Differences in peripheral neuropathy reports by race informed by electronic patient-reported outcomes (ePROs) deployed in multiple myeloma (MM) clinical practice Free

Background: Past study has shown that African Americans are over twice as likely to be diagnosed with MM than Whites (Padala et al. 2021). Although Blacks are about 14% of the U.S. population, they constitute about 20% of all MM patients (International Myeloma Foundation 2025). The incidence is growing, creating an enormous burden. Current treatment guidelines recommend the combination of a proteasome inhibitor, an immunomodulatory agent, and a corticosteroid as preferred MM induction therapy. Bortezomib use comes with the risk of peripheral neuropathy (PN) with potential need for dose reduction, therapy interruption, and additional supportive medications. Black race has been shown to be an independent risk factor for the development of Bortezomib-induced PN (BIPN), warranting frequent monitoring and care measures for this population (Sun et al. 2023). Digital remote symptom monitoring (RSM) platforms with electronic patient-reported outcomes (ePROs) enable patients to report symptoms and experience during treatment while facilitating outcomes monitoring by the care team. Using data collected from ePROs deployed in MM practice, this study aimed to: 1) characterize patterns of patient-reported PN and explore its differences by race (White vs. Non-White) in MM, and 2) describe patient-reported physical function, quality-of-life (QoL), and treatment bother of MM patients with high-risk of developing severe PN.

Methods: Eligible MM patients who enrolled in Carevive PROmpt, a digital RSM platform, and reported PN at least once between September 2020 and June 2025 were included. Patients submitted weekly surveys to report PRO-CTCAE®-derived symptoms (SXs). Composite scores ranked the SXs as mild, moderate, and severe, where “alert” notifications were triggered to the care team when moderate or severe SXs were reported. Baseline characteristics were described and compared by race. Severe PN was defined as the time to first PN-associated alert. Cox Proportional Hazard model to assess the time to first PN-associated alert was conducted, with covariates including age, sex, frailty status, treatment type, and presence of pre-existing PN (yes/no). Longitudinal function (measured by PROMIS 4A), QoL (measured by GHS/QoL items of EORTC-QLQ C30), and treatment bother (measured by FACT-GP5) were explored by race.

Results: Of 149 patients included, 106 (71.1%) were White and 43 (28.9%) were Non-White (40 Black, 2 Asians, 1 multiracial). About 47% of patients (n=70) reported moderate/severe PN at least once, generating a total of 375 PN-associated alerts during the study period. Of these alerts, 150 (40%) came from Non-White. Of the 70 patients generating alerts, 25 (36%) were Non-White. Non-Whites had a higher proportion of pre-existing PN (72.1% vs 62.3%). Age, sex, frailty status, baseline Bortezomib-use, treatment setting, and ePROs follow-up were similar by race. Median time to first PN-associated alert appeared shorter in the Non-White vs. White group (12 vs. 29 days, respectively). Cox Proportional Hazard model showed Non-White (HR=2.2,p=0.028), Male (HR=2.1,p=0.04), Bortezomib use (HR=4.3, p=0.04), and Pre-existing PN (HR=2.8, p=0.008) increase the odds of reporting PN-associated alert sooner, indicative of early severe PN report. A descriptive exploration of average QoL, function, and bother scores over time in patients with pre-existing PN showed a similar trajectory for QoL and bother was by race, yet worse function in Non-Whites. Conversely, in patients without pre-existing PN, a trajectory for function and bother was similar by race, yet worse QoL for Non-Whites.

Discussion: The value of ePROs collected as part of routine MM care is seen in identifying actionable interventions to mitigate negative outcomes. Non-Whites represented 29% of the study cohort yet contributed 40% of the PN-associated alerts generated. Higher proportion of pre-existing PN and earlier severe PN report were observed in the Non-White compared to White group. Longitudinal trajectory in those with pre-existing PN showed Non-Whites had poorer physical functioning and poorer QoL in those with no pre-existing PN, suggesting a possible difference of PN impact by race. Future studies with a larger sample size are warranted. These results illustrate the value of digital RSM platform with ePROs to enable additional prevention strategies, close monitoring, and appropriate supportive care measures for Non-Whites at high risk for developing PN.