Overall survival of Black patients with newly diagnosed multiple myeloma in the era of triplet and quadruplet therapies.

Abstract

11055 Background: Black individuals have been shown to have a higher incidence of multiple myeloma, as well as worse survival, compared with White patients. A single VA-based study demonstrated that with equal access to myeloma therapy, Black patients have superior survival compared to White individuals. Nevertheless, it is unknown whether this finding holds in other settings. Methods: This retrospective cohort study included adult patients newly diagnosed with multiple myeloma between January 1, 2017, and December 31st, 2023, in one health system in Ohio and Florida. We captured receipt of triplet or quadruplet therapy within one year of diagnosis, as well as patients’ overall survival (OS) through September 30, 2025, using the Cleveland Clinic electronic health record, including linked state and federal death records. A multivariable logistic regression model examined the association of race with the receipt of either triplet or quadruplet therapy within one year of diagnosis, and a multivariable Cox regression model examined the association of race with 5-year all-cause mortality. The Cox model was adjusted for receipt of either a triplet or quadruplet regimen within 1 year, age at diagnosis, sex, Charlson comorbidity index (CCI), ECOG performance status, baseline eGFR, urbanicity of patient’s residence, area deprivation index based on Census Block Group, insurance type, and year of diagnosis. Results: We identified 1230 patients, 54.1% male, 74.1% White, 22.8% Black, 3.1% other races. Mean (SD) age at diagnosis of 67.2 (11.1); it was 67.7 (10.8) for White and 65.9 (11.7) for Black patients. Overall, 66.3% of the cohort had an ECOG performance score of 0-1, 59.9% had baseline eGFR ≥60, and 51.1% had a CCI of ≤2. Within one year of diagnosis, 707 patients (57.5% of the cohort) received either triplet or quadruplet therapy, including 56.6% (n=516) of White and 58.9% (n=165) of Black individuals. Both univariable and multivariable analyses did not indicate a significant association between race and receipt of either a triplet or quadruplet therapy (aOR for Black race vs. White, 0.91, 95% CI, 0.64-1.28). According to Kaplan-Meier estimate, the probability of 5-year OS in the overall cohort was 62.1% (95% CI, 59.0%-65.4%). In the multivariable Cox regression model for all-cause mortality at 5 years, aHR for death for Black patients vs. White was 0.76 (95% CI, 0.58-1.00). Conclusions: In this large and diverse cohort of patients who had equal access to triplet or quadruplet therapies for newly diagnosed multiple myeloma, Black patients did not have a higher risk of all-cause mortality at 5 years compared to White individuals. Our findings indicate that health equity initiatives aimed at improving access to multiple myeloma care among minority patients have the promise of addressing race-based disparities in survival.