Disparities in African Americans

The following differences in socioeconomic status and barriers to healthcare access exist for African Americans with myeloma: 

• issues of financial toxicity⁴ 
• less access to full testing⁵ 
• less access to novel treatments⁶ 
• fewer enrollments in "pivotal" clinical trials that led to FDA drug approvals⁷ 
• less access to CAR T-cell therapy⁸ 
• systemic racism
• lack of trust of the healthcare system

African Americans with myeloma face these disparities in care as well:⁹ 

• fewer transplants 
• more blood product transfusions 
• fewer palliative care consultations  
• less inpatient chemotherapy 
• more use of intensive care 

The clinical significance of these access gaps is quantified in the research literature. One high-quality analysis found that Black patients are 37% less likely to undergo autologous stem cell transplant and 21% less likely to receive bortezomib — and that these treatment gaps are associated with a 12% increased hazard of death. However, the same body of research demonstrates that when these treatment gaps are closed, Black patients show equal or superior survival. In studies conducted in equal-access settings, Black patients with myeloma had significantly better survival outcomes than White patients. 

African Americans, as well as those of other races/ethnicities, would likely benefit from “having a shared racial ethnic background between provider and patient.”² 

New research known as a “Survey on Racism, Discrimination, and Health: Experiences and Impacts Across Racial and Ethnic Groups” conducted by the Kaiser Family Foundation revealed that Black, Hispanic, American Indian Alaskan Native (AIAN,) and Asian adults experience higher levels of unfair treatment during health care visits compared to white adults, with Black women reporting even higher incidences. 

These incidents bring about the possibility of receiving insults, where racial groups feel compelled to be mindful of their appearance to get fair treatment during their health care visits

This “large, nationally representative survey finds that among those who used health care in the past three years, six-in-10 (60%) Black adults, about half of American Indian and Alaska Native (52%) and Hispanic (51%) adults, and four-in-10 (42%) Asian adults say they prepare for possible insults from providers or staff and/or feel they must be very careful about their appearance to be treated fairly during health care visits at least some of the time as compared to one-in-three (33%) White adults who have the same observation.

Additionally, the survey “finds that Black, Hispanic, and Asian adults who have more health care visits with providers who share their racial and ethnic background report more frequent positive and respectful interactions.”²

African Americans may face delayed diagnosis from the time of onset of myeloma symptoms. 

Furthermore, IMF Chief Medical Officer Joseph Mikhael, MD, sheds light on disparities in multiple myeloma care for African Americans in his presentation at the M-Power Project New York City Webinar¹⁰.

In this webinar, Dr. Mikhael said that the average myeloma patient sees their primary doctor three times with symptoms and signs consistent with multiple myeloma. Yet, he pointed out, that the delay from symptom onset to diagnosis is even longer in African Americans, for many reasons including the following: 

• Confounding disease (like diabetes)  
• Access to adequate diagnostics and care  
• Awareness in primary care providers  
• Timely referral to specialists  

Dr. Mikhael, who is active with the IMF’s M-Power Project, set a call to action to educate healthcare providers, health institutions, and patients to be aware of the disease symptoms to be able to capture diagnoses more quickly. 

Additionally, Dr. Mikhael was part of the team that has conducted the following December 2023 retrospective study: “Addressing the disparities: the approach to the African American patient with multiple myeloma.”¹¹ We encourage you to review this study to learn about both biologic and non-biologic disparities unique to African Americans as well as to learn about ways to address these barriers to care.  

Addressing diagnostic delays is particularly important given that research shows earlier and equal access to treatment can fully close — and in some analyses reverse — the survival gap between Black and White myeloma patients.

A 2022 review in The American Journal of Medicine (Mikhael, Bhutani, and Cole) provides practical guidance for closing the diagnostic gap. The review found that Black patients are less likely than White patients to undergo a complete initial diagnostic evaluation for multiple myeloma, including proper protein testing and imaging. When myeloma is suspected, the recommended testing protocol consists of three serum assays: serum protein electrophoresis (SPEP), serum free light chain assay (sFLC), and serum immunofixation electrophoresis (sIFE). Combining SPEP and sFLC achieves 100% diagnostic sensitivity — eliminating the need for cumbersome 24-hour urine collection — while adding sIFE characterizes the type of abnormal protein present. Ensuring Black patients consistently receive this full workup is a concrete, evidence-based step toward closing the diagnostic disparity.

The review also highlights that monoclonal gammopathy of undetermined significance (MGUS) — the precursor condition to multiple myeloma — is up to four times more common in Black/African Americans than in Whites, with a prevalence as high as 17% in this population. This elevated MGUS prevalence, combined with a family history of blood cancers, suggests a genetic predisposition and points to the need for heightened awareness among primary care providers treating African American patients.

Even though there is no definitive evidence to explain why myeloma has a higher incidence among African Americans, some studies have revealed a few factors contributing this.

Notably, research has found that the biology of myeloma in Black patients may actually confer certain advantages: Black patients have a lower prevalence of high-risk cytogenetic markers such as deletion 17p and TP53 mutations compared to White patients. A 2024 systematic review found that TP53 somatic mutations — associated with worse prognosis — appeared in 6% of White patients and 0% of Black patients in one analyzed cohort. This biological profile, combined with equal access to care, may explain why Black patients in equal-access settings have demonstrated superior survival. 

Explore the IMF's M-Power Project. Partnered with cities across the U.S., this project aims to eliminate health disparities and create better and more equitable access to healthcare for all.