Titles and Affiliations
Assistant Professor
Hematology/Oncology, Department of Medicine
Damon Runyon Cancer Research Foundation
Research Area
Investigating whether a common genetic variant contributes to racial disparities in cancer treatment and outcomes.
Impact
Black women with breast cancer consistently experience worse outcomes than white women, and this disparity persists even after accounting for factors like stage at diagnosis and access to care. The reasons behind this gap are multifactorial, encompassing social and structural barriers to care as well as underlying biological and genetic differences that are only beginning to be understood. Dr. Merz’s research focuses on one such biological factor. The absence of a protein called Duffy on red blood cells, known as the Duffy null phenotype, is common in people who identify as Black or African American but rare in those of European or Asian descent. This variant naturally lowers white blood cell counts without increasing infection risk, yet many cancer treatments are reduced or paused when the counts fall below safety thresholds established mostly in people without this variant. Because lower treatment doses lead to worse cancer outcomes, and Black patients already experience worse cancer outcomes overall, Dr. Merz’s research investigates whether the Duffy null phenotype, rather than race itself, may explain part of this persistent disparity. Prior work has already linked Duffy null status to a higher risk of triple-negative breast cancer (TNBC) and to lower delivered chemotherapy doses in Duffy null patients on standard therapy.
What’s Next
In her DRCRF-BCRF supported research, Dr. Merz will first assess how Duffy status relates to treatment-related side effects and delivered dose intensity in both multiple myeloma and TNBC. She will utilize multiple existing clinical trial datasets to examine whether any resulting differences in treatment dose translate into differences in outcomes. Building on these findings, she will then run a pilot trial testing whether Duffy null patients can safely receive standard treatment using a lower white blood cell count threshold, comparing outcomes to usual care in patients without the variant. If successful, this pilot will lay the groundwork for a larger randomized trial, with the goal of ensuring cancer treatment guidelines account for this genetic variant, reducing racial disparities in oncology outcomes and enabling more personalized cancer care.
Biography
Lauren Merz, MD is an Assistant Professor of Medicine in the Division of Hematology/Oncology at the University of Michigan and a member of the Rogel Cancer Center’s Cancer Control and Population Science program. She completed her medical degree and a master’s in clinical research at the University of Michigan, followed by internal medicine residency and a hematology/oncology fellowship at Brigham and Women’s Hospital/Mass General Brigham–Dana-Farber Cancer Institute. Dr. Merz’s research focuses on the Duffy-null phenotype, a genetic variant present in 80–100% of individuals of West African ancestry and less than 1% of those of European or Asian ancestry, and its impact on cancer risk, treatment eligibility, and outcomes. She has led the development of Duffy-null-specific absolute neutrophil count reference intervals, work that produced the first institution-specific reference ranges of their kind and has since been extended across 23 health care systems through funding from the Doris Duke Foundation. Her broader research program aims to determine whether disparities linked to Duffy status reflect differences in baseline neutrophil counts or in underlying cytokine biology, with the goal of improving clinical trial eligibility and treatment decisions for patients who have been historically underrepresented in cancer care.
