Disparities in relapsed or refractory multiple myeloma: recommendations from an interprofessional consensus panel

Area of Science:

• Hematology
• Oncology
• Health Services Research

Background:

• Racial, socioeconomic, and geographic disparities are documented in multiple myeloma diagnosis and frontline treatment.
• However, little is known about disparities in managing relapsed/refractory multiple myeloma (RRMM) despite numerous novel therapies.

Purpose of the Study:

• To review the manifestations of disparities in RRMM management.
• To discuss strategies for mitigating these disparities and ensuring equitable patient care.

Main Methods:

• Literature review focusing on disparities in RRMM treatment and supportive care.
• Analysis of how novel therapies (immunomodulatory drugs, CAR T-cell, bispecific antibodies) and supportive care contribute to disparities.
• Identification and discussion of proposed solutions to address identified disparities.

Main Results:

• Disparities manifest in dosing (e.g., immunomodulatory drugs), access to specialized centers for novel therapies (CAR T-cell, bispecific antibodies), and supportive care (pain control, primary care access).
• Factors contributing to disparities include Duffy-null status, time/financial toxicity, logistical hurdles, and limited availability of expertise outside high-volume centers.
• Inadequate pain control in Black patients and limited rural primary care access are significant supportive care disparities.

Conclusions:

• Addressing disparities in RRMM requires multifaceted strategies, including bidirectional co-management, social determinants of health screening, building clinical trial trust, and ensuring primary care access.
• These efforts are crucial for equitable access to the expanding landscape of RRMM treatments for all US patients.