Addressing Disparities in Multiple Myeloma Outcomes and Comorbidities

Disparities in outcomes for multiple myeloma patients continue to persist, with socioeconomic and geographic factors significantly influencing mortality rates. This issue was the focus of two poster presentations at the 2025 American Society of Clinical Oncology (ASCO) annual meeting, held from May 30 to June 3 in Chicago, Illinois. Despite advancements in treatment over the last two decades, evidence suggests that not all patients benefit equally from therapeutic innovations.

The first study presented analyzed incidence-based mortality (IBM) rates for multiple myeloma from 2000 to 2021, revealing that individuals from lower-income backgrounds are disproportionately affected. According to the findings, patients in households earning less than $40,000 annually had an IBM rate of 7.3 per 100,000, nearly double the rate of 5.31 per 100,000 seen in those with household incomes exceeding $120,000. The study, which utilized data from the Surveillance, Epidemiology, and End Results (SEER) program across 17 cancer registries, also highlighted that residents of non-metropolitan or rural areas faced higher mortality rates (6.14 per 100,000) compared to urban populations (5.94 per 100,000).

Researchers attributed these disparities to several critical factors, including limited access to insurance, novel therapies, and specialized healthcare resources in underserved communities. Rural patients often encounter significant travel barriers to access oncological care, while low-income individuals may delay seeking treatment due to prohibitive costs associated with care and inadequate insurance coverage. Moreover, clinical trials and advanced diagnostic tools are predominantly available at large academic centers located in urban areas, which are often inaccessible to rural populations. As noted by the study authors, “These findings call for targeted interventions to reduce these disparities and further research to address the underlying causes, ensuring equitable access to advancements in myeloma care.”

The second poster presentation focused on the impact of comorbidities on myeloma progression and overall survival. A retrospective chart review of 267 patients with confirmed multiple myeloma, published in the Journal of Clinical Oncology, revealed that chronic kidney disease (CKD) significantly correlates with adverse outcomes. CKD was found to be a risk factor for high-risk multiple myeloma, with rates of 8.4% versus 1.7% (P = .019) in patients with and without CKD, respectively. The study also indicated that those with CKD have a higher likelihood of diagnosis at the Revised International Staging System (R-ISS) stage III (11.0% vs. 1.4%; P < .001) and experience higher mortality rates (12.3% vs. 4.0%; P = .026).

Furthermore, atrial fibrillation (AF) was more prevalent among high-risk patients, with rates of 15.9% compared to 6.7% in standard-risk patients (P = .028). The researchers speculate that CKD may lead to delays in diagnosis due to symptom overlap and complex management needs, necessitating increased awareness and improved management strategies for comorbidities to enhance patient outcomes.

The intersection of socioeconomic status and clinical complexity presents a multifaceted challenge in the management of multiple myeloma. Notably, chronic conditions, particularly in older adults, frequently co-occur with multiple myeloma. As the demographic of patients with multiple myeloma ages, the burden of chronic diseases is expected to increase, further complicating treatment landscapes.

Both studies underscore that multiple myeloma outcomes are influenced by more than just disease biology and available therapies; they are significantly impacted by socioeconomic status, geographic location, and comorbid conditions. Addressing these barriers is essential for improving diagnosis, treatment, and survival outcomes for multiple myeloma patients. The findings advocate for a paradigm shift towards equitable healthcare policies and targeted interventions aimed at mitigating these disparities, fostering a healthcare environment where all patients have equal access to effective treatment options.