Doctors and scientists have made big breakthroughs in treating multiple myeloma. They’ve helped people with the disease to keep it in check and live longer, healthier lives. Despite this, the condition still affects some groups unequally. These populations face differences in care.
Multiple myeloma is a type of blood cancer. It happens when white blood cells (plasma cells) build up in your bone marrow until they crowd out healthy cells. Because healthy plasma cells normally make antibodies that target and attack germs, you’re then more exposed to infection.
Researchers haven’t closely studied multiple myeloma in Hispanic people. In the first and largest review of this group, researchers found that Hispanic people are more likely to have it. They tend to have a less serious form of myeloma than white people yet have a shorter life span.
There’s much more research on the impact of multiple myeloma in Black people, and it mirrors some of the findings from the Hispanic community. Researchers have found that the disease is more common in people with African ancestry.
Black Americans are two times more likely to have the disease and to lose their lives because of it than white Americans. As with Hispanic people, Black people also have multiple myeloma at a younger average age (66 years old) and have a less serious form of the condition.
There are many possible reasons for racial and ethnic differences in multiple myeloma. Scientists are looking at genes, family health, and whether parents can pass the disease to their children. Right now, there’s not much evidence to show these are the main causes of these differences.
Researchers are also studying the role of a different yet related condition. Monoclonal gammopathy of undetermined significance, or MGUS (pronounced “EM-guss”), is a noncancerous condition. But it could be a sign of multiple myeloma. Anyone who has ever had active myeloma has also had MGUS. And if you’re Black, research shows you’re twice as likely to have it as someone who’s white.
But the reasons for these differences go beyond biological causes. Experts say racial and ethnic differences in multiple myeloma come down to access to equal health care.
Although multiple myeloma is more common in Black and Hispanic people and causes more deaths, “if you treat groups equally, the outcome is the same,” says Yvonne Efebera, MD, director of the Blood and Marrow Transplant and Cellular Therapy Program at OhioHealth in Columbus, OH.
There’s no cure for multiple myeloma, but with proper treatment, 70% of people with the disease live 10 years or longer, up from 20% to 30% in the early 2000s. This includes access to things like health insurance, anti-cancer medicines, clinical trials, and specialists.
“Equal access to health care, closing that gap, is a huge thing,” Efebera explains. She says people without insurance will often put off treatment “until they’re having a lot of pain and can no longer go on. Then they end up in the emergency room.”
A 2013 study also found that newly diagnosed white people with private insurance have more access to new treatments than people of color who use the government-funded health programs Medicaid and Medicare.
A separate study echoed these results, showing that white people with more resources, like money and education, benefit more from new treatments. As a result, they live longer.
In recent years, treatment for multiple myeloma has advanced remarkably. While this means more treatment options, not everyone may receive them equally.
Stem cell transplant is a standard treatment for multiple myeloma. Doctors replace unhealthy bone marrow with healthy bone marrow using stem cells collected from your blood. Thanks to this type of treatment, many people with the disease live longer.
Unfortunately, there are disparities in who gets stem cell transplants. Hispanic people have the lowest transplant rates, at around 8% to 17%. Black people with multiple myeloma are about 40% to 50% less likely to have stem cell transplants than white people. Studies show that doctors delay referring Black people with multiple myeloma for stem cell transplants by more than a year.
Efebera has researched stem cell transplants in multiple myeloma. She says that when underserved communities with the condition get stem cell transplants, “there’s no difference whatsoever” in their survival and remission rates.
She wants to see racial barriers to stem cell transplants broken down and encourages doctors to put aside biases and refer all qualified patients to transplant centers. “Treat the patient as you would treat your own family — your sister, brother, mother, father — and give them the best option there is.”
Clinical studies help researchers figure out if new or existing treatments are safe and work well. The people who volunteer for them are a critical part of this process.
Certain groups, like racial minorities, are often poorly represented in clinical research for multiple myeloma. One study looked at clinical trial enrollment for studies into the disease over 2 decades. Researchers found that just 18% of people who took part in the studies were Black, Hispanic, or other nonwhite races.
Racial minorities are also less likely to join studies that look at the response of genes to medicines, a field of research called pharmacogenomics. These studies can tell researchers whether a drug works in the same way among different groups.
Underrepresented minorities may not be aware of clinical studies through their doctor or other sources. Cultural, location, or financial barriers also affect who takes part in them. Other hurdles include a lack of diversity in clinical trial researchers and in cancer treatment in general.
This is something Efebera says the health care community should work to change. “Patients — African American, Hispanic, or Asian — feel comfortable when they have someone that looks like them. They smile more, they’re happy, and they take their treatment.”
