Racial disparities in clinical outcomes among patients with newly diagnosed and relapsed multiple myeloma in the United States: A 21-year comparative analysis

Abstract Background: Despite significant therapeutic advances, racial disparities persist across the continuum of care for patients with multiple myeloma (MM), affecting both newly diagnosed and relapsed patients. While individuals who identify as Black have a higher incidence of MM, their survival and complication profiles differ markedly from those who are White and Asian. This study evaluates 5 year all-cause mortality and other adverse clinical outcomes across racial groups in individuals with newly diagnosed and relapsed MM using a large real-world US database spanning 2000–2020. Methods: Data were derived from the TriNetX US Collaborative Network. Adults (≥18 years) with newly diagnosed or relapsed MM were identified and grouped by self-identified race. Patients were propensity score matched based on age, sex, and comorbidities. Individuals with prior MM diagnoses or remission before 2000 were excluded. Outcomes included all-cause mortality, hospitalization, neurologic events (stroke, seizure), chronic kidney disease (CKD), heart failure and osteoporosis. Log binomial regression was used to calculate risk ratios (RRs) and 95% confidence intervals (CIs) with level of statistical significant at 0.05 Results: Among newly diagnosed MM patients included in this study, participants who were Black had significantly higher risks of stroke (RR = 1.42, 95%CI: 1.24–1.61), CKD (RR 1.41, 95%CI: 1.30–1.50), seizures (RR 1.34, 95% CI 1.18–1.53) and heart failure (RR = 1.25, 95%CI: 1.17–1.34) compared to those who were White. However, they had lower risks of osteoporosis (RR = 0.64, 95%CI: 0.59–0.71). Our results revealed that patients who were Black had significantly lower all-cause mortality (RR 0.94, 95%CI: 0.90–0.98) compared to those who were White. Among relapsed MM patients, participants who were Black had significantly higher risks of stroke (RR = 1.41, 95% CI: 1.05 -1.90), seizures (RR = 1.39, 95%CI: 1.07-1.83) heart failure (RR = 1.34, 95%CI: 1.17 - 1.53) and CKD (RR = 1.45, 95%CI: 1.27 - 1.65) while mortality was significantly lower (RR 0.91, CI 0.853–0.978) compared to those who were White. Hospitalization rate, osteoporosis and tumor lysis syndrome risk did not statistically differ between the two groups among those with newly diagnosed or relapsed MM. In the cohort newly diagnosed with MM, participants who were Asian had significantly lower rates of hospitalization (RR = 0.90, 95%CI: 0.81–0.99), seizure (RR = 0.64, 95%CI: 0.44–0.94), and osteoporosis (RR = 0.72, 95%CI: 0.59–0.89), compared to those who were White. However, there was no statistically significant difference in mortality between these two groups (RR = 0.93, 95%CI: 0.84–1.03). Among relapsed MM patients, hospitalization and neurologic risk (stroke and siezures) did not differ statistically between two groups. Finally, mortality was significantly lower among participants who were Asian (RR 0.81, 95%CI: 0.67–0.99), compared to those who were White. Conclusions: This study highlights persistent and multifaceted racial disparities in MM. Interestingly patients who were Black had a higher burden of renal, cardiovascular, and neurologic complications, yet demonstrated improved survival compared to those who were White, raising questions about underlying disease biology and treatment patterns. Patients who self-identified as Asian exhibited generally favorable profiles. These findings underscore the need for individualized supportive care strategies, improved representation in clinical research, and expanded access to primary care—especially for underrepresented patient populations facing disproportionate comorbidity and mortality burdens.