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Multiple myeloma gammopathies

Racial and age-related disparities in early mortality affect the outcomes of multiple myeloma patients

Leukemia volume 35, pages 250–254 (2021)Cite this article

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Multiple myeloma (MM) is an incurable hematologic malignancy with disparities in outcomes noted among racial-ethnic subgroups [1, 2]. A number of prior studies comparing overall survival (OS) of European Americans (EA) and African Americans (AA) with MM have found disparities, with lower OS among AA tied, in part, to worse socioeconomic factors among AA leading to less access to the novel treatments [3,4,5]. In a surprising rebuttal of previous findings, a recent study from Veterans Affairs hospitals showed that AA with MM have a superior OS than EA when all patients have equal access to novel therapies and transplant [6]. Their report is unique given the potential elimination of racial differences in drug affordability and healthcare access among the study population. The investigators examined patients in two groups: those 65 years and older and those younger than age 65. Even when doing this, AA had better OS; they showed that AA patients diagnosed before turning 65 had a significantly better median OS (7.07 years; 95% CI, 6.36–7.70 years) compared with EA (5.83 years; 95% CI, 5.44–6.09 years). At age 65 and beyond, median OS was similar between AA and EA. In another study, a meta-analysis of upfront MM clinical trials over more than two decades showed similar OS between enrolled AA and EA [7]. These two studies together suggest that unequal access to effective anti-myeloma therapy may partially explain the previously reported discrepancies between EA and AA with MM.

The contribution of early mortality (EM) on OS has not been assessed in any of these studies. EM in MM is usually attributed to advanced disease causing organ failure and comorbidities, while late mortality is mostly caused by emerging biologically resistant disease. EM maybe underreported in frontline MM clinical trials, given the selection bias towards enrolling younger patients with good performance status, adequate organ function, and favorable socioeconomic factors. In addition, race-based EM assessment is difficult in MM clinical trials because only ~5% of enrolled patients are AA, while they represent 20% of all MM patients in the US [8]. Therefore, it maybe instructive to identify the influence of EM on the outcome of AA and EA in the real-world setting.

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Fig. 1: Outcomes of the patients.

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Authors and Affiliations

  1. Adult Hematologic Malignancies & Stem Cell Transplant Section, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Fahrettin Covut, James Joseph Driscoll, Brenda Cooper, Molly Gallogly, Marcos De Lima & Ehsan Malek

  2. Case Western Reserve University, Cleveland, OH, USA

    James Joseph Driscoll, Brenda Cooper, Molly Gallogly, Marcos De Lima & Ehsan Malek

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  1. Fahrettin Covut
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Correspondence to Ehsan Malek.

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Covut, F., Driscoll, J.J., Cooper, B. et al. Racial and age-related disparities in early mortality affect the outcomes of multiple myeloma patients. Leukemia 35, 250–254 (2021). https://doi.org/10.1038/s41375-020-0812-2

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