In 2018, researchers from Dana-Farber Cancer Institute launched a large, ambitious screening study called PROMISE (ClinicalTrials.gov identifier NCT03689595). The objectives of the study were to identify people with premalignant precursor conditions of multiple myeloma, understand the molecular signs of progression to myeloma, and develop therapies to thwart that progression.
PROMISE’s goal is to enroll 50,000 individuals between the ages of 40 and 75 in the United States and Canada who are at high risk of developing multiple myeloma. That population includes those with a first-degree relative diagnosed with the blood cancer or one of its precursor conditions (ie, monoclonal gammopathy of undetermined significance, smoldering myeloma, or Waldenström’s macroglobulinemia) and African Americans with or without a family history of multiple myeloma.
Earlier this year, as the global COVID-19 pandemic was sweeping across the United States, patient screening for the PROMISE study was halted to protect the safety of study participants and researchers. Enrollment in the study will resume once the pandemic subsides.
Ending Indifference to Human Suffering
Although age is a critical risk factor in the development of multiple myeloma—most of the approximately 32,000 people diagnosed each year are older than age 651—persons of African and African American descent have a threefold increased prevalence of the cancer compared with white individuals, even after adjusting for socioeconomic and other risk factors. In addition, those with a familial history of the disease have between a twofold and fourfold increased risk.
Although overall survival is similar for both black and white patients with myeloma, black patients have the highest death rate and shortest survival of any racial/ethnic group in the United States for most other cancers.2 African Americans also face higher rates of infection and death from COVID-19 than white individuals.3
We must never let the indifference to human suffering be our legacy.— Irene M. Ghobrial, MD, and the PROMISE study team
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Irene M. Ghobrial, MD, is Director of the Michele & Steven Kirsch Laboratory; Director, Clinical Investigator Research Program at Dana-Farber Cancer Institute; Professor of Medicine at Harvard Medical School; and principal investigator of the PROMISE study. In acknowledgment of the health-care disparities in the United States that contribute to worse survival outcomes for minority patients, as well as the protests taking place in the United States in response to the recent killing of George Floyd and other African Americans, Dr. Ghobrial issued the following statement to the PROMISE community:
During a challenging time in our nation’s history—one where COVID-19 has introduced new levels of pain and suffering—the recent killings of George Floyd, Breonna Taylor, Ahmaud Arbery, and others have underscored an older, deeper crisis: unnecessary violence against people of color. Our society fails morally and ethically when we no longer recognize a common humanity. The pain and suffering that many are experiencing should not be ignored.
COVID-19 has exacerbated the challenges minority communities face in their fight for equitable and accessible health care. African Americans are disproportionately represented on the front lines of COVID-19 response and are dying at higher rates—a direct result of systemic and multigenerational inequities in access to health care, healthy food options, and safe working conditions. We urge people to come together to actively support each other to help identify lasting solutions to heal our most vulnerable communities.
The PROMISE Study Family consists of participants across the country from all walks of life with different backgrounds and beliefs. Since multiple myeloma disproportionally affects African Americans, we continue our mission to raise awareness about existing health disparities and actively do our part to fight indifference with a renewed sense of urgency.
DISCLOSURE: Dr. Ghobrial has consulted for Takeda, Janssen, Bristol-Myers Squibb, and Celgene.
1. American Cancer Society: Key statistics about multiple myeloma. Available at https://www.cancer.org/cancer/multiple-myeloma/about/key-statistics.html. Accessed June 4, 2020.
2. American Cancer Society: Cancer Facts & Figures for African Americans 2019-2021. Available at www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-facts-and-figures-for-african-americans/cancer-facts-and-figures-for-african-americans-2019-2021.pdf. Accessed June 4, 2020.
3. Thebault R, Tran AB, Williams V: The coronavirus is infecting and killing black Americans at an alarmingly high rate. The Washington Post, April 7, 2020.