increased levels of lactate dehydrogenase (LDH) (which tends to increase as the disease progresses), have also been found to be more common in African American myeloma patients. A recent study also found higher incidences of hypercalcemia (a condition in which the calcium level in your blood is above normal and can cause bone weakening), renal dysfunction, anemia, and dialysis (for treating kidney disease) in African American myeloma patients.
To improve the detection and management of multiple myeloma in African American patients, a greater recognition of the genetic, molecular, and biological underpinnings of racial disparities on the part of both patients and health care providers is essential. There are also disparities in the care of African American myeloma patients that need to be understood further and addressed. Issues relating to access to care and services, and lack of awareness of risk factors and optimal treatment strategies, contribute to care disparities. African American patients are 50% less likely to undergo a stem cell transplantation, even though this treatment provides the same survival benefit for African American and Caucasian myeloma patients. African American patients are less likely than Caucasian patients to be treated with Velcade or Revlimid—despite the fact that Velcade has largely become the standard of care for myeloma patients.
Studies have shown that when African American myeloma patients receive appropriate, timely care and treatment, they can achieve the same results as other myeloma patient populations. In such cases, response rate, survival, and total health care costs are similar across myeloma patient populations of different races. Despite disparities in incidence and outcomes of multiple myeloma among patients of different racial groups, the available evidence suggests that these disparities can be overcome. Ensuring equal access to appropriate therapeutic options is one essential step toward this goal. Increasing awareness of these disparities and their solutions—among patients and providers alike—is another.
Have questions? The Nurse Patient Navigators in the MMRF Patient Support Center are always available at 866-603-6628!
MMRF CoMMpass Study Data Featured at AACR 2019.