Shebli Atrash, MD, physician, plasma cell disorder team, Levine Cancer Institute, North Carolina, highlights findings presented at the 63rd ASH Annual Meeting & Exposition that indicated racial discrepancies in patients’ access to timely treatment for multiple myeloma.

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Welcome back to PopHealth Perspectives, a conversation with the Population Health Learning Network where we combine expert commentary and exclusive insight into key issues in population health management and more.

Today, we are joined by Dr Shebli Atrash, physician at the Levine Cancer Institute in Charlotte, North Carolina. He highlights findings presented at the 63rd ASH Annual Meeting and Exposition that indicated racial discrepancies in patients' access to timely treatment for multiple myeloma. Dr Atrash?

My name is Shebli Atrash. I'm a physician. I'm a member of the plasma cell disorder team here at the Levine Cancer Institute in Charlotte, North Carolina. I work, basically, with multiple myeloma, amyloidosis, and plasma cell disorder patients.

Can you tell us what inspired you and your coinvestigators to conduct this research?

Here in North Carolina, in Charlotte, we have a large population of Black patients. Those patients historically have less access to standard-of-care treatments for multiple myeloma. We know from previous data analyses that Black patients have less access to novel therapies and less access to stem cell transplant.

As part of our mission here to provide care for our community, we are trying to reach out to everybody in the community and make sure everyone has equal access to care. We wanted to look at our patients' access to novel therapies here in North Carolina, and we included another center in New York City.

The aim was to assess what's the access to novel treatments, and when do they receive this treatment? Is it equal across different subgroups of patients, or is there any difference in access to therapies?

Previously, we published our results with autologous stem cell transplant, and we showed that patients who get equal access to autologous stem cell transplant, regardless of phase, ended up with similar outcomes. Part of the mission is to re-evaluate and see how accessible those treatments to our community.

Could you tell us a little bit about the study design and the inclusion criteria for participants?

It's a retrospective chart review that included two centers in the United States, the Levine Cancer Institute here in Charlotte and the Weill Cornell Medical Center. Both institutes are academic institutes.

We obtained the identified data, and we looked at patients from the index date, which is the initiation of the first dose of daratumumab treatment. Daratumumab has been approved for treatment of multiple myeloma. The point was to measure how accessible daratumumab is to patients across the different subgroups.

We looked at patients who are at least 18 years old, diagnosed with multiple myeloma, with a complete treatment history of multiple myeloma, who received daratumumab throughout their treatment.

We looked at the treatment patterns, when the first dose of daratumumab was given, what line of treatment it was given in, and we looked at the duration of the regimen, which is defined as the time between the initiation of daratumumab combination therapy to the discontinuation of the treatment.

Also, we looked at the clinical outcomes in terms of International Myeloma Working Group classification, overall response, partial response, very good partial response, and complete remission, during the treatment of daratumumab.

We looked at the characteristics of the patients who received daratumumab, and we reported the results as separate, as Black and White patients. We looked at the line of treatment they received daratumumab and the time to next treatment after starting daratumumab.

What would you say are the key findings from the study, and did any of them surprise you?

We enrolled about 252 patients. Out of those, there were 89 Black and 163 White patients. Black patients had a longer time between initial myeloma diagnosis and initiation of daratumumab treatment: 43 months for Black patients vs 34 months for White patients. Multiple myeloma stage at diagnosis was similar between both groups.

It's interesting, to me, that Black patients received treatment with daratumumab most commonly in their third line, whereas most White patients received it in the first and second line of their treatment. That's the surprising finding, showing that despite the access/availability for Black patients to novel treatments, it's still delayed access.

We know that starting the best treatment for multiple myeloma early on is the standard of care, and it seems that the most effective treatment for multiple myeloma included daratumumab in earlier lines. In our dataset, we see that there's a delay in adapting daratumumab for Black patients.

This cannot be generalized everywhere because we used two academic centers, we used a chart review, we excluded patients with incomplete history of treatments. Still, it gives us an insight about the importance of reaching out to different subgroups of patients and ensuring getting equal access to treatment among all patients.

Did you want to say anything else about how these findings can be put into clinical practice?

It's important to first identify the reasons why Black patients have less access to novel treatments. All future studies should continue to investigate such discrepancy in the treatment access, and the potential reasons for this discrepancy.

More importantly, we should find strategies to mitigate this effect on new therapies for multiple myeloma, as multiple myeloma as a field is changing rapidly. Ensuring equal access to treatment is very important, and to continue to investigate ways to mitigate this discrepancy is very important.

Do you have any plans to expand on this research in the future?

Yes, we do have plans to build upon this. We have multiple projects that are ongoing. One of those, I would like to mention, Dr Bhutani's project looking at monoclonal gammopathy for Black patients, which is a screening project.

The hope here is to try to screen patients in our area earlier on, identify their cancer earlier on, and increase their participation in the clinical trials. Also, our clinical trial focus is now to reach out more to our Black population and increase enrollment in the clinical trials for those patients.

As far as stem cell transplant, we're doing a good job here. The numbers are showing equal results between Black and White patients who get stem cell transplant and the availability and access to stem cell transplant as part of the standard of care of multiple myeloma.

However, we need to revisit those data frequently to make sure we are delivering equal care and equal access to patients to all novel treatments.

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