One of the National Cancer Institute's (NCI) priority research areas is understanding the underlying causes of cancer health disparities. In recent years, there have been multiple efforts focusing on the disparities that exist within various cancer types, for example, the higher risk of triple-negative breast cancer in black women and prostate cancer in black men. One disease in which disparities are seen prominently is multiple myeloma (MM), the second most common hematologic malignancy, with an estimated 31,000 new cases to be diagnosed in 2018. Despite new treatments significantly improving survival rates, MM remains incurable and incidence rates continue to increase. Furthermore, the burden from MM and its premalignant conditions, monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM), is not shared equally across racial/ethnic groups in the US. Blacks have the highest incidence of MGUS and MM, with a rate 2-3 times higher than non-Hispanic whites. Blacks and Hispanic/Latinos are more likely to experience an earlier age of onset, and blacks are twice as likely to die compared to other racial/ethnic groups, even when matched for socioeconomic and other factors, suggesting that biologic differences may play an important role in the observed disparity. To understand the current state of MM research in the context of disparities, a trans-NCI group organized a one-and-a-half-day Think Tank and Provocative Question (PQ) Session on March 5-6, 2018. Over 35 MM researchers and more than 20 NCI staff from disciplines spanning the cancer continuum attended. The meeting began with the PQ session, which was designed to challenge participants to think creatively about MM and disparities and discuss understudied research questions that, if answered, could move the field forward. The Think Tank uncovered gaps and identified challenges that hinder progress in understanding progression from normal to premalignant conditions to MM in different racial/ethnic populations. The final portion of the day was dedicated to discussing strategies for accelerating the field. The subject matter experts identified several scientific and resource gaps that are barriers to making progress in this area. These included the need for hematologic malignancy models (cell lines and PDX models) from diverse populations, serial biospecimen collection from MGUS, SMM and MM patients of various racial/ethnic groups, and increased clinical trial accrual of minorities. Areas of research that were considered priorities to understand the underlying causes of increased incidence among different populations included biomarker discovery to identify high-risk patients, increased use of multiple ‘omics analysis, and understanding the role of the immune system. Another priority discussed was the need for innovative sensing technology for accurate detection of the premalignant MGUS. The NCI is pursuing several areas that are ripe for further investment to help eliminate the disparities in multiple myeloma.
Citation Format: Amy E. Kennedy, L. Michelle Bennett. Uncovering research gaps and strategizing future efforts: NCI Think Tank on multiple myeloma and disparities [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A121.