Myeloma Deaths Are Falling Fast in the US, but a Stark Racial Divide Refuses to Close

Multiple myeloma, an incurable cancer of plasma cells in the bone marrow, has quietly become one of the clearest success stories of modern oncology. Proteasome inhibitors, immunomodulatory drugs, anti-CD38 monoclonal antibodies, and most recently chimeric antigen receptor T-cell therapies have transformed a disease that was once almost uniformly fatal within a few years into a condition many patients live with for a decade or more. Yet a sweeping new analysis of national death records shows that this therapeutic revolution has not reached all Americans equally, and that some of the most alarming gaps in survival are projected to persist well into the next decade.

The study, published in Cancer Causes & Control, examined multiple myeloma mortality across the United States from 1999 through 2024 and extended forecasts to 2034. Researchers drew on the CDC Wide-Ranging Online Data for Epidemiologic Research database, identifying myeloma-related deaths with the ICD-10 code C90.0. From these records they calculated age-adjusted mortality rates per one million population, standardized to the 2000 US population, and applied joinpoint regression to detect statistically significant shifts in trend over time. To look forward, they built autoregressive integrated moving average models, selected by the Akaike Information Criterion, projecting rates with 95 percent confidence intervals through 2034.

The headline finding is genuinely encouraging: age-adjusted myeloma mortality fell from 37.6 to 25.1 deaths per million between 1999 and 2024, an average annual decline of 1.8 percent. More striking is when that decline accelerated. The annual percent change dropped to minus 3.2 percent after 2012, a statistical inflection that the authors link directly to the widespread adoption of novel therapeutic agents. That year, landmark trials of lenalidomide maintenance after stem-cell transplantation reshaped standard care, and the subsequent years brought proteasome inhibitor combinations, lenalidomide-based regimens, daratumumab, bispecific antibodies such as teclistamab, and CAR T-cell products like idecabtagene vicleucel into the clinic.

Beneath the encouraging national curve, however, lies a stratified picture that has barely budged in twenty-five years. Men consistently died at far higher rates than women, recording 32.4 deaths per million in 2024 compared with 19.8 for women. Adults aged 65 and older carried the heaviest burden by far, with a mortality rate of 175 per million in 2024, down from 230 in 1999, reflecting both the age-dependent incidence of myeloma and the challenges of treating frail elderly patients with intensive regimens. Geriatric assessment has been shown to predict survival and toxicity in older myeloma patients, yet undertreatment in this population remains a persistent concern.

The starkest disparity is racial. Black or African American individuals experienced the highest myeloma mortality of any group throughout the entire study period, and in 2024 their age-adjusted death rate stood at 48.0 per million, more than double the rate of 23.5 among White individuals. This is not simply a reflection of higher incidence, though Black Americans do develop myeloma more frequently. Prior SEER-Medicare analyses have documented racial differences in treatment patterns and outcomes, and population-based studies have shown that disparities in myeloma incidence and survival track closely with access to specialty care, novel agents, and clinical trial participation. Even as average outcomes improve, the benefits of new drugs appear to accrue faster to populations already closer to centers of excellence.

Geography tells a parallel story of uneven progress. The South and nonmetropolitan counties consistently showed higher mortality than other census regions and metropolitan areas. Rural patients face longer travel distances to hematologists, fewer transplant-capable facilities, and lower enrollment in the clinical trials that have driven recent advances. Analyses of the National Cancer Database have linked hospital facility characteristics and socioeconomic factors to myeloma treatment and outcomes, underscoring that where a patient lives and receives care can matter nearly as much as which drugs exist.

The study also tracked where Americans die of myeloma, an indicator that reflects both end-of-life care patterns and access to hospice. Earlier national work on cancer deaths has documented racial, age, and geographic disparities in place of death, and the broader shift of American deaths from hospitals to homes and hospice facilities has been well described. The persistence of these patterns among myeloma patients suggests that disparities extend beyond drug access into the structure of palliative and supportive care itself.

Looking ahead, the ARIMA projections offer a mixed forecast. National age-adjusted mortality is expected to continue declining, reaching approximately 20.0 per million by 2034, with a confidence interval of 17.5 to 22.5. That trajectory would represent a further one-third reduction from current levels, plausibly driven by bispecific antibodies, CAR T-cell therapy, and the growing arsenal of agents moving into earlier lines of treatment. But the models also indicate that racial, geographic, and sociodemographic gaps are projected to persist essentially unchanged. In other words, if current patterns of access hold, the average American with myeloma will fare better in 2034, while the excess burden borne by Black Americans, rural residents, and Southerners will remain stubbornly intact.

The authors argue that closing these gaps will require more than new molecules. Equitable access to care, earlier diagnosis, and improved representation of underserved populations in clinical research are named as essential complements to therapeutic innovation. Earlier diagnosis is particularly consequential because myeloma is often preceded by identifiable precursor states, and delays in detection disproportionately affect populations with weaker connections to routine medical care. Clinical trial diversity matters because the drugs of the next decade will be calibrated on the populations that test them, and myeloma trials have historically under-enrolled the very groups with the highest disease burden.

For a disease affecting roughly tens of thousands of newly diagnosed Americans each year, the quarter-century record synthesized in this analysis is a testament to how rapidly biomedical science can change survival curves. It is also a cautionary tale about who shares in that progress. The decline in myeloma mortality after 2012 is one of the clearest population-level signatures of the precision medicine era, yet the doubling of death rates between Black and White Americans in 2024 shows that a rising tide of innovation has lifted boats unevenly. As immunotherapies push ever deeper into myeloma treatment, the central policy question the study poses is no longer whether effective drugs exist, but whether the health system can deliver them equitably across the lines of race, age, sex, and geography that this national data set lays so plainly bare.

Subject of Research: National trends and persistent disparities in multiple myeloma mortality in the United States, 1999–2024

Article Title: Two decades of progress, persistent inequity: national trends in multiple myeloma mortality in the United States, 1999–2024

Article References: Two decades of progress, persistent inequity: national trends in multiple myeloma mortality in the United States, 1999–2024. (n.d.). https://doi.org/10.1007/s10552-026-02253-x

Image Credits: AI Generated

DOI: 10.1007/s10552-026-02253-x

Keywords: multiple myeloma, mortality trends, health disparities, CDC WONDER, joinpoint regression, ARIMA forecasting, racial disparities, novel therapies, age-adjusted mortality, health equity, cancer epidemiology, decades