Equal Access to Modern Therapy May Help Eliminate Survival Differences in Multiple Myeloma

Black patients with newly diagnosed multiple myeloma did not experience worse survival outcomes compared with white patients when they had equal access to modern triplet and quadruplet therapies, according to findings presented at the 2026 American Society of Clinical Oncology Annual Meeting.

The retrospective cohort study, which evaluated adults diagnosed with multiple myeloma across the Cleveland Clinic system in Ohio and Florida, found no significant differences in receipt of contemporary multiple myeloma therapies across patient populations. Investigators also reported that Black patients did not have a higher risk of all-cause mortality at five years compared with their white counterparts

The findings add to growing evidence suggesting that differences in multiple myeloma outcomes may be driven less by disease biology and more by structural differences in healthcare access and delivery.

Examining multiple myeloma outcomes

“Historically, there have been studies looking at patients diagnosed with multiple myeloma and comparing outcomes among different populations, including African American patients,” says study author Faiz Anwer, MD, Cleveland Clinic. “We are in a city like Cleveland with a significant African American population, so we wanted to evaluate outcomes among our own patients—comparing different cohorts.”

The study included adult patients diagnosed with multiple myeloma between Jan. 1, 2017, and Dec. 31, 2023. Investigators used electronic health record data and linked state and federal death records to evaluate treatment patterns and overall survival through Sept. 30, 2025.

Researchers specifically examined receipt of triplet or quadruplet therapy within one year of diagnosis, as well as five-year all-cause mortality. Multivariable analyses adjusted for several clinical and socioeconomic factors, including age, sex, Charlson comorbidity index, ECOG performance status, kidney function, insurance type, urbanicity and area deprivation index.

“We know from prior data that Black patients are generally diagnosed with myeloma at a younger age compared to white patients, often by about 10 years,” Dr. Anwer says. “This effort was really about looking at our own cohort and our own experience to compare our outcomes with the published data and learn from it.”

He notes that investigators also wanted to evaluate whether there were opportunities to improve care within their own patient population. “We wanted to determine whether we were doing a good job treating Black patients and whether their life expectancy or outcomes were inferior in any way,” he says. “If they were, we wanted to identify opportunities to improve care.”

Comparable treatment, comparable survival

The analysis included 1,230 patients, 54.1% of whom were male. Overall, 74.1% of patients were white, 22.8% were Black and 3.1% identified as other races. The mean age at diagnosis was 67.7 years for white patients and 65.9 years for Black patients, demonstrating a trend toward earlier diagnosis among Black individuals, although the gap was smaller than has been reported in some national datasets.

Investigators found no significant differences in access to modern therapy. Overall, 57.5% of patients received triplet or quadruplet therapy within one year of diagnosis, including 56.6% of white patients and 58.9% of Black patients. Multivariable analyses demonstrated no significant association between race and receipt of these regimens.

Survival outcomes were similarly encouraging. According to Kaplan-Meier estimates, the probability of five-year overall survival for the entire cohort was 62.1%. In adjusted analyses, Black patients did not have a higher risk of death compared with white patients.

“Another important point is that published literature has suggested that Black patients may have worse outcomes compared with white patients,” Dr. Anwer notes. “However, in our internal cohort, we showed that if patients receive good care, their outcomes are just as good for both groups of patients.”

According to Dr. Anwer, the findings suggest that differences in outcomes may be driven more by differences in access to care than by biologic differences in disease behavior. “Instead, there may be social, economic or healthcare obstacles contributing to poorer outcomes. When those obstacles are overcome—patients are seen in clinic, diagnosed and treated appropriately—their outcomes are comparable to those of other races.”

Expanding awareness and early detection efforts

These data may have important implications for both clinical practice and future research, particularly regarding awareness and earlier evaluation among high-risk populations. “There is clearly a trend that these patients are younger, so clinicians may need to begin evaluating Black patients earlier when they present for care,” Dr. Anwer notes.

“Physicians should not necessarily wait to see a 70-year-old patient before considering multiple myeloma,” he continues. “These patients may be diagnosed five or 10 years earlier. In our own cohort, we only saw about a two-year difference, but the trend is still there.”

The research team is also continuing to build on these findings through additional research initiatives. “We are currently working on another study focused on high-risk populations, particularly African American patients,” Dr. Anwer says. “We are screening patients within that population for smoldering myeloma and MGUS, which are precancerous conditions that can ultimately progress to multiple myeloma.”

He adds that the effort also includes community education initiatives aimed at improving awareness of myeloma risk among Black patients and their families. “There is an ongoing effort to educate the Black community about their higher risk, and we are conducting screening to determine how many individuals in this high-risk population test positive for MGUS or smoldering myeloma,” he says.

Dr. Anwer emphasizes that advances in therapy have substantially improved outcomes for patients with multiple myeloma overall. “I think it is important to highlight that treatment for multiple myeloma has improved significantly,” he says. “Survival rates for patients with myeloma have essentially doubled with the introduction of newer therapies, including immunotherapies, antibodies and CAR T-cell therapies.”

As treatment options continue to evolve, he says ensuring universal access to diagnosis and care will remain essential.

“We should remain vigilant in identifying patients with myeloma and treating them promptly and appropriately,” Dr. Anwer concludes. “If we do that, patient outcomes will improve, and survival rates will be comparable not only to national averages, but also across all populations.”

This work was supported by the National Cancer Institute grant # R00CA277136 (PI: H. Gasoyan).