Multiple Myeloma in the African American Community

No group is hit harder by multiple myeloma than African Americans. Multiple myeloma (MM) is a rare and incurable blood cancer characterized by the proliferation of malignant plasma cells in the bone marrow. Multiple myeloma accounts for 2% of all cancers, but it is the most common blood cancer in African Americans. In fact, 1 in 5 people diagnosed with multiple myeloma are African American and the number of new cases in African American communities is increasing at twice the rate of White communities. 

Health Disparities in Multiple Myeloma

Multiple myeloma is much more common in the Black community than one might imagine and research points to worsening rates if something isn’t done. It is estimated that African Americans will make up roughly 24% of the newly diagnosed multiple myeloma population by 2034. Black Americans are also more likely to receive their diagnosis earlier than White Americans—around 66 years old compared to 70 years of age for White Americans.

Black Americans die at a disproportionately accelerated rate from multiple myeloma compared to other races as well. Despite improved survival rates—as a result of newer drug treatments, greater awareness of the disease, and more timely treatment—African Americans have gained 0.8 years of life compared to 1.3 years for White Americans over the past decade.

Some research has pointed to exposure to radiation and genetic differences for differences in multiple myeloma rates between African Americans and those of other races but the role each plays is unclear. While there are many factors that contribute to this health disparity—such as differences in health insurance access and income—there is no doubt that stem cell transplants and newer, often expensive drugs have not been as accessible to the African American population.

Monoclonal Gammopathy of Undetermined Significance (MGUS)

The pre-myeloma condition, monoclonal gammopathy of undetermined significance (MGUS), is twice as common in African Americans than White Americans. MGUS always precedes multiple myeloma, but it rarely turns into full-blown cancer.

MGUS is found in 3% of the general population and 1% of those with MGUS go on to develop multiple myeloma per year, which is significant given the high prevalence of multiple myeloma in the African American community. Those with intermediate to high risk of MGUS are recommended to receive annual blood tests to check for signs of progression. 

MGUS may progress to smoldering myeloma, but this version of multiple myeloma is asymptomatic and does not result in organ damage. Smoldering myeloma is monitored but not usually treated with medication or chemotherapy.

Diagnosis

Multiple myeloma is most often diagnosed incidentally while looking into the possibility of having another condition such as anemia, bone pain, or renal insufficiency. The pre-myeloma condition, MGUS, is often diagnosed incidentally by serum protein electrophoresis (SPEP), which is an antibody-protein tracking test.

If a healthcare professional suspects that you might have multiple myeloma, they may recommend several tests including blood, urine, bone marrow, and imaging tests. An oncologist, radiologist, and pathologist will review the results. 

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Blood and Urine Tests

An oncologist will look at your blood or urine to see if your plasma cells are producing excessive amounts of monoclonal protein, an immunoglobulin protein that can crowd out red and white cells in the bone marrow. In full-blown multiple myeloma, red and white cell levels may be abnormally low. 

Excessive amounts of monoclonal protein can also clog the kidneys so urine and kidney functioning tests need to be performed to make sure the organ is working properly.

Bone Marrow Aspiration and Biopsy

Bone marrow aspiration and biopsy is the gold standard diagnostic tool used by doctors to figure out whether or not you have multiple myeloma. In a bone marrow aspiration and biopsy, a thin needle is inserted into the pelvic bone, and cells are sucked out for inspection. The bone marrow cells are analyzed by a pathologist. In a healthy person, plasma cells account for 2 to 3% of the cells in the bone marrow, but if a pathologist finds more than 10% plasma cells, multiple myeloma is the likely diagnosis.

Imaging

PET scans and MRIs are done to see the extent of the disease and corresponding organ damage.

Symptoms

The most common symptoms of multiple myeloma are non-specific, which means that you can experience these symptoms with multiple medical conditions.

Multiple myeloma can permanently weaken bones and slowly damage organs so these symptoms can sometimes be confused with pains that are associated with old age. Therefore, healthcare professionals should have a high degree of suspicion for multiple myeloma when two or more of these symptoms present at the same time. Heightened awareness of multiple myeloma in the African American population means healthcare professionals can run tests and check labs to help get an early diagnosis. Earlier diagnoses are linked to better outcomes.

Treatment

African Americans tend to have a better prognosis with multiple myeloma when they receive timely diagnosis and standard treatment. Common treatments that have led to an increase in survival rates are:

• Autologous stem cell transplant
• Newer drugs, such as proteasome inhibitors and immunomodulatory agents
• Using these newer drugs in combination

Standard therapy also includes the use of:

• Chemotherapy: Treatment with various cancer-inhibiting agents such as melphalan, cyclophosphamide, vincristine, and doxorubicin to stop or slow cancer growth.
• Immunotherapy: This treatment uses an advanced immunotherapy called adoptive cell therapy (ACT) to jumpstart the body’s defense system against cancer. Those who experience serious side effects from chemotherapy or newer drugs can improve significantly from this treatment because it uses the body’s own T cells to fight cancer. 
• Monoclonal antibodies: The immune-protective agents bind to specific targets in the body, marking cancer cells so they are easier to detect and destroy by the body’s immune system. 

Access to Clinical Trials

One way to better understand the effect of multiple myeloma in African Americans is by engaging and encouraging Black communities to participate in clinical trials. Currently, there are huge disparities in multiple myeloma research. Despite the fact that African Americans comprise 20% of the population of multiple myeloma patients, they only account for 6% of patients in clinical trials.

Several genetic and treatment studies, like National Cancer Institute Endurance Study, are helping us to not only better understand how multiple myeloma impacts African Americans differently from other groups, but also how certain treatments work within this high risk group. 

A Word From Verywell

Many people with multiple myeloma go on to live happy and healthy lives, but early diagnosis is key. The combination of new medication therapies and the rapid advancement of novel immunotherapies are increasing the life expectancies of those with the disease.

Research shows that disparities in multiple myeloma survival within the African Community stem from inferior treatment utilization and access rather than underlying pathogenesis. Innovative and multidisciplinary approaches are urgently needed to enhance our understanding of the many disparities that exist at each stage of the multiple myeloma disease continuum to facilitate the elimination of these disparities.