Black Americans Face Higher Multiple Myeloma Risk, Earlier Onset

Black and African American individuals face a stark reality: they are more than twice as likely to develop multiple myeloma compared to white Americans. This disparity, highlighted by specialists like Dr. Leslie Popplewell, chief of hematology at City of Hope Cancer Center Atlanta, shows the need to explore the factors driving this increased risk.

Unraveling the Disparity: Biology, Genetics, and Beyond

While the exact reasons remain unclear, experts point to a combination of factors. Biology and genetics likely play a role, with inherited susceptibility potentially contributing to the higher incidence. Dr. Tulio Rodriguez, director of the Bone Marrow Transplant and Cellular Therapy Program at City of Hope Cancer Center Chicago, emphasizes that there’s probably no single explanation.

Another factor is monoclonal gammopathy of undetermined significance (MGUS). This condition, marked by an abnormal protein in the blood, is more common in Black individuals and can precede multiple myeloma. Dr. Rodriguez notes that the higher prevalence of MGUS may contribute to increased myeloma rates in this population.

Early Onset and Symptoms: Identifying the Signs

The disparity extends beyond incidence rates. Black Americans are diagnosed with multiple myeloma at a younger age. Dr. Joseph Mikhael, a hematologist and professor at the Translational Genomics Research Institute (TGen), suggests that genetic patterns driving the increased risk may also contribute to earlier onset.

Identifying symptoms early is vital, as there are no routine screening guidelines for healthy individuals. Fatigue, bone pain, and anemia are key indicators. Dr. Mikhael stresses that when these symptoms persist without a clear cause, especially in higher-risk groups like African Americans, multiple myeloma should be considered a potential diagnosis.

While family history can double the risk, most people with multiple myeloma have no family history of the disease. Dr. Mikhael clarifies that family members are generally not screened unless multiple relatives are affected or symptoms arise.

The impact of race on prognosis is complex. Although Black Americans are twice as likely to die from myeloma compared to White Americans, Dr. Popplewell highlights that this doesn’t guarantee a worse outcome. Studies in settings with equal access to care show that Black patients can have similar, and sometimes better, survival rates.

Historically, Black patients have faced barriers to accessing key treatments, including triplet therapies and stem cell transplantation. They are also underrepresented in clinical trials, limiting access to new treatments.

Researchers are investigating potential biological differences among racial groups. However, Dr. Rodriguez emphasizes that treatment decisions should be based on individual disease characteristics, genetics, and overall health, rather than race alone.

One example is the deletion 17p genetic change, linked to aggressive disease. Studies suggest this may be less common in Black patients, potentially contributing to better survival rates in certain settings.

Treatment Advances and Access: A Path Forward

Modern multiple myeloma treatment often starts with a combination of three or four medications, targeting the disease from multiple angles. Dr. Rodriguez explains that this approach is tailored to individual needs, considering factors like eligibility for stem cell transplantation. For eligible patients, guidelines recommend a regimen of four drugs: an anti-CD38 antibody, bortezomib, lenalidomide, and dexamethasone. These medications work together to combat myeloma cells effectively.

After initial treatment, patients may undergo an autologous stem cell transplant using their own stem cells. Maintenance therapy often follows, involving lower-intensity treatments to control the disease. If myeloma returns, advanced options like antibody-based treatments, bispecific antibodies, and CAR T-cell therapy are available. Dr. Popplewell highlights that these innovative treatments, once reserved for later stages, are now used earlier, even at first relapse. She emphasizes the importance of equal access to these therapies, stating that race, ethnicity, or location should not determine who receives them.

Clinical Trials and Representation: Addressing Historical Mistrust

Clinical trials are essential for advancing treatments and ensuring their safety and efficacy. However, Black patients remain underrepresented in multiple myeloma trials. Dr. Mikhael attributes this to a complex history, including the infamous Tuskegee trials, which have left a legacy of mistrust in the medical system. This historical mistreatment has made engaging Black communities in clinical research challenging.