Black Patients with Multiple Myeloma Less Likely to Receive Evaluation

Lucia Notardonato, MD

A new real-world analysis of patients with newly diagnosed multiple myeloma found that Black patients were less likely to undergo a complete evaluation when compared to white patients.

Despite rates of beta-2 microglobulin and fluorescence in-situ hybridization (FISH) cytogenetics testing being low among this patient population, Black patients were less likely to undergo testing needed to complete staging for ISS/R-ISS or proper imaging to assess for extramedullary disease.

The study was presented the American Society of Hematology (ASH) Annual Meeting and Exposition.

Mutliple myeloma is known as the most common hematologic malignancy in Black patients, with a 2-to-3 fold higher incidence rate compared to White patients.

Lucia Notardonato, MD, Section of General Internal Medicine, University of Notre Dame, Chicago, and fellow investigators added that racial desparities in outcomes are prevalent and could be attributed to inferior access to novel therapies and autologous stem cell transplant among Black patients.

As such, the team sought to assess the presence of racial disparities in the diagnostic workup of newly diagnosed multiple myeloma among Black and White patients.

The Methods

The retrospective cohort study was performed using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database.

The database included 16.174 multiple myeloma patients with patient-level demographics, survival data, and health care claims information.

Data included patients who were 65 years and older with a diagnosis of multiple myeloma between 2001-2015. The race of each patient was also documented by SEER registries, and lab and imaging data were collected 180 days before and after diagnosis.

Additionally, CPT codes were queried to determine the frequency of the diagnostic tests of interest, and all data were analyzed through R version 4.0.2. Pearson chi-squared tests that compared frequency of diagnostic testing between racial groups.

The Findings

A total of 18,267 MM patients were identified in the SEER-Medicare linked database, with 15,360 multiple myeloma patients having been identified with peripheral blood laboratory, bone marrow, and imaging health care claims data available.

Of the multiple myeloma patients included in the study, 2715 were Black while 12,645 were White.

Complete blood count and comprehensive metabolic panel serum testing demonstrated that >89% (13,723/15,360) of individuals had both tests performed.

Generally, Black patients had lower frequency of nearly all serum and imaging tests completed relative to White patients. Only 61% of White patients underwent the testing components necessary to adequately risk-stratify disease by ISS compared to 50% of Black.

Investigators observed low overall rates of FISH cytogenetics, with White individuals undergoing FISH cytogenetics at a rate of 30% compared to 25% among Black individuals (relative difference 18%).

Notardonato and colleagues were unsure of whether these differences between Black and White patients in the initial diagnostic workup led to differences in treatment strategies and survival outcomes, though they believed it warranted further study.

“Further work is needed to improve access to complete diagnostic evaluation among Black patients with newly diagnosed MM,” the team wrote.

The study, “Racial Disparities in the Diagnostic Evaluation of Multiple Myeloma,” was published online for ASH2021.