Black patients with multiple myeloma face a devastating reality: they are twice as likely to develop the disease but live only half as long as White patients with the same diagnosis. This disparity persists despite evidence showing Black patients respond just as well to treatment once barriers to care are removed, according to the International Myeloma Foundation (IMF).
To address these inequities, the IMF launched M-Power in 2021, a comprehensive initiative designed to improve both short- and long-term outcomes for Black patients with multiple myeloma. The program comes at a critical time, as Black patients currently represent 20% of new multiple myeloma cases in the United States, a figure projected to rise to 25% by the next decade.
Three-Pillar Approach to Health Equity
M-Power operates through what Joseph Mikhael, MD, MEd, FRCPC, IMF's chief medical officer and professor at the Translational Genomics Research Institute, describes as "3 simple pillars": engage, educate, and enhance.
The community engagement pillar focuses on raising awareness in churches, fraternities, sororities, and community centers. "Early symptoms of multiple myeloma can look like other diseases, such as diabetes," Mikhael explained. The initiative has partnered with health care leaders in cities including Atlanta, Charlotte, and Detroit to spread awareness about recognizing early symptoms.
Primary care education addresses the critical issue of delayed diagnosis. The program ensures primary care providers understand early signs and symptoms of myeloma, know how to test for it, and when to refer patients to hematology specialists.
The third pillar, enhancement of care, focuses on the healthcare team providing culturally competent care and improving access to therapies and clinical trials.
Addressing Clinical Trial Underrepresentation
Despite comprising 20% of new multiple myeloma cases, Black patients represent only 5-8% of clinical trial participants. To tackle this disparity, M-Power recently launched a diversity in clinical trials program featuring patient testimonials.
"We've recorded them all," Mikhael said, describing video testimonials from five patients and one care partner who shared their clinical trial experiences. One patient initially rejected the idea of participating in a trial, saying "There's no way I'm going to do that. I don't trust the system." However, after careful explanation from healthcare providers, she enrolled and later stated, "I'm here today because of that trial."
The testimonial approach recognizes the importance of peer-to-peer communication in building trust. "It's one thing to hear it from Dr Joe. It's another thing to hear it from a peer," Mikhael noted.
Training the Next Generation
The M-Power program includes a Scholars for Health Equity in Myeloma initiative, pairing medical students—many from historically Black colleges and universities—with myeloma experts for six-month projects on health disparities. These students present their research at the annual meeting of the National Medical Association.
"If we're going to achieve health equity, if we're going to help reduce these disparities, it's not going to be done overnight," Mikhael explained. "Part of the long game is training a generation of doctors who are familiar with these disparities and understand them and represent their community."
Beyond Numbers: Quality of Representation
While improving representation numbers remains important, Mikhael emphasizes that meaningful participation goes beyond percentages. "It's less about the numbers, but to me, it's the whole process," he said. This includes trial design, patient engagement throughout implementation, appropriate trial locations, and staff training.
The approach also addresses emerging clinical considerations. Research suggests potential differences in adverse events from immunotherapies, such as cytokine release syndrome and neurological toxicities, based on race and ethnicity. Certain inflammatory markers are typically higher in African American and Latino American patients compared to White patients, potentially influencing treatment responses.
Building Trust from the Ground Up
M-Power's strategy recognizes that clinical trial participation requires foundational trust in the healthcare system. "We can't just think about clinical trials," Mikhael said. "I want to begin at the very basics of trusting the health care system, let alone a specific trial."
The initiative works with local community leaders, including church leaders and celebrities. Mikhael collaborated with rapper Ice-T on a video broadcast in Times Square during Black History Month, demonstrating the program's commitment to authentic community engagement.
Navigating Current Challenges
Despite political environments that have deprioritized diversity, equity, and inclusion initiatives, M-Power continues its mission. "We're as committed to it, if not even more committed to it in the environment we live," Mikhael stated. The organization maintains its apolitical stance while adapting messaging when necessary to avoid barriers to opportunity.
The program has received strong community support, with many expressing that "now more than ever, M-Power is important," according to Mikhael.
Transforming Multiple Myeloma Care
Multiple myeloma treatment has undergone significant transformation over the past 20 years, with average survival times increasing from approximately three years to more than a decade. However, these improvements have not been equally distributed across all patient populations.
The disparities stem from three core areas related to social determinants of health: inaccessible insurance systems, delayed diagnosis beyond typical delays, and limited access to novel therapies. M-Power's comprehensive approach addresses each of these barriers while building the trust necessary for sustainable change in multiple myeloma care for underserved communities.
