International Myeloma Foundation Chief Medical Office Joseph Mikhael, MD, shares how the M-Power initiative is addressing disparities through community engagement, education, and improved clinical trial access. This interview appears in the August issue of Evidence-Based Oncology.
Treatment for multiple myeloma has gone through a transformation over the past 20 years, with average survival times increasing from approximately 3 years to more than a decade.1 Amid this success, however, a stubborn fact remains: Black individuals are twice as likely to develop the disease, but their survival times have not matched those for the overall population.2 Yet, according to the International Myeloma Foundation (IMF), Black patients respond just as well to treatment, once barriers to care come down. With this in mind, the IMF launched an initiative in 2021 called M-Power, which seeks to improve both short- and long-term outcomes for Black patients with myeloma.3
From the start, M-Power focused on engagement by partnering with health care leaders in several cities—Atlanta, Georgia; Charlotte, North Carolina; and Detroit, Michigan, for example—to spread the word: Early symptoms of multiple myeloma can look like other diseases, such as diabetes.3 Doctors and patients need to know what to look for, so treatments have a greater chance of success. As M-Power expands, it coordinates outreach with Black fraternities and sororities, which serve as ongoing professional and personal networks long after members finish college.
Joseph Mikhael, MD | Image: T-GEN
For its second pillar, education, M-Power has poured energy and resources into other initiatives, according to Joseph Mikhael, MD, MEd, FRCPC, IMF’s chief medical officer and a professor at the Translational Genomics Research Institute, part of City of Hope, in Phoenix, Arizona. These include a mentoring program for young physicians who may become myeloma researchers; if they don’t, they will be more informed about the disease in their careers in primary care or other specialties. For this program, IMF partners with the National Medical Association, the country’s oldest organization representing Black physicians and their patients.4
Finally, M-Power’s third pillar calls for improving outcomes for Black patients. This includes educating the treatment team along with a brand-new initiative to get more Black patients into multiple myeloma clinical trials, where they are currently underrepresented.5
In a summer 2025 interview, Evidence-Based Oncology (EBO) spoke with Mikhael about M-Power’s evolution and IMF’s awareness campaign, the need to build trust before focusing on numbers in clinical trials, and how M-Power is adapting to a political environment that has deprioritized diversity, equity, and inclusion.6
This interview has been edited for length and clarity.
EBO: Can you share with our audience the reasons why M-Power is needed?
Mikhael: The backdrop is that myeloma is arguably the most disparate cancer within the African American community and has tremendous health disparities within the Latino American community and many others. Those are the 2 [communities] we’ve highlighted because those are the 2 that have the greatest disparity that at least we know of. That is to say, a Black man or Black woman diagnosed today with myeloma is expected to live half as long as the same aged White man or White woman.2
That’s not because the biology is more aggressive. Instead, it has to do with 3 core areas of the social determinants of health. First, the way the insurance system runs is not accessible; second, there is a delayed diagnosis of myeloma beyond the usual delay of diagnosis that we see in the majority of our patients; and finally, there are issues with access to specific novel therapies.
We’ve shown that these are 3 areas of disparity. So the M-Power program, which is a bit of a play on the words myeloma and power, was designed to improve the short- and the long-term outcomes of individuals with multiple myeloma who historically had such inferior outcomes, primarily the African American and Latino American populations.
EBO: What are the core parts of the program?
Mikhael: The M-Power program was really built on 3 simple pillars, if you will. No. 1 is community engagement. No. 2 is primary care education, and No. 3 is enhancement of the care of [patients with myeloma]. So the 3 e’s of engage, educate, and enhance.
The engagement part is the notion that we go to churches, fraternities, sororities, community centers, anywhere and everywhere people are going to be, to just raise general awareness of myeloma—to know the signs, to know the symptoms—because this disease can be so insidious in how it affects these communities in such a dramatic way. As you know, African Americans like myself are at twice the risk of developing myeloma; if they know someone with myeloma, we can provide them the support that they need.
Primary care education is really all about that late diagnosis. We are making sure our primary care providers know the early signs and symptoms of myeloma, how to test for it, and when to refer to hematology. To facilitate that process, and probably most relevant to the discussion we are having today, is that third pillar of the enhancement of care for the [patient with myeloma]. This focuses [on] the health care team that takes care of [these] patients: the physicians, the nurses, the other allied health [professionals]. Are we providing the most culturally competent and relevant care?7 Are we providing the kind of care that will indeed help reduce disparities, which includes access to therapies, access to clinical trials, and ensuring that the workforce of health care providers [is] very much aligned with this thinking and representative of that community?7
EBO: Which initiatives are your highest priorities today?
Mikhael: What’s the top of our list now? We continue to roll out this program, but probably 2 things have the greatest focus right now: No. 1 is our medical students—our Scholars for Health Equity in Myeloma program. We have medical students, many of whom are from historically Black colleges and universities, and we pair them together with a myeloma expert for 6 months to work on a project on health disparities. Then we all gather at the annual meeting of the National Medical Association (NMA) to present the posters because we do this in partnership with the Cobb Institute, which is the research arm of the NMA.
The idea here is, if we’re going to achieve health equity, if we’re going to help reduce these disparities, it’s not going to be done overnight. It takes a long time, and part of the long game is training a generation of doctors who are familiar with these disparities and understand them and represent their community. They can provide better health care to all, whether they become myeloma doctors or not. Of course, I want [more] doctors.
Finally, and relevant to the discussion you are anticipating is that we’ve just launched our diversity in clinical trials program. So many different groups have worked on [this] in different ways, in different capacities. I think it’s one of those issues, like any other major problem, where there’s no 1 simple solution. One solution that we in M-Power at the IMF felt that we could bring to this equation that is not brought by many others is to have patients from underrepresented communities who have been on a clinical trial share their story.
And so what we’ve done is, we’ve recorded them all. We all gathered together in Atlanta and in different settings and recorded them in short clips, long clips. We’d have them work with a coach to talk about what was it like to be on a trial. And it’s remarkable to me to listen to some of these individuals. One individual in particular I can think of, she said, soon as [she] heard the word clinical trials, “There’s no way I’m going to do that. I don’t trust the system.” But then, when she took the time and had the opportunity with...a health care provider who is very careful in their explanation of it, ultimately, she went on trial. And she said, “I’m here today because of that trial.”
So now our plan to roll this out is the IMF, with all of the strength of our social media but also all of our patient programs....We will be...having these individuals—we recorded the stories of 5 patients and 1 care partner—either in person or [via] these video clips...share that with the audience so that they can understand and appreciate it. Because it’s one thing to hear it from Dr Joe. It’s another thing to hear it from a peer.
EBO: Is this important when you’re dealing with a population that, for very good reason, has historical distrust of the health system?
Mikhael: Absolutely, absolutely.
EBO: As you know, the data reported show that the percentage of newly diagnosed patients with multiple myeloma who are African American is rising and is expected to be 25% by the next decade. Are your efforts going to keep pace with that, or is that going to be a lift?
Mikhael: I think there are different ways of looking at it. I mean, the numbers are staggering. Even now, 20% of patients in this country are African descent, and yet most clinical trials representation is only somewhere between 5% and 8% typically. Obviously, that is beginning to improve as well, and that number, as you commented, is going to climb.
Yes, we want to keep pace with that. We want to have more access for patients, to have clinical trials [that include] all backgrounds, but in particular, those who have been underrepresented. But at the same time, I always remind people, it’s not just about a formal numbers representation, right? It’s ensuring that in the whole of the process that people understand that if patients are not well represented on these trials, we cannot say that these drugs are both safe and efficacious for all.
For example, we’re starting to see some differences in some of the...adverse events of immunotherapies, things like cytokine release syndrome and neurological toxicities. There may be some differences based on race and ethnicity. There are certain inflammatory markers that are typically higher in African American or Latino American patients than White patients. And so this may have an influence.
“The idea here is, if we’re going to achieve health equity, if we’re going to help reduce these disparities, it’s not going to be done overnight. It takes a long time, and part of the long game is training a generation of doctors who are familiar with these disparities and understand them and represent their community. They can provide better health care to all, whether they become myeloma doctors or not.”
—Joseph Mikhael, MD, MEd, FRCPC
So if I’m going to speak to my patient tomorrow, who is Black, who says to me, “Well, doc, I see the CAR [chimeric antigen receptor] T-cell therapy had this great outcome, but there [was] only 1% representation of Black patients on this clinical trial. Can you really tell me whether this is both safe and good for me?”
Those are the kinds of discussions that we have to have. So it’s incumbent on us to do that and to keep pace. I’m not saying that every trial needs 24% representation of African Americans and 13% representational Latino. It’s less about the numbers, but to me, it’s the whole process. It’s in the design of the trial. It’s patient engagement throughout that design and implementation of the trial. It’s having [a team] that is going to recognize that we have to facilitate participation, not just once everything has been completed and done.
It involves the trial locations. It involves the training of the staff who are doing the trial, and it involves our health care system genuinely reaching out to this community and not just expecting them to come to us when they’re sick.
...One of the greatest lessons I’ve learned through this process is that if health care institutions are just designed to react to ill health, then we’re not promoting health and prevention and wellness in general. And I do think we’re seeing that change. We’re starting to see hospitals and hospital networks reaching out into the community, and that’s part of the goal of M-Power—to reach out first and not just wait until someone’s diagnosed with myeloma to start to deal with it.
EBO: So if a patient is diagnosed, they’re not starting from ground zero, of not even knowing what a clinical trial is. Is that the mission?
Mikhael: That’s part of it as well. Because the other way I like to look at this is that one of the reasons why clinical trials was not the first item on our agenda of M-Power was that when we look at health disparity in myeloma, and when we look at health disparities in general, we can’t just think about clinical trials. With due respect to our industry colleagues, sometimes that’s sort of the top of their list, but I want to begin at the very basics of trusting the health care system, let alone a specific trial.
At the same time, I also believe that we need to normalize clinical trials, and one of the goals of our program and having these patients share with us is [for others to hear] they didn’t have to go to a different planet to go on to a clinical trial but that it’s right there, typically within their clinic or within theirregion. [This will] normalize the care of trials so that people see that it’s not just about another generation, that they’re helping themselves. This is part of natural treatment and normal treatment.
EBO: So the idea here is that as long as you see trial enrollment trending in the right direction, the specific percentages are less important than the overall trend line?
Mikhael: That’s correct. In any one study, it’s hard to identify that trend. It’s very important. And then I do think it’ll be a bit of a self-fulfilling prophecy because as more people are engaged, they’ll realize, “Oh, this is something that is reasonable,” and they’ll share that within their community….And that’s why for us, and for M-Power,...we don’t want to make it sound like we just descend with some cape and provide a solution and leave.7 We engage the local individuals who have that credibility—the church leaders, the community leaders; we’ve worked with famous actors and actresses. For example, I did a video with Ice-T that we broadcast in Times Square throughout Black History Month. These are the sorts of things where we hope that it will be within the community and not just external.
EBO: How is the current environment with this administration affecting your work?
Mikhael: I think the way I answer that is that we know how important the work that we’re doing is, and we’re as committed to it, if not even more committed to it in the environment we live. We’re an apolitical organization. We’re not partisan. We don’t do things on a political basis, but the way I look at it is, to quote that lovely expression, “Be wise as serpents and harmless as doves.” There are times when we may have to change some of our wording for the sake of not offending individuals or not barring opportunity, but at the same time, the principles behind what we believe are the same.
So are there challenges? Yes, there are going to be challenges. There are going to be challenges of explaining things to individuals. There are going to be funding challenges. But at the same time, we have seen a wonderful response within the community to say, “Now more than ever, M-Power is important.” We continue to do the work, and we do continue to do it, always intelligently, always wisely, but just as passionately.
References
Sequencing CAR T and Bispecifics for Multiple Myeloma: Tyler Sandahl, PharmD
July 8th 2025Tyler Sandahl, PharmD, a clinical pharmacist at Mayo Clinic, explains that sequencing novel multiple myeloma therapies with CAR T-cell therapy is generally prioritized first for eligible patients, while bispecific antibodies are reserved for later lines or for patients unable to tolerate CAR T.
Read More
Driving Value via Outcomes-Based Pricing and EHR Interoperability: Tyler Sandahl, PharmD
July 7th 2025Tyler Sandahl, PharmD, a clinical pharmacist at Mayo Clinic, discussed the complexities of alternative payment models for chimeric antigen receptor T-cell and bispecific therapies and the need for improved data sharing in cancer care.
Read More
FDA Expands Access to Approved CAR T-Cell Therapies by Eliminating REMS
June 30th 2025The FDA has removed Risk Evaluation and Mitigation Strategies (REMS) for approved chimeric antigen receptor (CAR) T-cell therapies for hematologic malignancies, aiming to ease provider burden and expand patient access.
Read More
