Racial disparities in multiple myeloma: biological heterogeneity, treatment access, and prognostic implications

Unlike the well-recognized two-fold higher incidence rate and an earlier age of onset of MM among African Americans (AA) compared to European Americans (EA) in the United States, findings on racial disparities in survival outcomes of MM are inconclusive, ranging from worse survival, to no difference, to better overall survival in AA patients than EA patients. The clinical outcomes for patients with MM depend on a complex interplay of factors including age, disease severity, cytogenetics, treatment modalities, biological features of the responsible clone, and non-biological factors such as treatment utilization and access to care. This review focuses on genetic and molecular heterogeneity of the disease biology and characteristics among MM patients from different populations. The review discusses possible determinants of racial and ethnic disparities in the outcomes of MM and considers potential strategies to address them with an ultimate goal of decreasing MM health disparities.