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Higher incidence in Black Americans, younger average onset
Overview
Multiple myeloma (MM) is a cancer of plasma cells — the antibody-producing immune cells that reside in the bone marrow. Malignant plasma cells accumulate in the marrow, produce abnormal proteins (M-proteins or paraproteins detectable in blood and urine), suppress normal blood cell production, destroy bone, and damage kidneys. The International Myeloma Working Group (IMWG) diagnostic criteria require clonal bone marrow plasma cells ≥10% or biopsy-confirmed plasmacytoma plus one or more CRAB criteria (hypercalcemia, renal insufficiency, anemia, bone lesions) or specific high-risk biomarkers. Precursor states — MGUS (monoclonal gammopathy of undetermined significance) and smoldering myeloma — precede MM and require monitoring for progression. MM accounts for approximately 10% of all hematologic malignancies and is the second most common blood cancer after non-Hodgkin lymphoma.
How Multiple Myeloma affects Black patients
Black Americans have approximately twice the incidence of multiple myeloma compared to white Americans — the largest racial disparity in incidence of any hematologic malignancy. Black patients are also diagnosed 6–10 years younger on average. The precursor condition MGUS is approximately twice as prevalent in Black adults, and smoldering myeloma (the intermediate stage) progresses to active myeloma at higher rates in Black patients. Despite higher incidence and earlier onset, Black patients have historically had similar or marginally better survival when treated with equivalent regimens — suggesting that access and treatment quality drive observed outcome disparities, not tumor biology.
Black patients are substantially underrepresented in pivotal myeloma clinical trials despite comprising the highest-incidence group. The Connect MM Registry and ASH 2023 data both document persistent enrollment gaps. Black patients with myeloma should be actively encouraged to enroll in trials, and advocacy organizations including the International Myeloma Foundation specifically support Black patient outreach.
Symptoms
- Bone pain — most commonly back, ribs, or hips — that is persistent and not explained by injury
- Fatigue and weakness from anemia
- Frequent or recurrent infections (bacterial pneumonia, UTI)
- Kidney problems: elevated creatinine, decreased urine output, foamy urine
- Hypercalcemia symptoms: nausea, constipation, excessive thirst, confusion
- Bone fractures from minor trauma or spontaneously (pathologic fracture)
- Numbness, tingling, or weakness in limbs (spinal cord compression — neurologic emergency)
When to see a doctor
Seek prompt evaluation for unexplained persistent bone pain, recurrent bacterial infections, unexplained anemia, or elevated calcium or creatinine on routine labs. Pathologic fractures or new-onset spinal cord compression symptoms (limb weakness, bowel/bladder dysfunction) are neurological emergencies requiring immediate imaging and evaluation.
If a provider finds an elevated M-protein on serum protein electrophoresis (SPEP) or an abnormal free light chain ratio, request a hematology/oncology referral promptly — MGUS and smoldering myeloma require monitoring and risk stratification to detect early progression to active myeloma.
Screening
No population-level myeloma screening is currently recommended. Myeloma is typically identified through abnormalities on routine blood work — elevated total protein, anemia, hypercalcemia, elevated creatinine, or elevated ESR — or through radiologic incidental findings. SPEP (serum protein electrophoresis), serum immunofixation, and serum free light chains (kappa/lambda) are diagnostic tests for M-proteins. Whole-body low-dose CT or PET-CT is the preferred imaging modality for bone assessment at diagnosis. Bone marrow biopsy with flow cytometry and cytogenetics quantifies plasma cell burden and risk stratification (FISH for del(17p), t(4;14), t(14;16), 1q21 amplification).
Treatment overview
Treatment is guided by transplant eligibility and risk stratification. Triplet or quadruplet induction regimens are now standard of care: daratumumab + bortezomib + lenalidomide + dexamethasone (Dara-VRd/IsaVRd) for transplant-eligible patients, or Dara-VRd for transplant-ineligible patients based on GRIFFIN, PERSEUS, and MAIA trial data. Autologous stem cell transplantation (ASCT) remains standard for eligible patients after response to induction. Maintenance with lenalidomide (or daratumumab-based) after transplant prolongs progression-free survival. For relapsed/refractory myeloma, options include belantamab mafodotin, carfilzomib-based regimens, and CAR-T cell therapies: ciltacabtagene autoleucel (cilta-cel/Carvykti) and idecabtagene vicleucel (ide-cel/Abecma) are FDA-approved for patients who have received multiple prior lines of therapy and have transformed outcomes in refractory disease.
Questions to ask your doctor
Bring this list to your next appointment.
- What is my Revised International Staging System (R-ISS) stage, and what cytogenetic abnormalities do I have?
- Am I transplant-eligible, and when would you plan transplant relative to induction?
- Is my induction regimen a quadruplet (Dara-VRd), and if not, why not?
- Am I a candidate for CAR-T therapy (cilta-cel or ide-cel)?
- Are there clinical trials focusing on Black myeloma patients I should consider?
- What bone protection (bisphosphonate or denosumab) am I receiving?
- Should my siblings or children be checked for MGUS given my diagnosis?
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This content is for informational and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about a medical condition. If you are experiencing a medical emergency, call 911 or your local emergency number immediately.