Hispanic Ethnicity Associated With Worse Multiple Myeloma Outcomes, Study Shows

Several therapies have received approval in the multiple myeloma space in recent years, driving shifts in the treatment paradigm and improvements in patient outcomes. However, medical literature suggests race- and ethnicity-related disparities continue to impact patient care and access to treatment.

In this interview, Dr Hira Shaikh sat down with First Report Managed Care to discuss her research into disparities in multiple myeloma outcomes, particularly for Hispanic patients.

What inspired your research into race-related outcomes in multiple myeloma?

Multiple myeloma is the second most common hematologic malignancy in the United States. It constitutes around 1.8% of new cancer cases, according to the Surveillance, Epidemiology, and End Results (SEER) database. It is a heterogeneous disease influenced by a lot of sociodemographic factors, with survival varying by ethnicity and race.

We have some data about how multiple myeloma affects Black patients; however, the data about Hispanic patients is limited, and the clinical characteristics and outcomes of multiple myeloma in Hispanic patients are not well understood. The Hispanic population is actually one of the fastest growing populations in the United States. According to the 2020 census, 19% of the US population is Hispanic. This population has grown by 23% since 2000, compared to a rate of 4% among non-Hispanic individuals.

The implementation of new therapies for multiple myeloma has resulted in better outcomes, but equal access to therapies is still lacking, which is why we conducted our research.

Thank you, Dr Shaikh. Can you walk through your study’s methods and any findings that stood out to you?

We used the Texas Cancer Registry, which is comprised of patients living in Texas who were not included in the SEER database. We assessed clinical characteristics and multiple myeloma outcomes for about 5000 Hispanic patients as compared to about 22,000 non-Hispanic patients.

We found Hispanic individuals presented with multiple myeloma at a younger age than non-Hispanic individuals, at 65.2 vs 68 years of age, or a difference of about 3 years. Also, Hispanic ethnicity was significantly associated with worse outcomes compared to non-Hispanic White ethnicity after we controlled for age, diagnosis, gender, and treatment.

Some other covariates were associated with poor survival, which included increasing age, male gender, and lack of transplants, as well as patients who did not have private insurance, such as those who were uninsured or had Medicare or Medicaid. All these factors were associated with higher mortality rates in Hispanic individuals compared to non-Hispanic individuals.

How can these data inform clinical practice and/or coverage decision-making?

To our knowledge, this is the largest analysis reporting multiple myeloma outcomes in Hispanic patients in the United States. We believe this is important because this data highlights the need for improved access to equitable health care and clinical trials for Hispanic individuals.

Now that there is a spotlight on disparities in health care, we believe this has important implications not just for the research aspects of multiple myeloma, but also how we provide care to these patients. We need to include Hispanic individuals more in clinical trials, where we see drastic under-representation of all minority populations.

Do you intend to expand on your research?

Yes. We are trying to obtain more data to compare other covariates that could affect overall survival, particularly treatment. We already know certain treatments might work in some patients and ethnicities better than others, so we would like to expand on that data. We are also looking into performing DNA and RNA sequencing to identify polymorphisms, which may explain the difference in outcomes and why patients of minority ethnicities may present or be treated differently.

About Dr Shaikh

Hira Shaikh, MD, is an assistant professor of hematology, oncology, and bone marrow transplant at the University of Iowa Hospitals and Clinics.