Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, 02215, USA.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
Blood Cancer J. 2020 Feb 17;10(2):19. doi: 10.1038/s41408-020-0284-7.
Multiple myeloma (MM) is a fatal plasma cell dyscrasia with a median overall survival of 5 to 10 years. MM progresses from the more common but often subclinical precursor states of monoclonal gammopathy of undetermined significance (MGUS), and smoldering multiple myeloma (SMM) to overt MM. There are large racial disparities in all stages of the disease. Compared with Whites, Blacks have an increased MGUS and MM risk and higher mortality rate, and have not experienced the same survival gains over time. The roots of this disparity are likely multifactorial in nature. Comparisons of Black and White MGUS and MM patients suggest that differences in risk factors, biology, and clinical characteristics exist by race or ancestry, which may explain some of the observed disparity in MM. However, poor accrual of Black MGUS and MM patients in clinical and epidemiological studies has limited our understanding of this disparity and hindered its elimination. Disparities in MM survival also exist but appear to stem from inferior treatment utilization and access rather than underlying pathogenesis. Innovative and multidisciplinary approaches are urgently needed to enhance our understanding of disparities that exist at each stage of the MM disease continuum and facilitate their elimination.
多发性骨髓瘤（MM）是一种致命的浆细胞恶性肿瘤，中位总生存期为 5 到 10 年。MM 由更为常见但通常处于亚临床前期的单克隆丙种球蛋白病（MGUS）和冒烟型多发性骨髓瘤（SMM）进展而来。在疾病的各个阶段，不同种族之间存在着巨大的差异。与白人相比，黑人的 MGUS 和 MM 风险增加，死亡率更高，而且随着时间的推移并没有获得同样的生存获益。这种差异的根源可能是多因素的。对黑人和白人 MGUS 和 MM 患者的比较表明，种族或祖源不同会导致危险因素、生物学和临床特征存在差异，这可能解释了 MM 中观察到的部分差异。然而，由于黑人 MGUS 和 MM 患者在临床和流行病学研究中的入组率较低，限制了我们对这一差异的理解，也阻碍了其消除。MM 患者的生存差异也存在，但似乎源于治疗利用和获取方面的不足，而不是潜在的发病机制。迫切需要创新和多学科方法来加强我们对 MM 疾病连续体各个阶段存在的差异的理解，并促进消除这些差异。
