ASH 2019: Good News for Myeloma Treatment Today, Still Addressing Race-Associated Risks
Respected myeloma expert, Dr. Ajay Kumar Nooka, provides an update from the 61st American Society of Hematology (ASH) meeting. Dr. Nooka shares why this is a good time in myeloma research and the important work that remains around myeloma treatment disparities for people of color.
Ajay K. Nooka, myeloma minority populations, multiple myeloma, American Society of Clinical Oncology 2019, CAR T cell, racial disparities, BiTES, myeloma Hispanics, myeloma education, myeloma African American, Emory University School of Medicine, access to myeloma care, minority myeloma access, stem cell transplant, NCDB, National Cancer Database, clinical trial African American
Dr. Nooka, do you feel this is a good time for patients living with myeloma?
Dr. Ajay Nooka:
This is a really good time with a lot of improvements in myeloma. We’ve seen significant improvements over the last 20 years, but this is a time where we are seeing the benefits of what has really happened over the last 20 years in terms of the objective numbers, so that’s great news. We have newer forms of cellular therapies, the CAR T cells, the BiTES, the ADC’s – those are available to all of the myeloma patients nowadays.
This is all good news for the patients, for the providers, for the patient families and we tend to see this field to be expanding more and offering more therapeutic options.
Can you talk about the racial disparities and race-associated risks observed in the treatment of myeloma patients?
Dr. Ajay Nooka:
Myeloma is a disease that presents very early in African Americans, almost 5 years earlier in African Americans compared to Caucasians. So maybe the age of diagnosis in Caucasian populations is 69 years and in African Americans it is 64 years or so. So, it tends to present younger. It also has a lot of preponderance for the male population, so if I have to put it in the perspective, an African American male has 4 times higher rate of having myeloma compared to a Caucasian female. SO again, as we talked about, there’s a huge biological aspect that we need to understand more, why this is the case.
From a perspective of access to care, there are disparities that we see mostly in the minorities. African Americans as well as Hispanics tend to have a longer period of time for diagnosis, longer period to access initial treatment. And lesser amounts of stem cell transplant availability for the monitories compared to the Caucasian patients. This has been shown multiple times, again and again.
What’s really interesting in this meeting is that there has been a lot of large database integrations, including one database called the National Cancer Database (NCBD) where people have looked at 20 year history of how these treatments have panned out. Which of the minority populations or which subset of patients gained the most benefit over the last 20 years? And we see minorities have gotten a lot of improvement and a lot of access to the care over the last 20 years, but that’s not the end of the story, we have to catch up a lot more.
How are knowledge gaps about racial disparities in multiple myeloma being closed?
Dr. Ajay Nooka:
So, number one, education and awareness is the biggest gap that we tend to see -- or the most objective way of saying it. So education about development of clinical trials, the ability to participate in the clinical trials. To give you an example, if you take the entire clinical trials and select a pool of all these drugs, the clinical trial participation in African Americans is around 5% or even lesser, so that does not present a true demographic. So what we need is more education to take off the fear of what a clinical trial is, more education to empower them about the availability of the treatments -- make them aware of what is out there for them. Involve people that are really there -- in terms of support groups -- to make the patients aware there are clinical trials.
Dr. Nooka, thank you for your time today
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