Structural Racism Identified as Key Driver of Survival Disparities in Myelofibrosis

Structural racism, rather than biological differences or treatment patterns, appears to drive survival disparities in myelofibrosis (MF) among minority patients, according to a new multicenter analysis, according to study results published in Blood Cancer Journal.

Structural racism is the largest mediator of survival in acute myeloid leukemia, but few analyses have examined the potential drivers of disparity in myeloproliferative neoplasms (MPNs). “With this in mind, we aimed to investigate potential drivers of disparate outcomes in patients with MF, including patient characteristics, disease features, treatment modalities, and census-tract level measures,” explained Andrew Palmer, University of Chicago Pritzker School of Medicine, Chicago, IL, and coauthors. “Furthermore, we aimed to characterize the applicability of current MF risk stratification tools in a heterogeneous population of patients.”

Researchers from 6 Chicagoland institutions conducted a retrospective review of 548 adults diagnosed with MF since 2011 to examine potential contributors to survival disparities. The cohort included non-Hispanic white (NHW), non-Hispanic Black (NHB), Hispanic, and non-Hispanic Other (NHO) patients, with comprehensive data collected on demographics, disease biology, treatments, complications, and neighborhood-level social determinants.

Driver mutations did not differ by race, nor did many disease features. However, treatment patterns varied: JAK inhibitors were prescribed less often to NHB patients (40%) than to NHW, Hispanic, or NHO patients (53% to 57%), though these differences disappeared when low-risk patients were excluded. Rates of allogeneic transplant were also numerically lower for NHB patients, but not statistically significant.

Survival analysis revealed a 42% higher risk of death for NHB patients compared with NHW patients after adjusting for age and gender. Crucially, when census-tract measures of structural racism, such as neighborhood disadvantage and racial segregation, were added to the model, the disparity disappeared entirely (hazard ratio = 0.98). Similar patterns were observed for NHO patients. Neither insurance status, JAK inhibitor use, nor transplant rate meaningfully mediated disparities.

The study also found that widely used prognostic scoring systems (DIPSS+ and MIPSS70+ v2.0) underperformed in Hispanic patients, raising concerns about the applicability of existing risk tools in more diverse populations.

“In conclusion, our study demonstrates an enduring disparity in survival for NHB patients relative to NHW patients, which is largely driven by structural racism,” concluded the study authors.

Reference

Palmer A, Rauscher G, Schoen A, et al. Assessing drivers of disparate outcomes and applicability of risk stratification in a cohort of patients with myelofibrosis. Blood Cancer J. 2025;15(1):158. doi:10.1038/s41408-025-01366-x