Black and African American individuals face a disproportionate burden from multiple myeloma, being more than twice as likely as White Americans to develop the disease, often at younger ages. To understand this disparity, we spoke with three specialists.
Racial Disparities in Multiple Myeloma Incidence
Dr. Leslie Popplewell, a hematologist and chief of hematology at City of Hope Cancer Center Atlanta, confirmed the stark statistical gap. “We know the disparity is real, but we don’t yet fully understand why it exists,” she said.
Several factors may contribute to this risk, including biological and genetic differences such as inherited susceptibility. Researchers are also studying other possible factors like obesity. Dr. Tulio Rodriguez, a hematologist-oncologist and director of the Bone Marrow Transplant and Cellular Therapy Program at City of Hope Cancer Center Chicago, agreed. “We know that Black Americans are diagnosed with multiple myeloma at higher rates than other racial groups, but there is likely no single explanation,” he said.
Another possible factor is monoclonal gammopathy of undetermined significance (MGUS), a condition that can precede multiple myeloma. Dr. Rodriguez stated, “Research suggests that precursor conditions such as monoclonal gammopathy of undetermined significance, or MGUS, occur more frequently in Black individuals, which may contribute to the increased incidence of myeloma.”
Dr. Joseph Mikhael, a hematologist, professor at the Translational Genomics Research Institute (TGen), and medical advisor to the International Myeloma Foundation, noted, “We do not have a simple explanation for” why Black Americans are diagnosed at a younger age. “Still, we know individuals of African descent have twice the risk of developing myeloma, so we suspect that the same genetic patterns and this increased risk are involved in the younger development of myeloma. Interestingly, we also see myeloma diagnosed at a younger age on average in the Latino American community.”
Recognizing Symptoms and Risk Factors
There are no routine screening guidelines for multiple myeloma or MGUS in otherwise healthy individuals. Key symptoms include fatigue, bone pain, and anemia. “When any of these exist without a clear explanation, especially in higher-risk populations, such as African Americans, the diagnosis of myeloma should at least be considered,” Dr. Mikhael said.
Family history can double a person’s risk, though Dr. Mikhael emphasized that “the overall risk remains low.” Most people with multiple myeloma don’t have a family history of it. Screening is generally not recommended unless multiple relatives have the disease or someone develops signs or symptoms associated with myeloma.
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Despite higher incidence rates, being Black does not automatically mean a worse prognosis. Dr. Popplewell explained, “Studies in settings where access to care is more equal have found that Black patients can have outcomes similar to, and in some studies better than, White patients.” Historically, Black patients have been less likely to receive key treatments like triplet therapies and stem cell transplantation and remain underrepresented in clinical trials. “That tells us these disparities aren’t inevitable,” she said.
Current treatment often begins with a combination of three or four medications targeting the disease in different ways. For those eligible for a stem cell transplant, guidelines recommend an anti-CD38 antibody, bortezomib, lenalidomide, and dexamethasone, according to Dr. Popplewell.
After initial treatment, autologous stem cell transplantation may follow, along with maintenance therapy. For relapsed myeloma, options include antibody-based treatments, bispecific antibodies, and CAR T-cell therapy. “Treatments once reserved for much later, including CAR T-cell therapy and other immune-based treatments, can now be appropriate for some patients beginning at first relapse,” Dr. Popplewell said. She stressed, “Race, ethnicity, or ZIP code shouldn’t determine who gets access to them.”
Biological Differences and Treatment Response
Race alone cannot predict how multiple myeloma will affect an individual, Dr. Rodriguez said. “Treatment decisions must always be based on the individual’s disease characteristics, genetics, and overall health rather than race alone.”
One genetic change, deletion 17p, is linked to a higher risk of aggressive disease but may be less common in Black patients. “That may help explain why Black patients have had equal or even better survival in some settings where access to care is comparable,” Dr. Popplewell noted.
Expanding Access to Advanced Therapies
Clinical trials offer access to promising treatments, but Black patients remain underrepresented. Dr. Mikhael observed, “The terrible history of trials such as Tuskegee, where Black patients were horribly treated in the context of clinical trials, has produced several generations of mistrust of the medical system in general and specifically for clinical trials.”
Limited outreach and representation also hinder participation. Rural areas face additional challenges in accessing trials. Addressing these barriers is key for improving equitable care.