BOSTON – While recent studies have identified a significant and increasing disparity in survival among African American and Caucasian patients diagnosed with multiple myeloma in the United States, that does not appear to be the case at the VA.

Nor do veterans appear to face disparity in access to novel chemotherapy and stem-cell transplant, according to a presentation at the recent American Society of Clinical Oncology annual meeting.1

VA Boston Healthcare System-led researchers investigated whether the disparity exists at the VA, which does not use a fee-for-service model. To do that, researchers used the VA’s nationwide Corporate Data Warehouse to identify patients diagnosed with MM from 1999 to 2017. Information also was gathered about the patients’ age, race, therapy at induction, and stem-cell transplant status.

The study included 15,717 patients diagnosed with MM, including 3,254 AA and 8,845 Caucasian patients. With the median age at diagnosis being 65.6 years for AA patients and 70.1 for Caucasian patients, the researchers noted that “age has a substantial effect on overall survival” and adjusted their survival analysis accordingly.

The authors reported that they found no difference in age-adjusted overall survival between AA and Caucasian patients, measured by hazard ratio of risk of death among AA relative to Caucasian (HR 0.99, 95% CI 0.94-1.05, P=0.69).

“However, among patients younger than 65 at diagnosis, we observed a significant decrease in age-adjusted risk of death for AA compared to Caucasian patients (HR 0.86, 95% CI 0.79-0.94, P=0.001),” the researchers wrote. “In patients >65 years, survival was similar between the 2 groups. The difference in younger population was not explained by access or utilization of the novel agents.”

The also advised that researchers “observed no racial disparity at the VA in the use of novel agents at induction (IMiD or PI), with 82.5% of AA patients and 81.5% of Caucasian patients receiving novel therapy (P=0.21); or in use of stem-cell transplant (10.1% of AA and 9.1% of Caucasian patients; P=0.09).”

Explaining that they found no disparities at the VA, the nation’s largest healthcare system, in terms of overall survival or treatment patterns, the authors suggested, “Taken with previous research that does show these disparities in other systems, this suggests that these disparities may be due primarily to economic factors, including cost of therapy, rather than factors related to disease biology.”


  1. Fillmore N, Yellapragada S, White PS, Ifeorah C, et. Al. Lack of racial disparity in outcome of African American (AA) and Caucasian patients with symptomatic multiple myeloma (MM) at the Veterans Affairs (VA) hospitals. (June 4-8, 2021) Nutritional status and outcomes of veterans undergoing curative surgery for colorectal cancer. ASCO 2021 annual meeting. Virtual.