Black and Low-Income Patients with Multiple Myeloma More Likely to Experience Treatment Delays, Study Finds

Multiple myeloma, which is the overgrowth of malignant plasma cells in the bone marrow, is characterized by hypercalcemia, renal failure, anemia and bone damage.

While some people may have asymptomatic multiple myeloma for some time, others may experience symptoms such as bone pain, bone weakness, and increased bone fractures.

Current treatment options have improved survival rates but have not provided a cure. Eventually, initial therapies stop working, and many patients relapse.

Today, therapy options can include novel targeted therapies, bispecific antibodies, and even chimeric antigen receptor T (CAR T)-cell therapy.

Although not all cases of multiple myeloma are symptomatic, timely treatment initiation is essential for preserving organ function and preventing complications, such as infections and bone damage.

In a study published in the June 2025 issue of the Journal of Managed Care and Specialty Pharmacy, Alexjandro Daviano, D.N., D.O.(M.P.), Dr.P.H., and his colleagues discuss treatment inequities among people living with multiple myeloma observed in previous studies.

According to Daviano, who is principal investigator at Humana Healthcare Research's External HEOR division in Boston, MA, and fellow investigators, inequities, including delayed treatment initiation and undertreatment, have contributed to a lapse in minority patients benefiting from the survival advantages of newer treatments.

To better understand the relationship between social determinants of health and multiple myeloma treatment patterns, Daviano and his research team conducted a retrospective database study characterizing individual and community-level social determinants of health in a real-world population of people living with multiple myeloma.

The researchers aimed to understand treatment patterns based on race and economic status and identify gaps in care.

The researchers used data from Humana Medicare Advantage prescription drug plan enrollee claims collected between January 1, 2016, and May 31, 2023. They identified 4,483 patients with newly diagnosed multiple myeloma first observed between January 1, 2017, and February 28, 2023.

In the study, it was revealed that Black patients were less likely to initiate treatment for multiple myeloma within 90 days of diagnosis compared with White patients.

Of all the identified individuals, 31.9% were Black, and 24.1% had dual eligibility status for Medicare and Medicaid or were eligible for low-income subsidy. Of the patients with dual eligibility or low-income subsidy status, 49.4% were Black.

Of the dual eligibility and low-income subsidy subgroup, 21.8% were eligible for a special needs plan. Individuals with special needs plan eligibility typically have more comorbidities, such as diabetes, obesity, kidney disease, and peripheral neuropathy.

Results showed that 43.3% of overall patients did not receive treatment within 12 months of diagnosis, including 18.1% with asymptomatic smoldering multiple myeloma. In comparison, 48.7% of patients with dual eligibility or low-income subsidy status did not receive treatment within a year of diagnosis, and 43.9% of non-White patients did not receive treatment within this time frame.

When evaluating a 90-day time frame, 52.2% of the overall cohort received treatment within three months of diagnosis, while 44.9% of dual eligibility or low-income subsidy patients received treatment within 90 days. When looking at race, 52% of White participants received treatment within 90 days of diagnosis versus 49.5% of non-White patients.

The median time to treatment initiation from diagnosis was 2.7 months in the overall cohort compared with 6.6 months for those in the dual eligibility or low-income subsidy group. For White patients, the time to treatment initiation was 2.4 months versus 3.2 months for non-White patients.

When looking at the overall cohort, Black patients were less likely to initiate treatment within 90 days of diagnosis compared with White patients. The same findings were observed for dual eligibility and low-income subsidy patients versus those not in this group and participants enrolled in a special needs plan compared with those who were not enrolled.

Daviano and his team concluded that there exist inequities in the timely initiation of treatment for newly diagnosed multiple myeloma in non-White patients and those with low-income status.

The authors advocate for initiatives to support earlier access to multiple myeloma specialists, which may require a multidisciplinary care team and include better screening for social needs and social barriers upon initiation of a patient’s cancer journey.