Many studies have documented racial, socioeconomic, geographic, and other disparities for United States (US) patients with multiple myeloma pertaining to diagnosis and frontline management. In contrast, very little is known about disparities in the management of relapsed/refractory multiple myeloma (RRMM) despite a plethora of novel treatment options. In this review, we discuss the manifestations of disparities in RRMM and strategies to mitigate their impact. Immunomodulatory drugs can create disparities on many axes, for example inappropriately low dosing due to Duffy-null status as well as time toxicity and financial toxicity from logistical hurdles for socioeconomically vulnerable patients. Access to myeloma expertise at high-volume centers is a critical consideration given the disconnect between how drugs like carfilzomib and dexamethasone are prescribed in trials versus optimized in real-world practice to lower toxicities. Disparities in chimeric antigen receptor T-cell therapy and bispecific antibody therapy span across racial, ethnic, and socioeconomic lines in large part due to their limited availability outside of high-volume centers. Another insidious source of disparities is supportive care in RRMM, ranging from inadequate pain control in Black patients to limited primary care provider access in rural settings. We discuss the rationales and evidence base for several solutions aimed at mitigating these disparities: for example, (1) bidirectional co-management with community-based oncologists, (2) screening for risk factors based on social determinants of health, (3) strategies to build patient trust with regard to clinical trials, and (4) longitudinal access to a primary care provider. As the treatment landscape for RRMM continues to expand, these types of efforts by the field will help ensure that this landscape is equally accessible and traversable for all US patients.

许多研究记录了美国 （US） 多发性骨髓瘤患者在诊断和一线管理方面的种族、社会经济、地理和其他差异。相比之下，尽管有大量新的治疗方案，但人们对复发/难治性多发性骨髓瘤 （RRMM） 的管理差异知之甚少。在本综述中，我们讨论了 RRMM 差异的表现形式以及减轻其影响的策略。免疫调节药物可以在许多轴上产生差异，例如由于 Duffy 无效状态而导致的不适当低剂量，以及社会经济弱势患者后勤障碍造成的时间毒性和经济毒性。鉴于卡非佐米和地塞米松等药物在试验中的处方方式与在实际实践中优化以降低毒性的方式之间存在脱节，因此在高容量中心获得骨髓瘤专业知识是一个关键的考虑因素。嵌合抗原受体 T 细胞疗法和双特异性抗体疗法的差异跨越种族、民族和社会经济界限，这在很大程度上是由于它们在高容量中心之外的可用性有限。差异的另一个隐蔽来源是 RRMM 的支持性护理，从黑人患者的疼痛控制不足到农村地区的初级保健提供者访问受限。我们讨论了旨在减轻这些差异的几种解决方案的基本原理和证据基础：例如，（1） 与基于社区的肿瘤学家进行双向共同管理，（2） 根据健康的社会决定因素筛查风险因素，（3） 建立患者对临床试验的信任的策略，以及 （4） 纵向访问初级保健提供者。 随着 RRMM 治疗前景的不断扩大，该领域的这些类型努力将有助于确保所有美国患者都能平等地进入和穿越这一领域。