African American patients with multiple myeloma had superior overall survival compared with Caucasian patients when studied within the Veterans Affairs (VA) system, which should represent equal access to healthcare and novel therapies.
“Taken with previous research in other healthcare systems that does demonstrate disparities, our study suggests disparity to be primarily due to socioeconomic factors,” wrote researcher Nathanael Fillmore, of VA Boston Healthcare System, and colleagues, in Blood. “Furthermore, the improved outcome in African American multiple myeloma patients also raises an important question about possible differences in disease biology.”
The study included 15,717 patients with symptomatic myeloma in the VA healthcare system from 2000 to 2017, including 3,254 African American patients.
The overall survival for patients in the study was 4.62 years. Patients diagnosed in their forties had the best median overall survival, at 7.5 years. However, this significantly decreased as patients aged, with a median overall survival of 5.9 years for patients in their fifties, 5.2 years for those in their sixties, 3.5 years for those in their seventies, and 2.6 years for those in their eighties.
The median overall survival was also significantly different by race. Among African Americans, the median overall survival was 5.07 years compared with 4.52 years for Caucasian veterans (P < .001).
To explore this further, the researchers looked at outcome by age (< 65 vs 65 and older). Even among patients younger than 65, African American patients had a significantly improved overall survival compared with Caucasian patients (7.07 vs 5.83 years; P < .001). There was no significant difference in patients 65 or older.
There was no disparity by race at the VA in terms of overall use of novel agents at induction, with similar use of immunomodulatory agents or proteasome inhibitors between African American and Caucasian patients.
Even after adjusting for age, gender, rurality, income, stage, transplant, and categories of therapy at induction, race remained an independent predictor, with a lower risk for death in African American patients.
Fillmore and colleagues called these results particularly relevant given that myeloma incidence is twofold higher in African Americans compared with Caucasians.
“Along with differences in incidence, the age of onset and superior overall survival in African Americans now highlights the need to further investigate race-related biological and genomic differences in the disease process to develop diagnostic, preventative, and therapeutic approaches,” the researchers concluded.
Commenting on the study, Ola Landgren, MD, chief of myeloma service at Memorial Sloan Kettering Cancer Center, called the study interesting and said its data help to understand how the disease is presenting and behaving differently in different populations.
“It is not yet possible to adjust treatments based on this because there are no treatments tailored around such findings,” Landgren said. “Therapies for myeloma are still quite broad acting, but in the future that could change.”
Studies related to disparities and disease are complicated and have many nuances, but provide important information to clinicians.
“If you look at myeloma, for example, there is a 10-plus-year earlier onset for African Americans, and that has great clinical importance,” Landgren said. “If a patient complains of back pain and fatigue, a doctor seeing a white 70-year-old patient might think of myeloma and work it up, but given that African Americans can have younger onset, clinicians, particularly family medicine doctors, need to be more aware and think of myeloma.”