Racial disparities in treatment initiation and early outcomes among patients with multiple myeloma: A real-world, multi-institutional cohort study

Abstract Background: Despite therapeutic advances in multiple myeloma (MM), racial disparities in treatment access and outcomes persist. Prior studies suggest underutilization of novel therapies and stem cell transplantation among racial and ethnic minorities. However, large-scale, real-world data evaluating early treatment patterns and outcomes across racial groups are limited. This study evaluates racial disparities in treatment initiation, hospitalization, ICU admission, and mortality among patients with newly diagnosed MM, using a multi-institutional electronic health record database. Methods: We conducted a retrospective cohort study using TriNetX, a US Nationwide de-identified database. Adults diagnosed with MM between 2017 and 2024 were included. Patients were stratified by race including Black, White, and Asian. Propensity score matching (1:1) was performed based on sex, age, diabetes mellitus, ischemic heart disease, and CKD. Outcomes included rates of systemic therapy initiation and receipt of novel therapies within 60 days of diagnosis, stem cell transplant within 1 year of diagnosis, hospitalization and ICU utilization, and mortality. Results: Among 17,953 Black and White MM patients, Black patients were significantly less likely to initiate systemic therapy within 60 days (25.1% vs. 28.1%, p < 0.0001) or receive novel agents (4.8% vs. 6.3%, p < 0.0001). They were also less likely to undergo stem cell transplant within 1 year (11.4% vs. 15.9%, p < 0.0001). Despite lower mortality at 1-year, Black patients experienced significantly higher rates of hospital admissions (e.g., 30-day: 25.1% vs. 20.1%, p < 0.0001) and ICU admissions (e.g., 60-day: 1.0% vs. 0.4%, p < 0.0001). In a separate analysis of 6,512 Asian and White patients, Asian patients had higher 30-day (2.5% vs. 1.8%, p = 0.0095), 60-day (4.0% vs. 2.9%, p = 0.0006), and 90-day mortality (4.6% vs. 3.5%, p = 0.0019), but were less likely to undergo stem cell transplant within 1 year (11.6% vs. 14.6%, p < 0.0001). No major differences were observed in novel therapy use or ICU admissions. Conclusions: Significant racial disparities exist in early treatment access and supportive care utilization for patients with MM. Black patients were less likely to receive timely therapy and advanced treatments despite higher hospitalization and ICU use. Asian patients showed elevated early mortality and lower transplant rates. These findings confirm the urgent need for interventions to address racial inequities in MM care pathways and outcomes.