Ethnic Minorities Under-enrolled in UK Myeloma Trials

Enrollment of ethnic minorities into academic clinical trials of multiple myeloma (MM) in the United Kingdom was below expected rates, according to a poster presentation at the 2021 American Society of Hematology (ASH) Annual Meeting.

According to Rakesh Popat, University College London Hospitals NHS foundation Trust, London, UK, who presented the data, the incidence of MM varies by ethnicity with Black patients about twice as likely to develop MM compared to White or Asian patients. Ethnic minorities have been reported to be underrepresented in clinic trials, but it is unknown if these disparities exist in a state-funded health care system where access to health care is free and should be equitable.

Popat and colleagues collected information on ethnicity, baseline demographics, progression-free survival, and overall survival from patients enrolled into first-line UK academic transplant eligible and transplant ineligible trials (Myeloma IX, XI, and XIV trials) and at first relapse (Myeloma X and XII trials). These trials enrolled patients from 2003 to 2021. Patients were enrolled across 120 centers covering a wide geographical distribution in the UK.

According to Popat, data from the National Cancer Registration and Analysis Service (NCRAS) showed an expected distribution of cases at 85.5% of cases White, 5.4% of cases Black, and 3.6% of cases to be Asian.

In all, 7291 patients were enrolled in these trials over 18 years. The ethnic distribution was 93.8% White, 2.2% Black, 1.8% Asian, and 0.6% other. The researchers noted that the skew of White patient enrollment was more apparent in transplant ineligible trials.

Enrollment distribution by ethnicity was consistent over the 18 years with no change in diversity over time despite there being an increase in non-White populations.

The researchers found that all ethnic groups derived and overall survival benefit from novel agents within trials that were not otherwise routinely available. However, a substantial proportion of ethnic minorities were not enrolled, particularly in transplant ineligible trials. This limited their potential survival gains.

Popat said that understanding the causes of inequality and addressing these is a priority for the UK-MRA to ensure that all groups can potentially benefit, and that trial results are representative of the UK population.