Background: Outcomes of Myelodysplastic syndromes (MDS) can be influenced by race, ethnicity, and socioeconomic factors. While individual studies have reported differences in survival and clinical trial participation between non-Hispanic Black (NHB) and non-Hispanic White (NHW) patients, pooled estimates have been lacking. Clinical trial participation, being a key driver of access to novel therapies, remains another scope where disparities persist. We conducted a meta-analysis to elucidate these incongruencies.

Methods: Using PRISMA guidelines, we searched PubMed, Web of Science, Cochrane, and ClinicalTrials.gov for studies published between 2015 and 2025 on MDS that reported hazard ratios (HRs) or odds ratios (ORs) in the context of race, treatment, or survival. From 5,529 records (with 361 duplicates counted twice), 79 studies met inclusion criteria; a subset with directly comparable effect measures was pooled for meta-analysis.

Results:

  • Overall Survival (OS), NHB vs NHW males: Three studies were eligible. The pooled HR was 0.85 (95% CI: 0.83–0.87, p < 0.001), I² = 92.6%, Q = 33.47 with p < 0.001 indicates a 15% lower hazard of death for NHB males. However, heterogeneity was high, indicating considerable variability in effect sizes across studies.

  • Clinical Trial Participation, NHB vs NHW males: The pooled OR from the two eligible studies was 0.64 (95% CI: 0.61–0.67, p < 0.001), I² = 92.6%, Cochrane's Q 13.49, p < 0.001. NHB males were 36% less likely to enroll in clinical trials. The narrow confidence interval and significance indicate a consistent disparity. Nonetheless, heterogeneity was high.

Conclusions: Our findings reveal two contrasting patterns: NHB males with MDS show better pooled OS compared to NHW males yet remain underrepresented in clinical trials. The high heterogeneity in survival outcomes suggests that study-level differences, such as population characteristics, treatment patterns, or data sources, may influence results. These disparities propound the need for more harmonized, prospective research designs to better understand the drivers behind these patterns and to ensure equitable access to clinical research and therapies in MDS.

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2025
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