Clinical trials and other studies of multiple myeloma (MM) underrepresent Black patients, yet these studies form the backbone of the International Myeloma Working Group (IMWG) guidelines, according to a cross-sectional review. The findings of this review were published in the Journal of Cancer Policy.

“Guidelines developed based on clinical studies that do not reflect the racial composition of the population may lead to inaccurate recommendations,” the authors wrote in their report.

The authors reviewed 59 IMWG papers published up to 2022 and each cited reference was reviewed. Of the 3956 total references cited in the IMWG publications, 2047 were included in the final analysis. The references included 39% that were clinical trials, 35% that were observational studies, 20% that were diagnostic and genetic testing, 3% that were population-based studies, and 3% that were considered other.

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There were 10.4% of the references that reported the race/ethnicity of their population. Of the 5,747,920 patients included across all studies, 6.5% were Black.

Race/ethnicity was reported by 8.8% of the clinical trials reviewed and Black patients represented 1.7% of the population in these studies. In the US-only clinical trials, 14.5% reported race/ethnicity of their population and 6.5% of the 38,050 total patients were Black.

“Guidelines should consider inclusion of observational, diagnostic, and population-based studies with more black patients to allow for better reflection of disease prevalence, clinical characteristics, and/or outcomes,” the authors concluded.

Disclosures: One of the study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of disclosures.


Fahmawi S, Schinke C, Thanendrarajan S, et al. Under-representation of black patients with multiple myeloma in studies supporting International Myeloma Working Group guidelines. J Cancer Policy. 2023;37:100433. doi: 10.1016/j.jcpo.2023.100433