1
|
Mahmood S, Gupta P, Ma H. A retrospective analysis of factors impacting survival in United States military veterans with multiple myeloma. Leuk Lymphoma 2024; 65:530-533. [PMID: 38148142 DOI: 10.1080/10428194.2023.2295791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/12/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Sharmeen Mahmood
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Pankaj Gupta
- VA Long Beach Healthcare System, Long Beach, CA, USA
| | - Helen Ma
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, Irvine, CA, USA
- VA Long Beach Healthcare System, Long Beach, CA, USA
| |
Collapse
|
2
|
Liu LW, Wang M, Grandhi N, Schroeder MA, Thomas T, Vargo K, Gao F, Sanfilippo KM, Chang SH. The Association of Agent Orange Exposure with the progression of monoclonal gammopathy of undetermined significance to multiple myeloma: a population-based study of Vietnam War Era Veterans. J Hematol Oncol 2024; 17:3. [PMID: 38191467 PMCID: PMC10773019 DOI: 10.1186/s13045-023-01521-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/11/2023] [Indexed: 01/10/2024] Open
Abstract
Herbicide and pesticide exposure [e.g., agent orange (AO)] is associated with an increased risk of multiple myeloma (MM) due to the contaminant, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). However, it is unclear whether TCDD/AO exposure (AO exposure hereafter) increases the risk of progression of monoclonal gammopathy of undetermined significance (MGUS) to MM. We sought to evaluate the association in a nationwide study of US Veterans. A natural language processing algorithm was used to confirm MGUS and progression to MM. We included Veterans who were diagnosed with MGUS from 10/1/1999 to 12/31/2021 and served during the Vietnam War Era from 1/9/1962 to 5/7/1975. AO exposure was stratified according to three TCDD exposure levels: high (1/9/1962-11/30/1965), medium (12/1/1965-12/31/1970), or low (1/1/1971-5/7/1975). The association between AO exposure and progression was analyzed using multivariable Fine-Gray subdistribution hazard model with death as a competing event. The analytic cohort included 10,847 Veterans with MGUS, of whom 26.3% had AO exposure and 7.4% progressed to MM over a median follow-up of 5.2 years. In multivariable analysis, high exposure was associated with an increased progression rate (multivariable-adjusted hazard ratio 1.48; 95% confidence interval 1.02-2.16), compared to Veterans with no exposure. This information is critical to inform progression risk in patients diagnosed with MGUS and prior AO exposure. It is also applicable to MGUS patients with occupational TCDD exposure from herbicides and pesticides.
Collapse
Affiliation(s)
- Lawrence W Liu
- Research Service, St. Louis Veterans Affairs Medical Center, 501 N. Grand Blvd Suite 300, St. Louis, MO, 63103, USA
- City of Hope National Comprehensive Cancer Center, 1500 E. Duarte Rd, Duarte, CA, 91010, USA
| | - Mei Wang
- Research Service, St. Louis Veterans Affairs Medical Center, 501 N. Grand Blvd Suite 300, St. Louis, MO, 63103, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
| | - Nikhil Grandhi
- Research Service, St. Louis Veterans Affairs Medical Center, 501 N. Grand Blvd Suite 300, St. Louis, MO, 63103, USA
- Department of Medicine, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8056, St. Louis, MO, 63110, USA
| | - Mark A Schroeder
- Department of Medicine, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8056, St. Louis, MO, 63110, USA
| | - Theodore Thomas
- Research Service, St. Louis Veterans Affairs Medical Center, 501 N. Grand Blvd Suite 300, St. Louis, MO, 63103, USA
- Department of Medicine, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8056, St. Louis, MO, 63110, USA
| | - Kristin Vargo
- Research Service, St. Louis Veterans Affairs Medical Center, 501 N. Grand Blvd Suite 300, St. Louis, MO, 63103, USA
| | - Feng Gao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
| | - Kristen M Sanfilippo
- Research Service, St. Louis Veterans Affairs Medical Center, 501 N. Grand Blvd Suite 300, St. Louis, MO, 63103, USA
- Department of Medicine, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8056, St. Louis, MO, 63110, USA
| | - Su-Hsin Chang
- Research Service, St. Louis Veterans Affairs Medical Center, 501 N. Grand Blvd Suite 300, St. Louis, MO, 63103, USA.
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA.
| |
Collapse
|
3
|
Mielnik M, Szudy-Szczyrek A, Homa-Mlak I, Mlak R, Podgajna-Mielnik M, Gorący A, Małecka-Massalska T, Hus M. The Clinical Relevance of Selected Cytokines in Newly Diagnosed Multiple Myeloma Patients. Biomedicines 2023; 11:3012. [PMID: 38002012 PMCID: PMC10669681 DOI: 10.3390/biomedicines11113012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/29/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Multiple myeloma (MM) is the second most common hematological neoplasm. Cytokines, chemokines, and their receptors, induced by the microenvironment of MM, participate in tumor growth, the attraction of leukocytes, cell homing, and bone destruction. This study aimed to assess the correlation between the pretreatment serum concentrations of interleukin-6 (IL-6), interleukin-8 (IL-8), angiogenic chemokine monocyte chemoattractant protein-1 (MCP-1), and vascular endothelial growth factor (VEGF) and the clinical outcomes and survival of patients newly diagnosed with MM. The study group consisted of 82 individuals. The IL-8 concentration was significantly positively correlated with the age of onset (p = 0.007), the International Staging System (ISS) stage (p = 0.03), the Eastern Cooperative Oncology Group (ECOG) performance status (p < 0.001), the degree of anemia before treatment (p < 0.0001), the degree of kidney disease (p < 0.001), and VEGF (p = 0.0364). Chemotherapy responders had significantly lower concentrations of IL-8 (p < 0.001), IL-6 (p < 0.001), and VEGF (p = 0.04) compared with non-responders. Patients with treatment-induced polyneuropathy had significantly higher levels of IL-8 (p = 0.033). Patients with a high level of IL-6 had a 2-fold higher risk of progression-free survival (PFS) reduction (17 vs. 35 months; HR = 1.89; p = 0.0078), and a more than 2.5-fold higher risk of overall survival (OS) reduction (28 vs. 78 months; HR = 2.62; p < 0.001). High levels of IL-6, IL-8, and VEGF demonstrated significant predictive values for some clinical conditions or outcomes of newly diagnosed MM patients. Patients with an early response to chemotherapy had a significantly lower concentration of these cytokines. A high pretreatment IL-6 concentration was an independent negative prognostic marker for newly diagnosed MM patients.
Collapse
Affiliation(s)
- Michał Mielnik
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland
| | - Aneta Szudy-Szczyrek
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland
| | - Iwona Homa-Mlak
- Department of Human Physiology, Medical University of Lublin, 20-080 Lublin, Poland; (I.H.-M.)
| | - Radosław Mlak
- Department of Laboratory Diagnostics, Medical University of Lublin, Doktora Witolda Chodźki 1 Str., 20-093 Lublin, Poland;
| | - Martyna Podgajna-Mielnik
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland
| | - Aneta Gorący
- Department of Hematology and Bone Marrow Transplantation, Saint Jan of Dukla Oncology Centre of the Lublin Region, Doktora Kazimierza Jaczewskiego 7 Str., 20-090 Lublin, Poland
| | | | - Marek Hus
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland
| |
Collapse
|
4
|
Liu LW, Wang M, Grandhi N, Schroeder MA, Thomas T, Vargo K, Gao F, Sanfilippo KM, Chang SH. The Association of Agent Orange (AO) Exposure with Monoclonal Gammopathy of Undetermined Significance (MGUS) to Multiple Myeloma (MM) Progression: A Population-based Study of Vietnam War Era Veterans. RESEARCH SQUARE 2023:rs.3.rs-3396573. [PMID: 37886452 PMCID: PMC10602142 DOI: 10.21203/rs.3.rs-3396573/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background Herbicide and pesticide exposure (e.g., agent orange [AO]) is associated with an increased risk of multiple myeloma (MM) due to the contaminant, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Monoclonal gammopathy of undetermined significance (MGUS) is the precursor state to MM; however, not all patients with MGUS progress to MM. It is unclear whether AO exposure increases the risk of progression of MGUS to MM. Purpose We aimed to determine the association between AO exposure and progression to MM in a nation-wide study of U.S. Veterans with MGUS. Patients and Methods This is a population-based cohort study of Vietnam Era Veterans diagnosed with MGUS. A natural language processing (NLP) algorithm was used to confirm MGUS and progression to MM. The association between AO and progression was analyzed using multivariable Fine-Gray subdistribution hazard model with death as a competing event. Veterans who served during the Vietnam War Era from 1/9/1962-5/7/1975 and were diagnosed with MGUS between 10/1/1999-12/31/2021 were included. We excluded patients with missing BMI values, progression within 1 year after MGUS diagnosis date, non-IgG or IgA MGUS, or birth years outside of the range of the AO exposed group, and race other than Black and White. AO exposure and service during 1/9/1962-;5/7/1975 and stratified according to TCDD exposure levels by three time periods: 1/9/1962-11/30/1965 (high), 12/1/1965-12/31/1970 (medium), or 1/1/1971-5/7/1975 (low). The association between AO and progression was analyzed using multivariable Fine-Gray subdistribution hazard model with death as a competing event. Results We identified 10,847 Veterans with MGUS, of whom 7,996 had AO exposure. Overall, 7.4% of MGUS patients progressed to MM over a median follow-up of 5.2 years. In multivariable analysis, AO exposure from 1/9/1962-11/30/1965, high TCDD exposure, was associated with an increased risk of progression (adjusted hazard ratio 1.48; 95% confidence interval 1.02-2.16), compared to Veterans with no exposure. Conclusions In patients with MGUS, the high Agent Orange exposure time period is associated with a 48% increased risk of progression to multiple myeloma. This suggests that patients with MGUS and prior Agent Orange exposure or occupational exposure to TCDD (eg. Agricultural workers) may require thorough screening for plasma cell dyscrasias.
Collapse
Affiliation(s)
| | - Mei Wang
- St. Louis Veterans Affairs Medical Center
| | | | | | | | | | - Feng Gao
- Washington University School of Medicine
| | | | | |
Collapse
|
7
|
Hanna KS, Larson S, Nguyen J, Tu S, Boudreau J, Rose S. Updates in the management of relapsed/refractory multiple myeloma. J Oncol Pharm Pract 2021; 27:1477-1490. [PMID: 34162244 DOI: 10.1177/10781552211028906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Multiple myeloma, a malignant neoplasm of plasma cells that accumulate in bone marrow, accounts for approximately 18% of hematologic malignancies in the United States. Patients are often treated with triplet therapy and may undergo stem cell transplantation. Despite effective therapies, multiple myeloma remains incurable. Patients often require maintenance therapy, and many will progress or relapsed following upfront treatment. Selection of treatment in the relapse/refractory setting is complex due numerous active therapeutic agents and combinations. Treatment is often tailored to prior exposure and duration. In 2020, three novel pharmacological agents were approved in the relapsed setting. We highlight the clinical safety and efficacy of selinexor, isatuximab-irfc, and belantamab mafodotin for patients with multiple myeloma.
Collapse
Affiliation(s)
- Kirollos S Hanna
- Mayo Clinic College of Medicine, Maple Grove, MN, USA.,M Health Fairview Maple Grove, Maple Grove, MN, USA
| | | | - Jenny Nguyen
- M Health Fairview Maple Grove, Maple Grove, MN, USA
| | - Sarah Tu
- M Health Fairview Maple Grove, Maple Grove, MN, USA
| | | | | |
Collapse
|