1
|
Malard F, Neri P, Bahlis NJ, Terpos E, Moukalled N, Hungria VTM, Manier S, Mohty M. Multiple myeloma. Nat Rev Dis Primers 2024; 10:45. [PMID: 38937492 DOI: 10.1038/s41572-024-00529-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/29/2024]
Abstract
Multiple myeloma (MM) is a haematological lymphoid malignancy involving tumoural plasma cells and is usually characterized by the presence of a monoclonal immunoglobulin protein. MM is the second most common haematological malignancy, with an increasing global incidence. It remains incurable because most patients relapse or become refractory to treatments. MM is a genetically complex disease with high heterogeneity that develops as a multistep process, involving acquisition of genetic alterations in the tumour cells and changes in the bone marrow microenvironment. Symptomatic MM is diagnosed using the International Myeloma Working Group criteria as a bone marrow infiltration of ≥10% clonal plasma cells, and the presence of at least one myeloma-defining event, either standard CRAB features (hypercalcaemia, renal failure, anaemia and/or lytic bone lesions) or biomarkers of imminent organ damage. Younger and fit patients are considered eligible for transplant. They receive an induction, followed by consolidation with high-dose melphalan and autologous haematopoietic cell transplantation, and maintenance therapy. In older adults (ineligible for transplant), the combination of daratumumab, lenalidomide and dexamethasone is the preferred option. If relapse occurs and requires further therapy, the choice of therapy will be based on previous treatment and response and now includes immunotherapies, such as bi-specific monoclonal antibodies and chimeric antigen receptor T cell therapy.
Collapse
Affiliation(s)
- Florent Malard
- Sorbonne Université, Centre de Recherche Saint-Antoine INSERM UMRs938, Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
| | - Paola Neri
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Canada
| | - Nizar J Bahlis
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Canada
| | - Evangelos Terpos
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nour Moukalled
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Salomon Manier
- Department of Hematology, Lille University Hospital and INSERM UMR-S1277 and CNRS UMR9020, Lille, France
| | - Mohamad Mohty
- Sorbonne Université, Centre de Recherche Saint-Antoine INSERM UMRs938, Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
| |
Collapse
|
2
|
Nielsen LH, Kristensen DT, Jakobsen LH, Bøgsted M, Gregersen H, Madsen J, Severinsen MT, Brøndum RF. Socioeconomic Status and Overall Survival Among Patients With Hematological Malignant Neoplasms. JAMA Netw Open 2024; 7:e241112. [PMID: 38436954 PMCID: PMC10912957 DOI: 10.1001/jamanetworkopen.2024.1112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/15/2024] [Indexed: 03/05/2024] Open
Abstract
Importance In recent years, there has been a focus on reducing the socioeconomic gap in survival for hematological malignant neoplasms. Understanding recent developments is important to develop further intervention to improve care. Objective To investigate the temporal trend in associations of socioeconomic status (SES) with survival among 3 aggressive hematological malignant neoplasms: multiple myeloma (MM), acute myeloid leukemia (AML), and diffuse large B-cell lymphoma (DLBCL). Design, Setting, and Participants This nationwide, population-based cohort study used retrospectively collected data from 3 clinical registries of patients diagnosed in Denmark between January 1, 2005, and December 31, 2020, with follow-up until December 31, 2021. Analyses were stratified by diagnosis year (2005-2009, 2010-2014, and 2015-2020). Participants were patients aged 25 to 65 years with hematological malignant neoplasms. Patients with missing data on education were excluded. Data were analyzed from October 14, 2022, to January 2, 2024. Exposure Education was used as a proxy for SES and defined low- and high-SES groups based on the completion of tertiary education. Main Outcomes and Measures The main outcome was overall survival (OS), analyzed using Kaplan-Meier (log rank) method and Cox proportional hazards regression adjusted for age, sex, performance status, comorbidities, and disease-specific prognostic indices. Two-year OS through time and survival difference were estimated using flexible parametric survival models. Results A total of 5677 patients (median [IQR] age, 58 [51-62] years; 3177 [57.0%] male) were assessed, including 1826 patients with MM, 1236 patients with AML, and 2509 patients with DLBCL. The 2-year OS increased over time for patients with MM (78.8% [95% CI, 75.4%-82.3%] to 91.4% [95% CI, 89.3%-93.5%]), AML (42.2% [95% CI, 37.8%-47.1%] to 52.7% [95% CI, 48.0%-57.9%]), and DLBCL (80.1% [95% CI, 77.4%-82.8%] to 88.1% [95% CI, 86.0%-90.3%]). For MM and DLBCL, no association of SES with survival was observed after adjustment (MM: hazard ratio [HR], 0.99 [95% CI, 0.85-1.15]; DLBCL: HR, 1.08 [95% CI, 0.91-1.29]). For AML, a negative association was observed between low SES and survival (HR, 1.49 [95% CI, 1.25-1.76]), but the association was attenuated in recent years. The difference in hazard for patients with low SES and AML was observed in the first 2 years after diagnosis. Conclusions and Relevance These findings suggest that survival has improved among patients with these hematological malignant neoplasms. While patients with MM and DLBCL had increased survival in all groups, disparities were observed in AML outcomes, primarily in the first years after diagnosis. These results suggest that differences originate in factors specific to AML.
Collapse
Affiliation(s)
- Lars Hernández Nielsen
- Center for Clinical Data Science, Department of Clinical Medicine, Aalborg University and Research, Education and Innovation, Aalborg University Hospital, Aalborg, Denmark
| | - Daniel Tuyet Kristensen
- Center for Clinical Data Science, Department of Clinical Medicine, Aalborg University and Research, Education and Innovation, Aalborg University Hospital, Aalborg, Denmark
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Lasse Hjort Jakobsen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Mathematical Sciences, Aalborg University, Aalborg, Denmark
| | - Martin Bøgsted
- Center for Clinical Data Science, Department of Clinical Medicine, Aalborg University and Research, Education and Innovation, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Gregersen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Jakob Madsen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Marianne Tang Severinsen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rasmus Froberg Brøndum
- Center for Clinical Data Science, Department of Clinical Medicine, Aalborg University and Research, Education and Innovation, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
3
|
Blue B, Pierre A, Mikhael J. Culturally Responsive Care Delivery in Oncology: The Example of Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:651-659. [PMID: 37290997 DOI: 10.1016/j.clml.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 06/10/2023]
Abstract
Multiple myeloma (MM) represents ∼1% of all cancers and is the second most common hematologic malignancy worldwide. The incidence of MM is at least two times higher in Blacks/African Americans compared with their White counterparts, and Hispanics/Latinxs are among the youngest patients diagnosed with the disease. Recent advances in available treatments for MM have demonstrated significant improvement in survival outcomes; however, patients from non-White racial/ethnic groups clinically benefit less due to multiple factors including access to care, socioeconomic status, medical mistrust, underutilization of novel therapies, and exclusion from clinical trials. Health inequities in disease characteristics and risk factors based on race also contribute to inequities in outcomes. In this review, we highlight racial/ethnic factors as well as structural barriers attributed to variations in MM epidemiology and management. We focus on three populations-Black/African American, Hispanic/Latinx, and American Indian/Alaska Native-and review factors that healthcare professionals may consider when treating patients of color. We offer tangible advice for healthcare professionals on how to incorporate cultural humility into their practice by following the five key steps: establishing trust, respecting cultural diversity, undergoing cross-cultural training, counseling patients on appropriate available clinical trial options, and connecting patients to community resources. The outlined recommendations will help the medical community to better understand and apply the important concept of cultural humility into their practice to provide the best care for all their patients, regardless of race/ethnicity.
Collapse
Affiliation(s)
- Brandon Blue
- H. Lee Moffitt Cancer Center and Research Institute, Department of Malignant Hematology, Tampa, FL.
| | - Amy Pierre
- Memorial Sloan Kettering Cancer Center, Division of Multiple Myeloma and Lymphoma, Montvale, NJ; Flatiron Health, Division of Research Oncology and Real World Evidence, New York, NY
| | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ; International Myeloma Foundation, Chief Medical Officer, Studio City, CA
| |
Collapse
|
4
|
Castañeda-Avila MA, Jesdale BM, Beccia A, Bey GS, Epstein MM. Differences in survival among multiple myeloma patients in the United States SEER population by neighborhood socioeconomic status and race/ethnicity. Cancer Causes Control 2021; 32:1021-1028. [PMID: 34089470 DOI: 10.1007/s10552-021-01454-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 05/26/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE We examined the combined influences of race/ethnicity and neighborhood socioeconomic status (SES) on long-term survival among patients with multiple myeloma (MM). METHODS Data from the 2000-2015 NCI Surveillance, Epidemiology, and End Results Program (SEER-18) were used. Census tract-level SES index was assessed in tertiles (low, medium, high SES). Competing-risk modeling was used to estimate sub-hazard ratios (SHR) and 95% confidence intervals (CIs) for SES tertile adjusted for sex and age at diagnosis and stratified by race/ethnicity. RESULTS Overall, living in a low SES neighborhood was associated with worse MM survival. However, we observed some variation in the association by racial/ethnic group. Living in a low versus a high SES neighborhood was associated with a 35% (95% CI = 1.16-1.57) increase in MM-specific mortality risk among Asian/Pacific Islander cases, a 17% (95% CI = 1.12-1.22) increase among White cases, a 14% (95% CI = 1.04-1.23) increase among Black cases, and a 7% (95% CI = 0.96-1.19) increase among Hispanic cases. CONCLUSION These results suggest that the influence of both SES and race/ethnicity should be considered when considering interventions to remedy disparities in MM survival.
Collapse
Affiliation(s)
- Maira A Castañeda-Avila
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Road North, Worcester, MA, 01655, USA.
| | - Bill M Jesdale
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Road North, Worcester, MA, 01655, USA
| | - Ariel Beccia
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Road North, Worcester, MA, 01655, USA
| | - Ganga S Bey
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Mara M Epstein
- Meyers Primary Care Institute and the Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
5
|
Jayakrishnan TT, Bakalov V, Chahine Z, Lister J, Wegner RE, Sadashiv S. Disparities in the enrollment to systemic therapy and survival for patients with multiple myeloma. Hematol Oncol Stem Cell Ther 2020; 14:218-230. [PMID: 33069693 PMCID: PMC7546959 DOI: 10.1016/j.hemonc.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/02/2020] [Accepted: 09/21/2020] [Indexed: 01/16/2023] Open
Abstract
Background Disparities driven by socioeconomic factors have been shown to impact outcomes for cancer patients. We sought to explore this relationship among patients with multiple myeloma (MM) who were not considered for hematopoietic stem cell transplant in the first-line setting and how it varied over time. Methods We queried the National Cancer Database for patients diagnosed with MM between 2004 and 2016 and included only those who received systemic therapy as the first-line treatment. Enrollment rates for therapy were calculated as receipt of systemic therapy as the incident event of interest (numerator) over time to initiation of therapy (denominator) and used to calculate incident rate ratios that were further analyzed using Poisson regression analysis. A multivariate Cox proportional hazards model was constructed for survival analysis, and differences were reported as hazard ratios (HRs). Results We identified 56,102 patients for enrollment analysis and 50,543 patients for survival analysis. Therapy enrollment in a multivariate model was significantly impacted by race and sex (p < .005). Advanced age, earlier year of diagnosis, lack of insurance or Medicaid, and higher comorbidity were associated with poor survival (HR > 1), whereas female sex, non-Hispanic black race, higher income, and treatment at an academic center were associated with improved survival (HR < 1). Conclusion Disparities in treatment of MM exist and are caused by a complex interplay of multiple factors, with socioeconomic factor playing a significant role. Studies exploring such determinants may help in equitable distribution of resources to overcome such differences.
Collapse
Affiliation(s)
| | - Veli Bakalov
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Zena Chahine
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - John Lister
- Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Rodney E Wegner
- Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Santhosh Sadashiv
- Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| |
Collapse
|
6
|
Dennis M, Maoz A, Cirstea D, Patel A, Lerner A, Sarosiek S. Treatment disparities in minority groups with multiple myeloma at a safety-net hospital. Leuk Lymphoma 2020; 61:2507-2510. [PMID: 32460648 DOI: 10.1080/10428194.2020.1767290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Michael Dennis
- Department of Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| | - Asaf Maoz
- Department of Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| | - Diana Cirstea
- Section of Hematology & Medical Oncology, Department of Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| | - Ami Patel
- Section of Hematology & Medical Oncology, Department of Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| | - Adam Lerner
- Section of Hematology & Medical Oncology, Department of Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| | - Shayna Sarosiek
- Section of Hematology & Medical Oncology, Department of Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| |
Collapse
|
7
|
Jones SJ, Stroshein S, Williams AM, Liu D, Spinelli JJ, Connors JM, Brooks-Wilson AR. Birth Order, Sibship Size, Childhood Environment and Immune-Related Disorders, and Risk of Lymphoma in Lymphoid Cancer Families. Cancer Epidemiol Biomarkers Prev 2020; 29:1168-1178. [PMID: 32169998 DOI: 10.1158/1055-9965.epi-19-1204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 12/04/2019] [Accepted: 03/09/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Familial aggregation of lymphoid cancers and immune-related disorders suggests a role for genetic susceptibility; however, few studies examine environmental factors. According to the hygiene hypothesis, adult-onset immune-related diseases may be a consequence of reduced childhood infectious exposures and aberrant immune development. In a cohort of 196 multiple-case lymphoid cancer families, we analyzed environmental factors related to the hygiene hypothesis. METHODS Family structure, childhood environment, and immune-related disorders were examined among 196 lymphoid cancer families, in relation to risk of lymphoid cancer. We report on 450 lymphoid cancer cases and 1,018 unaffected siblings using logistic regression models with generalized estimating equations to estimate ORs and 95% confidence intervals (CI) for association. RESULTS The risk of lymphoma tended to decrease with later birth order (OR = 0.83; 95% CI, 0.78-0.89) and larger sibship size (OR = 0.82; 95% CI, 0.79-0.85). High maternal education, above average family income during childhood, allergies (OR = 2.25; 95% CI, 1.44-3.51), and tonsillectomy (OR = 1.78; 95% CI, 1.14-2.78) were independent risk factors for lymphoma. Familial lymphoid cancer cases were more likely to report environment (OR = 1.90; 95% CI, 1.21-2.98) and drug (OR = 2.30; 95% CI, 1.41-3.73) allergies. CONCLUSIONS These associations underscore the complex etiology of familial lymphoma. To our knowledge, this is the largest multiple-case family-based study that supports the hygiene hypothesis contributing to lymphoid cancer risk. IMPACT Understanding the mechanism by which environmental and lifestyle factors affect lymphoid cancer risk may advance cancer prevention, even in the familial context.
Collapse
Affiliation(s)
- Samantha J Jones
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer, Vancouver, British Columbia, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sumara Stroshein
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Amy M Williams
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Dongmeng Liu
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - John J Spinelli
- Population Oncology, British Columbia Cancer, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph M Connors
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Angela R Brooks-Wilson
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer, Vancouver, British Columbia, Canada. .,Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| |
Collapse
|
8
|
Marinac CR, Ghobrial IM, Birmann BM, Soiffer J, Rebbeck TR. Dissecting racial disparities in multiple myeloma. Blood Cancer J 2020; 10:19. [PMID: 32066732 PMCID: PMC7026439 DOI: 10.1038/s41408-020-0284-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/17/2019] [Accepted: 08/01/2019] [Indexed: 01/12/2023] Open
Abstract
Multiple myeloma (MM) is a fatal plasma cell dyscrasia with a median overall survival of 5 to 10 years. MM progresses from the more common but often subclinical precursor states of monoclonal gammopathy of undetermined significance (MGUS), and smoldering multiple myeloma (SMM) to overt MM. There are large racial disparities in all stages of the disease. Compared with Whites, Blacks have an increased MGUS and MM risk and higher mortality rate, and have not experienced the same survival gains over time. The roots of this disparity are likely multifactorial in nature. Comparisons of Black and White MGUS and MM patients suggest that differences in risk factors, biology, and clinical characteristics exist by race or ancestry, which may explain some of the observed disparity in MM. However, poor accrual of Black MGUS and MM patients in clinical and epidemiological studies has limited our understanding of this disparity and hindered its elimination. Disparities in MM survival also exist but appear to stem from inferior treatment utilization and access rather than underlying pathogenesis. Innovative and multidisciplinary approaches are urgently needed to enhance our understanding of disparities that exist at each stage of the MM disease continuum and facilitate their elimination.
Collapse
Affiliation(s)
- Catherine R Marinac
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, 02215, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.,The Center for Prevention of Progression of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA, 02215, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Irene M Ghobrial
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, 02215, USA.,The Center for Prevention of Progression of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA, 02215, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Brenda M Birmann
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Jenny Soiffer
- University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Timothy R Rebbeck
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, 02215, USA. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| |
Collapse
|
9
|
Socioeconomic Position is Positively Associated with Monoclonal Gammopathy of Undetermined Significance in a Population-based Cohort Study. Ann Hematol 2019; 98:2761-2767. [PMID: 31691002 DOI: 10.1007/s00277-019-03825-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/11/2019] [Indexed: 12/19/2022]
Abstract
Knowledge of social inequalities in monoclonal gammopathy of undetermined significance (MGUS) will contribute to understanding multiple myeloma (MM) etiology, as MGUS consistently precedes MM. The aim of the present study was to examine whether socioeconomic position (SEP) is associated with MGUS in a population-based cohort including information on potential MGUS risk factors. Overall, 4787 study participants aged 45-75 years with information on MGUS were included. SEP indicators (education, income) and potential risk factors (i.e., body mass index, diabetes, smoking, dietary factors) were assessed at baseline. Overall, 260 MGUS cases were detected at baseline and prospectively over a 10-year follow-up. In age-adjusted logistic regression models, a lower chance of having MGUS at baseline or developing MGUS during 10 years of follow-up was indicated for groups of low SEP with odds ratios (OR) of 0.39 (95% confidence interval [95%-CI] 0.19-0.76) for women and 0.48 (95% CI 0.10-1.16) for men in the lowest compared to the highest educational group. After additionally including potential mediating risk factors in the regression models, the estimated ORs changed only slightly in magnitude. Similar results were obtained for income. Current smoking and low fruit consumption were associated with MGUS independently of SEP in women, but not in men. The present study indicates a lower MGUS risk in lower SEP groups. Supporting evidence is given that smoking and diet play a role in the development of MGUS independently of SEP, while it has to be assumed that risk factors unknown to date are responsible for the observed social inequalities in MGUS.
Collapse
|
10
|
Thordardottir M, Lindqvist EK, Lund SH, Costello R, Burton D, Steingrimsdottir L, Korde N, Mailankody S, Eiriksdottir G, Launer LJ, Gudnason V, Harris TB, Landgren O, Torfadottir JE, Kristinsson SY. Dietary intake is associated with risk of multiple myeloma and its precursor disease. PLoS One 2018; 13:e0206047. [PMID: 30383820 PMCID: PMC6211667 DOI: 10.1371/journal.pone.0206047] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/05/2018] [Indexed: 11/18/2022] Open
Abstract
The etiology of monoclonal gammopathy of undetermined significance (MGUS), the precursor state of multiple myeloma (MM), is mostly unknown and no studies have been conducted on the effect of diet on MGUS or progression from MGUS to MM. We aimed to explore the association between common foods and MGUS and progression to MM. Data from the population-based AGES Study (N = 5,764) were utilized. Food frequency questionnaire was used to assess dietary intake during adolescence, midlife, and late life. Serum protein electrophoresis and serum free light-chain assay was performed to identify MGUS (n = 300) and LC-MGUS cases (n = 275). We cross linked our data with the Icelandic Cancer Registry to find cases of MM in the study group. We found that intake of fruit at least three times per week during adolescence was associated with lower risk of MGUS when compared to lower fruit consumption (OR = 0.62, 95% CI 0.41–0.95). We additionally found that intake of fruit at least three times per week during the late life period was associated with decreased risk of progressing from MGUS to MM (HR = 0.34, 95% CI 0.13–0.89) when compared to lower intake. Adolescent intake of fruit may reduce risk of MGUS, whereas fruit intake after MGUS onset may reduce risk of progressing to MM. Our findings suggest that diet might alter the risk of developing MGUS and progression to MM.
Collapse
Affiliation(s)
| | - Ebba K. Lindqvist
- Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Sigrun H. Lund
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Rene Costello
- Multiple Myeloma Section, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Debra Burton
- Multiple Myeloma Section, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | | | - Neha Korde
- Myeloma Service, Division of Hematologic Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Sham Mailankody
- Myeloma Service, Division of Hematologic Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | | | - Lenore J. Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, Maryland, United States of America
| | - Vilmundur Gudnason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- The Icelandic Heart Association, Kopavogur, Iceland
| | - Tamara B. Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, Maryland, United States of America
| | - Ola Landgren
- Myeloma Service, Division of Hematologic Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Johanna E. Torfadottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- The Icelandic Cancer Society, Reykjavik, Iceland
| | - Sigurdur Y. Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
11
|
Tarín-Arzaga L, Arredondo-Campos D, Martínez-Pacheco V, Martínez-González O, Ramírez-López A, Gómez-De León A, Gutiérrez-Aguirre CH, Cantú-Rodríguez O, Jaime-Pérez JC, Gómez-Almaguer D. Impact of the affordability of novel agents in patients with multiple myeloma: Real-world data of current clinical practice in Mexico. Cancer 2018; 124:1946-1953. [DOI: 10.1002/cncr.31305] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/17/2018] [Accepted: 01/23/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Luz Tarín-Arzaga
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Daniela Arredondo-Campos
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Victor Martínez-Pacheco
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Odra Martínez-González
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Alba Ramírez-López
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Andrés Gómez-De León
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Cesar Homero Gutiérrez-Aguirre
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Olga Cantú-Rodríguez
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - José Carlos Jaime-Pérez
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - David Gómez-Almaguer
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| |
Collapse
|
12
|
Standardized cancer incidence disparities in Upper Manhattan New York City neighborhoods: the role of race/ethnicity, socioeconomic status, and known risk factors. Eur J Cancer Prev 2018; 25:349-56. [PMID: 26186470 DOI: 10.1097/cej.0000000000000180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We examined the effects of race/ethnicity and neighborhood, a proxy of socioeconomic status, on cancer incidence in New York City neighborhoods: East Harlem (EH), Central Harlem (CH), and Upper East Side (UES). In this ecological study, Community Health Survey data (2002-2006) and New York State Cancer Registry incidence data (2007-2011) were stratified by sex, age, race/ethnicity, and neighborhood. Logistic regression models were fitted to each cancer incidence rate with race/ethnicity, neighborhood, and Community Health Survey-derived risk factors as predictor variables. Neighborhood was significantly associated with all cancers and 14 out of 25 major cancers. EH and CH residence conferred a higher risk of all cancers compared with UES (OR=1.34, 95% CI 1.07-1.68; and OR=1.39, 95% CI 1.12-1.72, respectively). The prevalence of diabetes and tobacco smoking were the largest contributors toward high cancer rates. Despite juxtaposition and similar proximity to medical centers, cancer incidence disparities persist among EH, CH, and UES neighborhoods. Targeted, neighborhood-specific outreach may aid in reducing cancer incidence rates.
Collapse
|
13
|
Landgren O, Graubard BI, Kumar S, Kyle RA, Katzmann JA, Murata K, Costello R, Dispenzieri A, Caporaso N, Mailankody S, Korde N, Hultcrantz M, Therneau TM, Larson DR, Cerhan JR, Rajkumar SV. Prevalence of myeloma precursor state monoclonal gammopathy of undetermined significance in 12372 individuals 10-49 years old: a population-based study from the National Health and Nutrition Examination Survey. Blood Cancer J 2017; 7:e618. [PMID: 29053158 PMCID: PMC5678222 DOI: 10.1038/bcj.2017.97] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 08/03/2017] [Indexed: 01/20/2023] Open
Abstract
We studied the prevalence of monoclonal gammopathy of undetermined significance (MGUS) in younger individuals, age 10–49 years, using samples from the National Health and Nutritional Examination Survey (NHANES) III. NHANES prevalence rates were standardized to the 2000 US total population. Among 12 372 individuals (4073 blacks, 4146 Mexican-Americans, 3595 whites, and 558 others), MGUS was identified in 63 persons (0.34%, 95% CI 0.23–0.50). The prevalence of MGUS was significantly higher in blacks (0.88%, 95% CI 0.62–1.26) compared with whites (0.22%, 95% CI 0.11–0.45), P=0.001. The prevalence of MGUS in Mexican-Americans was at an intermediate level (0.41%, 95% CI 0.23–0.73). The disparity in prevalence of MGUS between blacks and whites was most striking in the 40–49 age-group; 3.26% (95% CI 2.04–5.18) versus 0.53% (95% CI 0.20–1.37), P=0.0013. There was a trend to earlier age of onset of MGUS in blacks compared with whites. MGUS was seen in only two persons in the 10–19 age-group (both Mexican-American), and in three persons in the 20–29-year age-group (all of whom were black). In persons less than 50 years of age, MGUS is significantly more prevalent, with up to 10 years earlier age of onset, in blacks compared with whites.
Collapse
Affiliation(s)
- O Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - B I Graubard
- Divsion of Cancer Epidemiology and Genetics, Biostatistics Branch, National Cancer Institute, Rockville, MD, USA
| | - S Kumar
- Division of Hematology, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - R A Kyle
- Division of Hematology, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - J A Katzmann
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - K Murata
- Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - R Costello
- Multiple Myeloma Section, Center for Cancer Research, Lymphoid Malignancies Branch, National Cancer Institute, Rockville, MD, USA
| | - A Dispenzieri
- Division of Hematology, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - N Caporaso
- Divsion of Cancer Epidemiology and Genetics, Biostatistics Branch, National Cancer Institute, Rockville, MD, USA
| | - S Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - N Korde
- Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - M Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - T M Therneau
- Division of Biostatistics, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - D R Larson
- Division of Biostatistics, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - J R Cerhan
- Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - S V Rajkumar
- Division of Hematology, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
14
|
Aspirin and risk of multiple myeloma in adults: A systematic review and meta-analysis. Leuk Res Rep 2017; 7:23-28. [PMID: 28331798 PMCID: PMC5348598 DOI: 10.1016/j.lrr.2017.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 02/09/2017] [Accepted: 02/23/2017] [Indexed: 01/01/2023] Open
Abstract
Multiple myeloma is a relatively uncommon plasma cell malignancy. Preclinical and clinical studies have suggested that aspirin might modify the risk of multiple myeloma. We performed a systematic review and meta-analysis of studies to examine the association between regular aspirin use and risk of multiple myeloma. Five observational studies including 332,660 adults were evaluated. The pooled estimate had a hazard ratio of 0.90 (95% confidence interval =0.58−1.39; P=0.638). Odds ratios from the two case-control studies were similar. The findings demonstrated that there was no significant association between aspirin use and the risk of multiple myeloma. This is a systematic review of aspirin use on the incidence risk of multiple myeloma. There is no evidence that aspirin modifies the risk of multiple myeloma. More studies are needed to assess the impact of aspirin on the risk of multiple myeloma.
Collapse
|
15
|
VanValkenburg ME, Pruitt GI, Brill IK, Costa L, Ehtsham M, Justement IT, Innis-Shelton RD, Salzman D, Reddy ESP, Godby KN, Mikhail FM, Carroll AJ, Reddy VB, Sanderson RD, Justement LB, Sanders PW, Brown EE. Family history of hematologic malignancies and risk of multiple myeloma: differences by race and clinical features. Cancer Causes Control 2015; 27:81-91. [PMID: 26596855 PMCID: PMC4703620 DOI: 10.1007/s10552-015-0685-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/16/2015] [Indexed: 11/30/2022]
Abstract
Purpose Multiple myeloma (MM) is the most common hematologic malignancy affecting Blacks in the USA, with standardized incidence rates that are twofold to threefold higher than Whites. The rationale for the disparity is unclear. Methods Using participants enrolled in the Molecular And Genetic Epidemiology study of myeloma (259 MM cases; 461 controls), we examined the risk of MM associated with family history of cancer, differences by race and among cases, defining clinical features. Risk estimates were calculated using odds ratios and corresponding 95% confidence intervals from logistic regression adjusted for confounders. Results Overall, MM risk in cases with relatives affected with any hematologic malignancy was significantly elevated compared to controls (OR 1.89, 95% CI 1.25–2.86). Myeloma risk associated with a family history of MM was higher than the risk associated with any hematologic malignancy (OR 3.75, 95% CI 1.75–8.05), and the effect was greater for Blacks (OR 20.9, 95% CI 2.59–168) than Whites (OR 2.04, 95% 0.83–5.04), among cases with early onset (≤60 years; OR 4.58, 95% CI 1.21–17.3) and with increasing numbers of affected relatives (p trend = 0.001). Overall, frequencies of end organ damage differed in cases with relatives affected with any hematologic malignancy and significantly more cases exhibited κ light chain restriction (OR 3.23, 95% CI 1.13–9.26). Conclusions The excess risk of MM observed in Blacks and the variation in clinical features observed in MM patients according to family history of hematologic malignancy may be attributed to a shared germline and environmental susceptibility. Electronic supplementary material The online version of this article (doi:10.1007/s10552-015-0685-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- MaryAnn E VanValkenburg
- Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294-3300, USA
| | - Gwendolyn I Pruitt
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ilene K Brill
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Luciano Costa
- Division of Hematology and Medical Oncology, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,UAB Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maryam Ehtsham
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.,School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ian T Justement
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.,School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Racquel D Innis-Shelton
- Division of Hematology and Medical Oncology, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,UAB Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Donna Salzman
- Division of Hematology and Medical Oncology, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,UAB Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - E Shyam P Reddy
- Cancer Biology Program, Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Kelly N Godby
- Division of Hematology and Medical Oncology, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,UAB Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fady M Mikhail
- Department of Genetics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew J Carroll
- Department of Genetics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vishnu B Reddy
- Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294-3300, USA.,UAB Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ralph D Sanderson
- Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294-3300, USA.,UAB Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Louis B Justement
- UAB Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Microbiology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul W Sanders
- UAB Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Nephrology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Elizabeth E Brown
- Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294-3300, USA. .,UAB Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA. .,, 1824 6th Avenue South, WTI 602C, Birmingham, AL, 35294-3300, USA.
| |
Collapse
|
16
|
Andreotti G, Katz M, Hoering A, Van Ness B, Crowley J, Morgan G, Hoover RN, Baris D, Durie B. Risk of multiple myeloma in a case-spouse study. Leuk Lymphoma 2015; 57:1450-9. [PMID: 26422532 DOI: 10.3109/10428194.2015.1094693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study examined lifestyle, occupation, medical history and medication use with multiple myeloma risk in a case-spouse study (481 patients, 351 spouses). Odds ratios (ORs) and 95% confidence intervals (CI) were calculated using logistic regression. Compared to spouse controls, cases were more likely to have a family history of multiple myeloma (OR = 2.8, 95% CI = 1.2-6.4) and smoked cigarettes (OR = 1.7, 95% CI = 1.2-2.5), but less likely to have consumed alcohol (OR = 0.6, 95% CI = 0.4-0.9). Nurse/health practitioners (OR = 2.8, 95% CI = 1.3-6.2) and production workers (OR = 3.7, 95% CI = 1.0-13.7) had significantly increased risks; and some occupations linked to diesel exhaust had elevated, but non-significant, risks. History of herpes simplex (OR = 1.7, 95% CI = 1.2-2.4), shingles (OR = 1.7, 95% CI = 1.1-2.7), sexually transmitted diseases (OR = 2.0, 95% CI = 1.0-3.7) and medication allergies (OR = 1.7, 95% CI = 1.2-2.4) were associated with higher risks. Use of angiotensin-converting enzyme inhibitors, anti-convulsants, antidepressants, statins and diuretics were associated with reduced risks. The results are consistent with previous population-based studies and support the utility of patient databanks and spouse controls as a resource in epidemiologic research.
Collapse
Affiliation(s)
- Gabriella Andreotti
- a Division of Cancer Epidemiology and Genetics , National Cancer Institute, NIH, DHHS , Rockville , MD , USA
| | - Michael Katz
- b International Myeloma Foundation , Hollywood , CA , USA
| | - Antje Hoering
- c Cancer Research and Biostatistics , Seattle , WA , USA
| | - Brian Van Ness
- d Cancer Center, University of Minnesota , Minneapolis , MN , USA
| | - John Crowley
- c Cancer Research and Biostatistics , Seattle , WA , USA
| | - Gareth Morgan
- e Haemato-Oncology, Institute of Cancer Research , Sutton , UK
| | - Robert N Hoover
- a Division of Cancer Epidemiology and Genetics , National Cancer Institute, NIH, DHHS , Rockville , MD , USA
| | - Dalsu Baris
- a Division of Cancer Epidemiology and Genetics , National Cancer Institute, NIH, DHHS , Rockville , MD , USA
| | - Brian Durie
- b International Myeloma Foundation , Hollywood , CA , USA ;,f Cedar Sinai Medical Center , Los Angeles , CA , USA
| |
Collapse
|
17
|
Boyle EM, Davies FE, Leleu X, Morgan GJ. Understanding the multiple biological aspects leading to myeloma. Haematologica 2015; 99:605-12. [PMID: 24688108 DOI: 10.3324/haematol.2013.097907] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
18
|
Fiala MA, Finney JD, Liu J, Stockerl-Goldstein KE, Tomasson MH, Vij R, Wildes TM. Socioeconomic status is independently associated with overall survival in patients with multiple myeloma. Leuk Lymphoma 2015; 56:2643-9. [PMID: 25651424 DOI: 10.3109/10428194.2015.1011156] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Population-based studies suggest that black patients with multiple myeloma (MM) have a higher mortality rate than white patients. However, other studies suggest that this disparity is related to socioeconomic status (SES) rather than race. To provide clarity on this topic, we reviewed 562 patients diagnosed with MM at our institution. Patients with high SES had a median overall survival (OS) of 62.8 months (95% confidence interval [CI] 43.1-82.6 months), compared to 53.7 months (45.2-62.3 months) and 48.6 months (40.4-56.8 months) for middle and low SES, respectively (p = 0.015). After controlling for race, age, year of diagnosis, severity of comorbidities, stem cell transplant utilization and insurance provider, patients with low SES had a 54% increase in mortality rate relative to patients with high SES. To support our findings, we performed a similar analysis of 45,505 patients with MM from the Surveillance, Epidemiology and End Results-18 (SEER) database. Low SES is independently associated with poorer OS in MM.
Collapse
Affiliation(s)
- Mark A Fiala
- a Division of Oncology , Washington University School of Medicine , St. Louis , MO , USA
| | - Joseph D Finney
- a Division of Oncology , Washington University School of Medicine , St. Louis , MO , USA
| | - Jingxia Liu
- b Division of Biostatistics, Department of Medicine , Washington University School of Medicine , St. Louis , MO , USA
| | | | - Michael H Tomasson
- a Division of Oncology , Washington University School of Medicine , St. Louis , MO , USA
| | - Ravi Vij
- a Division of Oncology , Washington University School of Medicine , St. Louis , MO , USA
| | - Tanya M Wildes
- a Division of Oncology , Washington University School of Medicine , St. Louis , MO , USA
| |
Collapse
|
19
|
Racial disparities in the prevalence of monoclonal gammopathies: a population-based study of 12,482 persons from the National Health and Nutritional Examination Survey. Leukemia 2014; 28:1537-42. [PMID: 24441287 DOI: 10.1038/leu.2014.34] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 01/06/2014] [Indexed: 12/17/2022]
Abstract
Multiple myeloma (MM) incidence is markedly higher in blacks compared with whites, which may be related to a higher prevalence of monoclonal gammopathy of undetermined significance (MGUS). Our objective was to define the prevalence and risk factors of MGUS in a large cohort representative of the US population. Stored serum samples from the National Health and Nutritional Examination Survey (NHANES) III or NHANES 1999-2004 were available for 12,482 individuals of age ⩾50 years (2331 'blacks', 2475 Hispanics, 7051 'whites' and 625 'others') on which agarose-gel electrophoresis, serum protein immunofixation, serum-free light-chain assay and M-protein typing were performed. MGUS was identified in 365 participants (2.4%). Adjusted prevalence of MGUS was significantly higher (P<0.001) in blacks (3.7%) compared with whites (2.3%) (P=0.001) or Hispanics (1.8%), as were characteristics that posed a greater risk of progression to MM. The adjusted prevalence of MGUS was 3.1% and 2.1% for the North/Midwest versus South/West regions of the United States, respectively (P=0.052). MGUS is significantly more common in blacks, and more often has features associated with higher risk of progression to MM. A strong geographic disparity in the prevalence of MGUS between the North/Midwest versus the South/West regions of the United States was found, which has etiologic implications.
Collapse
|
20
|
Perrotta C, Staines A, Codd M, Kleefeld S, Crowley D, T' Mannetje A, Becker N, Brennan P, De Sanjosé S, Foretova L, Maynadié M, Nieters A, Boffetta P, Cocco P. Multiple Myeloma and lifetime occupation: results from the EPILYMPH study. J Occup Med Toxicol 2012; 7:25. [PMID: 23241100 PMCID: PMC3557218 DOI: 10.1186/1745-6673-7-25] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 11/06/2012] [Indexed: 01/28/2023] Open
Abstract
Background The EPILYMPH study applied a detailed occupational exposure assessment approach to a large multi-centre case–control study conducted in six European countries. This paper analysed multiple myeloma (MM) risk associated with level of education, and lifetime occupational history and occupational exposures, based on the EPILYMPH data set. Methods 277 MM cases and four matched controls per each case were included. Controls were randomly selected, matching for age (+/− 5 years), centre and gender. Lifetime occupations and lifetime exposure to specific workplace agents was obtained through a detailed questionnaire. Local industrial hygienists assessed likelihood and intensity for specific exposures. The odds ratio and 95% confidence intervals (OR, 95% CI) were calculated for level of education, individual occupations and specific exposures. Unconditional logistic regression models were run for individual occupations and exposures. Results A low level of education was associated with MM OR=1.68 (95% CI 1.02-2.76). An increased risk was observed for general farmers (OR=1.77; 95% CI 1.05-2.99) and cleaning workers (OR=1.69; 95% CI 1.04-2.72) adjusting for level of education. Risk was also elevated, although not significant, for printers (OR=2.06; 95% CI 0.97-4.34). Pesticide exposure over a period of ten years or more increased MM risk (OR=1.62; 95% CI 1.01-2.58). Conclusion These results confirm an association of MM with farm work, and indicate its association with printing and cleaning. While prolonged exposure to pesticides seems to be a risk factor for MM, an excess risk associated with exposure to organic solvents could not be confirmed.
Collapse
Affiliation(s)
- Carla Perrotta
- Medicina Familiar y Comunitaria, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
After completion of the human genome, genome-wide association studies were conducted to identify single nucleotide polymorphisms (SNPs) associated with cancer initiation and progression. Most of the studies identified SNPs that were located outside the coding region, and the odds ratios were too low to implement in clinical practice. Although the genome gives information about genome sequence and structure, the human epigenome provides functional aspects of the genome. Epigenome-wide association studies (EWAS) provide an opportunity to identify genome-wide epigenetic variants that are associated with cancer. However, there are problems and issues in implementing EWAS to establish an association between epigenetic profiles and cancer. Few challenges include selection and handling of samples, choice of population and sample size, accurate measurement of exposure, integrating data, and insufficient information about the role of repeat sequences. The current status of EWAS, challenges in the field, and their potential solutions are discussed in this article.
Collapse
Affiliation(s)
- Mukesh Verma
- Epidemiology and Genetics Research Program, Division of Cancer Control and Population Sciences, Division of Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), 6130 Executive Boulevard, Suite 5100, Bethesda, MD 20892-7324, USA
| |
Collapse
|
22
|
Greenberg AJ, Vachon CM, Rajkumar SV. Disparities in the prevalence, pathogenesis and progression of monoclonal gammopathy of undetermined significance and multiple myeloma between blacks and whites. Leukemia 2011; 26:609-14. [PMID: 22193966 DOI: 10.1038/leu.2011.368] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
There is marked racial disparity in the incidence of monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma, with a two to threefold increased risk in blacks compared with whites. The increased risk has been seen both in Africans and African Americans. Similarly, an increased risk of monoclonal gammopathies in blacks compared with whites has been noted after adjusting for socioeconomic and other risk factors, suggesting a genetic predisposition. The higher risk of multiple myeloma in blacks is likely a result of the higher prevalence of the premalignant MGUS stage; there are no data to suggest that blacks have a higher progression rate of MGUS to myeloma. Studies are emerging that suggest the baseline cytogenetic characteristics, and progression may differ by race. In contrast, to the increased risk noted in blacks, studies suggest that the risk may be lower in certain racial and ethnic groups, notably persons from Japan and Mexico. We review the literature on racial disparity in the prevalence, pathogenesis and progression of MGUS and multiple myeloma between blacks and whites. We also discuss future directions for research that could inform management of these conditions and positively influence patient outcomes.
Collapse
Affiliation(s)
- A J Greenberg
- Division of Epidemiology, Department of Health Sciences Research, Rochester, MN, USA
| | | | | |
Collapse
|
23
|
Buadi F, Hsing AW, Katzmann JA, Pfeiffer RM, Waxman A, Yeboah ED, Biritwum RB, Tettey Y, Adjei A, Chu LW, DeMarzo A, Netto GJ, Dispenzieri A, Kyle RA, Rajkumar SV, Landgren O. High prevalence of polyclonal hypergamma-globulinemia in adult males in Ghana, Africa. Am J Hematol 2011; 86:554-8. [PMID: 21674575 DOI: 10.1002/ajh.22040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 03/21/2011] [Indexed: 11/06/2022]
Abstract
Chronic antigenic stimulation is associated with hypergamma-globulinemia. Higher rates of hypergamma-globulinemia in tropical populations are maintained even with migration to temperate regions. We conducted a population-based screening study to assess the prevalence and risk factors for hypergamma-globulinemia in Ghana, Africa. 917 Ghanaian males (50-74 years) underwent in-person interviews and health examinations. Serum from all persons was analyzed by electrophoresis performed on agarose gel; serum with a discrete/localized band was subjected to immunofixation. 54 persons with monoclonal proteins were excluded and 17 samples were insufficient for analysis. Using logistic regression and Chi-square statistics we analyzed patterns of hypergamma-globulinemia. Among 846 study subjects, the median γ-globulin level was 1.86 g/dL. On the basis of a U.S. reference, 616 (73%) had hypergamma-globulinemia (>1.6 g/dL) and 178 (21%) had γ-globulin levels >2.17 gm/dl. On multivariate analyses, lower education status (P = 0.0013) and never smoking (P = 0.038) were associated with increased γ-globulin levels. Self-reported history of syphilis was associated with hypergamma-globulinemia. We conclude that three quarters of this population-based adult Ghanaian male sample had hypergamma-globulinemia with γ-globulin levels >1.6 g/dL. Future studies are needed to uncover genetic and environmental underpinnings of our finding, and to define the relationship between hypergamma-globulinemia, monoclonal gammopathy of undetermined significance (MGUS), and multiple myeloma.
Collapse
Affiliation(s)
- Francis Buadi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Hermann S, Rohrmann S, Linseisen J, Nieters A, Khan A, Gallo V, Overvad K, Tjønneland A, Raaschou-Nielsen O, Bergmann MM, Boeing H, Becker N, Kaaks R, Bueno-de-Mesquita HB, May AM, Vermeulen RCH, Bingham S, Khaw KT, Key TJ, Travis RC, Trichopoulou A, Georgila C, Triantafylou D, Celentano E, Krogh V, Masala G, Tumino R, Agudo A, Altzibar JM, Ardanaz E, Martínez-García C, Suárez MVA, Tormo MJ, Braaten T, Lund E, Manjer J, Zackrisson S, Hallmans G, Malmer B, Boffetta P, Brennan P, Slimani N, Vineis P, Riboli E. Level of education and the risk of lymphoma in the European prospective investigation into cancer and nutrition. J Cancer Res Clin Oncol 2011; 136:71-7. [PMID: 19582474 DOI: 10.1007/s00432-009-0638-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Accepted: 06/19/2009] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Lymphomas belong to the few cancer sites with increasing incidence over past decades, and only a few risk factors have been established. We explored the association between education and the incidence of lymphoma in the prospective EPIC study. MATERIALS AND METHODS Within 3,567,410 person-years of follow-up, 1,319 lymphoma cases [1,253 non-Hodgkin lymphomas (NHL) and 66 Hodgkin lymphomas (HL)] were identified. Cox proportional hazard regression was used to examine the association between highest educational level (primary school or less, technical/professional school, secondary school, university) and lymphoma risk. RESULTS Overall, no consistent associations between educational level and lymphoma risk were observed; however, associations were found for sub-groups of the cohort. We observed a higher risk of B-NHL (HR = 1.31, 95% CI = 1.02–1.68; n = 583) in women with the highest education level (university) but not in men. Concerning sub-classes of B-NHL, a positive association between education and risk of B cell chronic lymphatic leukaemia (BCLL) was observed only in women. In both genders, the risk of diffuse large B cell lymphoma (DLBCL) was significantly lower for subjects with university degree (HR = 0.46, 95% CI = 0.27–0.79) versus lowest educational level. No association was found for HL. CONCLUSION We could not confirm an overall consistent association of education and risk of HL or NHL in this large prospective study; although, education was positively related to the incidence of BCLL and B-NHL (in women) but inversely to incidence of DLBCL. Due to limited number of cases in sub-classes and the large number of comparisons, the possibility of chance findings can not be excluded.
Collapse
Affiliation(s)
- Silke Hermann
- Division of Cancer Epidemiology (C020), German Cancer Research Center, Heidelberg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Obesity is associated with an increased risk of monoclonal gammopathy of undetermined significance among black and white women. Blood 2010; 116:1056-9. [PMID: 20421448 DOI: 10.1182/blood-2010-01-262394] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Obesity and black race have been associated with excess risk of multiple myeloma. The association of obesity with monoclonal gammopathy of undetermined significance (MGUS) is unknown. Further, it is not known whether the increased risk of multiple myeloma and MGUS in blacks is related to socioeconomic status, genetic susceptibility, or both. We screened 1000 black and 996 white women (range, 40-79 years) of similar socioeconomic status for MGUS; the aim of the study was to assess MGUS risk in relation to obesity and race. A total of 39 (3.9%) blacks and 21 (2.1%) whites had MGUS. On multivariate analysis, obesity (odds ratio [OR] = 1.8; P = .04), black race (OR = 1.8; P = .04), and increasing age (> 55 vs < 43 years; OR = 2.5; P = .03) were independently associated with an excess risk of MGUS. Our findings support the hypothesis that obesity is etiologically linked to myelomagenesis. The 2-fold excess of MGUS among blacks compared with whites of similar socioeconomic status supports a role for susceptibility genes in MGUS.
Collapse
|
26
|
Redzepovic J, Weinmann G, Ott I, Gust R. Current Trends in Multiple Myeloma Management. J Int Med Res 2008; 36:371-86. [DOI: 10.1177/147323000803600301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Treatment of multiple myeloma, a B-cell cancer, is usually palliative, however, as a result of intensive clinical research there are numerous new treatment options available today. The present review summarizes non-transplant treatment options for multiple myeloma on the basis of available publications. Treatment with new substances, such as immunomodulatory agents, farnesyl transferase inhibitors and apoptosis stimulators, and their mechanisms of action are discussed. In addition to this systematic review of the available evidence on multiple myeloma therapy we have also summarized current recommendations from national and international organizations on aspects of the treatment of multiple myeloma. This should enable readers to see different points of view at a glance and, hopefully, will provide a basis for translation of the available evidence into the best possible therapy.
Collapse
Affiliation(s)
- J Redzepovic
- Institute of Pharmacy, Free University of Berlin, Berlin, Germany
| | | | - I Ott
- Institute of Pharmacy, Free University of Berlin, Berlin, Germany
| | - R Gust
- Institute of Pharmacy, Free University of Berlin, Berlin, Germany
| |
Collapse
|
27
|
Abstract
This review of the plasma-cell disorders begins with the definition of monoclonal gammopathy of undetermined significance (MGUS). The prevalence of MGUS in white and black populations is described. MGUS is a common finding in the medical practice of all physicians, and thus it is important to both the patient and the physician to determine whether the monoclonal protein remains stable or progresses to multiple myeloma (MM), Waldenström's macroglobulinemia (WM), primary systemic amyloidosis (AL), or a related disorder. The long-term (almost 40 years) follow-up data of 241 patients in the Mayo Clinic population is provided. In a large study of 1384 patients with MGUS from southeastern Minnesota, the risk of progression to MM, WM, AL, or other disorders was approximately 1% per year. Risk factors for progression are provided. The incidence of MM in Olmsted County, Minnesota, remained stable for the 56-year span 1945-2001. The apparent increase in incidence and mortality rates among patients with MM in many studies is due to improved case ascertainment, especially among the elderly. The incidence and mortality rates of MM in the United States and other countries are presented. The major emphasis is on the cause of MM, which is unclear. Exposure to radiation from atomic bombs, therapeutic and diagnostic radiation, and in workers in the nuclear industry field are addressed. Many studies involving agricultural occupations, exposure to benzene, petroleum products, and engine exhaust and other industrial exposures are discussed. Tobacco use, obesity, diet, and alcohol ingestion are all possible causes of MM. Clusters of MM have been noted. Multiple cases of MM have been found in first-degree relatives.
Collapse
Affiliation(s)
- Robert A Kyle
- Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | | |
Collapse
|
28
|
Chemotherapy and survival for patients with multiple myeloma: findings from a large nationwide and population-based cohort. Am J Clin Oncol 2007; 30:540-8. [PMID: 17921717 DOI: 10.1097/coc.0b013e3180592a30] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess the patterns of chemotherapy use for patients with multiple myeloma and to determine if chemotherapy is effective in prolonging survival outside the clinical trial settings. METHODS We studied a nationwide and population-based retrospective cohort of 4902 patients > or =65 years of age with stage II or III multiple myeloma from 1992 to 1999, identified from the Surveillance, Epidemiology, and End-Results-Medicare data. Multivariate logistic regression was used to estimate the odds ratio of receiving chemotherapy and Cox proportional hazard model was used to estimate the hazard ratio of mortality associated with chemotherapy. RESULTS Of 4902 patients with stage II or III multiple myeloma, 52.0% received chemotherapy during the course of the disease. The receipt of chemotherapy decreased significantly with age from 65.7% in the 65- to 69-year age group to 34.3% in those > or =80 years. Blacks (47.6%) were less likely to receive chemotherapy than whites (52.8%). Use of chemotherapy decreased significantly with comorbidity scores and increased over time. Risk of all-cause mortality was significantly reduced in patients who received chemotherapy compared with those who did not (adjusted hazard ratio = 0.65; 95% confidence interval = 0.61-0.69). A similar pattern as observed for myeloma-specific mortality (0.61; 0.56-0.67). Survival benefit increased with increasing cycles of chemotherapy (P < 0.001 for trend) and was significant across different age groups, gender, ethnic groups, and comorbidity scores. CONCLUSION Chemotherapy was significantly associated with increased survival in patients with multiple myeloma outside the clinical trial settings. This survival benefit was significant across different groups by age, gender, race, and comorbidity. A substantial number of patients with multiple myeloma did not receive chemotherapy.
Collapse
|
29
|
Hosgood HD, Baris D, Zahm SH, Zheng T, Cross AJ. Diet and risk of multiple myeloma in Connecticut women. Cancer Causes Control 2007; 18:1065-76. [PMID: 17694422 DOI: 10.1007/s10552-007-9047-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 07/13/2007] [Indexed: 01/25/2023]
Abstract
Multiple myeloma accounts for an estimated 19,900 incident cancer cases per year in the United States. A population-based case-control study, consisting of 179 incident cases and 691 controls, was conducted to examine the impact of diet on multiple myeloma risk. Diet was assessed using a food frequency questionnaire and odds ratios, 95% confidence intervals, and P-trends were calculated across quartiles of consumption. After controlling for potential confounders, we observed inverse associations for cooked tomatoes (P-trend = 0.002), cruciferous vegetables (P-trend = 0.01), fresh fish (P-trend < 0.001), alcohol (P-trend < 0.001), and vitamin A (P-trend < 0.001) with multiple myeloma risk. In contrast, consumption of cream soups (P-trend = 0.01), jello (P-trend = 0.01), ice cream (P-trend = 0.01), and pudding (P-trend < 0.001) were positively associated with multiple myeloma. Furthermore, there was a suggestion that carbohydrate intake may be positively associated, whereas vitamin D and calcium intake may be inversely associated, with multiple myeloma risk. Despite very limited data on dietary factors in relation to multiple myeloma, the findings from this study concur with previously published studies, suggesting an inverse association for consumption of fish, cruciferous vegetables and green vegetables, and a positive association for some dairy products.
Collapse
Affiliation(s)
- H Dean Hosgood
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-7240, USA.
| | | | | | | | | |
Collapse
|
30
|
Flowers CR, Glover R, Lonial S, Brawley OW. Racial Differences in the Incidence and Outcomes for Patients with Hematological Malignancies. Curr Probl Cancer 2007; 31:182-201. [PMID: 17543947 DOI: 10.1016/j.currproblcancer.2007.01.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Christopher R Flowers
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | | |
Collapse
|
31
|
Alexander DD, Mink PJ, Adami HO, Cole P, Mandel JS, Oken MM, Trichopoulos D. Multiple myeloma: A review of the epidemiologic literature. Int J Cancer 2007; 120 Suppl 12:40-61. [PMID: 17405120 DOI: 10.1002/ijc.22718] [Citation(s) in RCA: 201] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Multiple myeloma, a neoplasm of plasma cells, accounts for approximately approximately 15% of lymphatohematopoietic cancers (LHC) and 2% of all cancers in the US. Incidence rates increase with age, particularly after age 40, and are higher in men, particularly African American men. The etiology is unknown with no established lifestyle, occupational or environmental risk factors. Although several factors have been implicated as potentially etiologic, findings are inconsistent. We reviewed epidemiologic studies that evaluated lifestyle, dietary, occupational and environmental factors; immune function, family history and genetic factors; and the hypothesized precursor, monoclonal gammopathies of undetermined significance (MGUS). Because multiple myeloma is an uncommon disease, etiologic assessments can be difficult because of small numbers of cases in occupational cohort studies, and few subjects reporting exposure to specific agents in case-control studies. Elevated risks have been reported consistently among persons with a positive family history of LHC. A few studies have reported a relationship between obesity and multiple myeloma, and this may be a promising area of research. Factors underlying higher incidence rates of multiple myeloma in African Americans are not understood. The progression from MGUS to multiple myeloma has been reported in several studies; however, there are no established risk factors for MGUS. To improve our understanding of the causes of multiple myeloma, future research efforts should seek the causes of MGUS. More research is also needed on the genetic factors of multiple myeloma, given the strong familial clustering of the disease.
Collapse
|
32
|
Gebregziabher M, Bernstein L, Wang Y, Cozen W. Risk patterns of multiple myeloma in Los Angeles County, 1972-1999 (United States). Cancer Causes Control 2006; 17:931-8. [PMID: 16841260 DOI: 10.1007/s10552-006-0030-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Accepted: 03/29/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe the risk patterns of multiple myeloma in Los Angeles County (LAC). METHODS Incident multiple myeloma cases diagnosed from 1972 to 1999 were ascertained by the population-based cancer registry for LAC. Average annual age-specific and age-adjusted incidence rates (AAIR), standardized to the 2000 US census age distribution, were calculated using age-, race-, sex- and socioeconomic status (SES)-specific denominators estimated for all years from US census data for 1970, 1980 and 1990. Odds ratios (ORs) for risk by birthplace and religion were estimated using multivariate logistic regression, comparing multiple myeloma patients with other cancer patients. RESULTS All groups experienced increasing incidence with age; African-Americans experienced the steepest increase which began a decade earlier compared to other groups. Overall incidence rates were 50% higher among males (n = 4,692) than females (n = 4,343) (p < 0.05). AAIRs were highest for African-Americans, followed by Spanish-surnamed whites (SSW), non-Spanish-surnamed whites (NSSW), Filipinos and other Asian groups. Among African-Americans, incidence rates increased with increasing SES. US-born SSW had 14% lower risk compared to non-US born SSW (OR = 0.86, 95% confidence interval [CI] = 0.74-0.99]. Jews had an 11% higher risk compared to Protestants (OR = 1.11; 95% CI = 0.99-1.24). CONCLUSION Risk patterns suggest a role for both environmental and genetic factors.
Collapse
Affiliation(s)
- Mulugeta Gebregziabher
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089-9175, USA
| | | | | | | |
Collapse
|
33
|
Landgren O, Zhang Y, Zahm SH, Inskip P, Zheng T, Baris D. Risk of multiple myeloma following medication use and medical conditions: a case-control study in Connecticut women. Cancer Epidemiol Biomarkers Prev 2006; 15:2342-7. [PMID: 17132770 DOI: 10.1158/1055-9965.epi-06-0097] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Certain commonly used drugs and medical conditions characterized by chronic immune dysfunction and/or antigen stimulation have been suggested to affect important pathways in multiple myeloma tumor cell growth and survival. We conducted a population-based case-control study to investigate the role of medical history in the etiology of multiple myeloma among Connecticut women. METHODS A total of 179 incident multiple myeloma cases (21-84 years, diagnosed 1996-2002) and 691 population-based controls was included in this study. Information on medical conditions, medications, and medical radiation was obtained by in-person interviews. We calculated odds ratios (OR) as measures of relative risks using logistic regression models. RESULTS A reduced multiple myeloma risk was found among women who had used antilipid statin therapy [OR, 0.4; 95% confidence interval (95% CI), 0.2-0.8] or estrogen replacement therapy (OR, 0.6; 95% CI, 0.4-0.99) or who had a medical history of allergy (OR, 0.4; 95% CI, 0.3-0.7), scarlet fever (OR, 0.5; 95% CI, 0.2-0.9), or bursitis (OR, 0.4; 95% CI, 0.2-0.7). An increased risk of multiple myeloma was found among women who used prednisone (OR, 5.1; 95% CI, 1.8-14.4), insulin (OR, 3.1; 95% CI, 1.1-9.0), or gout medication (OR, 6.7; 95% CI, 1.2-38.0). CONCLUSIONS If our results are confirmed, mechanistic studies examining how prior use of insulin, prednisone, and, perhaps, gout medication might promote increased occurrence of multiple myeloma and how antilipid statins, estrogen replacement therapy, and certain medical conditions might protect against multiple myeloma may provide insights to the as yet unknown etiology of multiple myeloma.
Collapse
Affiliation(s)
- Ola Landgren
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, Building EPS/Room 7110, Bethesda, MD 20892-7236, USA.
| | | | | | | | | | | |
Collapse
|
34
|
Abstract
The interpretation of cancer incidence trends is complicated by short-term random variation, artifactual fluctuations introduced by screening, changes in diagnosis or disease classification, completeness of reporting, and by the multiplicity of factors that may affect risk for specific cancer sites. We analyzed trends in 56 different cancer sites and subsites in the U.S. SEER registries in the period 1975-2002 using join-point analysis. The increase in cancer incidence for all sites combined that became evident with the inception of the SEER registries in the mid-1970s has abated since the early 1990s. Among the 15 most common cancer sites in men, sites with increasing incidence rates during the most recent time period include melanoma of the skin and cancers of the prostate, kidney and renal pelvis (kidney), and esophagus. Among women, incidence rates are increasing for leukemia, non-Hodgkin's lymphoma, melanoma, and cancers of the breast, thyroid, urinary bladder, and kidney. Incidence rates for all childhood cancers combined increased 0.6% per year from 1975 to 2002. Cancer mortality rates have decreased in the United States since 1991 in both men and in women; site-specific death rates have decreased in the most recent time period for 12 of the top 15 cancer sites in men and 9 of the top 15 cancer sites in women. Similar trends in cancer incidence and mortality have been reported in other industrialized countries. Possible reasons for these trends are discussed.
Collapse
Affiliation(s)
- Elizabeth M Ward
- Department of Epidemiology and Surveillance Research, American Cancer Society, National Home Office, Atlanta, GA 30329-4251, USA.
| | | | | | | |
Collapse
|
35
|
Saraf S, Chen YH, Dobogai LC, Mahmud N, Peace D, Saunthararajah Y, Hoffman R, Chunduri S, Rondelli D. Prolonged responses after autologous stem cell transplantation in African-American patients with multiple myeloma. Bone Marrow Transplant 2006; 37:1099-102. [PMID: 16699527 DOI: 10.1038/sj.bmt.1705392] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Multiple myeloma (MM) has a double incidence in African-American (AA) than in non-AA patients and previous studies have shown a higher mortality in the former patient population. Here, we retrospectively analyzed the results of autologous stem cell transplantation (ASCT) in 38 AA and 32 non-AA consecutive patients. The two groups were comparable at diagnosis for age, stage of the disease, cytogenetic abnormalities, beta(2) microglobulin and albumin blood levels, and plasma cell marrow infiltration. The rates of complete and partial response observed in AA and non-AA patients after induction chemotherapy (9 and 42 vs 13 and 33%) and at 2 months (31 and 25 vs 30 and 20%) following ASCT were similar. At 6 months after ASCT, a greater relapse rate was observed in non-AA patients (P=0.009). At a median follow-up of 26 months, AA patients had a greater event-free survival (P=0.02) than non-AA patients, whereas overall survival was comparable in the two groups. The initial finding that AA patients with MM, compared to non-AA patients, had more prolonged responses and comparable survival after ASCT suggests that intensified chemotherapy is equally effective in patients of various ethnicities.
Collapse
Affiliation(s)
- S Saraf
- Section of Hematology/Oncology, University of Illinois at Chicago, 900 South Ashland Avenue, Chicago, IL 60607, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Landgren O, Linet MS, McMaster ML, Gridley G, Hemminki K, Goldin LR. Familial characteristics of autoimmune and hematologic disorders in 8,406 multiple myeloma patients: A population-based case-control study. Int J Cancer 2006; 118:3095-8. [PMID: 16395700 DOI: 10.1002/ijc.21745] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A population-based case-control study was conducted to evaluate risk of developing multiple myeloma (MM) associated with personal history of autoimmune diseases and occurrence of autoimmune and selected hematologic disorders in first-degree relatives. Data were obtained for all (n = 8,406) MM cases diagnosed in Sweden (1958-1998), with linkable relatives, 16,543 matched controls and first-degree relatives of cases (n = 22,490) and controls (n = 44,436). Odds ratios (ORs) were calculated to quantify the risk of MM in relation to personal/family history of 32 autoimmune disorders. Familial aggregation of malignancies was evaluated in a marginal survival model using relatives as the cohort. The risk for MM was significantly elevated among subjects with a personal history of pernicious anemia (OR = 3.27; 2.22-4.83) and individuals with a family history of systemic lupus erythematosus (OR = 2.66; 1.12-6.32). Compared with controls, relative risk (RR) of MM was significantly increased (RR = 1.67; 1.02-2.73) in relatives of cases, particularly relatives of probands aged > or =65 at diagnosis (RR = 2.50; 1.19-5.27). Risks were nearly 4-fold elevated among female relatives (RR = 3.97; 1.54-10.2) and among relatives of female probands (RR = 3.74; 1.58-8.83). MM cases had more cases of monoclonal gammopathy of undetermined significance (MGUS) among their relatives than controls, but the numbers were too small to be conclusive. There was generally no increase in risk of MM in probands whose relatives had hematologic malignancies other than MM. These findings do not support a strong association between personal/familial autoimmune diseases and MM. However, MM itself shows significant familial aggregation, implicating the etiologic importance of this type of hematological neoplasm and perhaps MGUS in germ line genes.
Collapse
Affiliation(s)
- Ola Landgren
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA.
| | | | | | | | | | | |
Collapse
|
37
|
A case of IgA multiple myeloma: Nutritional perspective in diagnostic testing. Indian J Clin Biochem 2005; 20:193-7. [PMID: 23105521 DOI: 10.1007/bf02893069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A 64-year-old security guard and longstanding known hypertensive presented with hypertensive heart disease (HHD), weight loss, an enlarged prostate, and a spontaneously fractured rib. Malignancy of the prostate with possible metastases to the ribs was strongly suspected. Biochemical profiling revealed a paraprotein. Other biochemical and hematological correlates that were on hand before serum protein electrophoresis were rather atypical. Paraprotein studies by immunofixation revealed IgA myelomatosis. Unlike previous reports from Caucasians there was normocalcaemia, normal protein level, microcytic hypochromia, low MCHC, cholesterol level at the lower limit of the reference range and normal urea level (in the face of markedly raised creatinine level). Nutritional modulation of the classical laboratory features of this disease may account for the fairly atypical laboratory picture.The need to appreciate the influence of nutritional status on the laboratory (especially biochemical) features of a disease and thus interpretation of diagnostic tests appears of exceptional current importance, given the widening gap in socioeconomic status and the level of poverty between the resource poor and developed countries from which the classical, clinical and laboratory features of most diseases were first described.This case report reminds of the need not only to recognize theoretically the impact of nutritional status on the laboratory characteristics of a disease but of the practical application of the nutritional perspective in the interpretation of diagnostic investigations, especially in nutritionally disadvantaged communities.
Collapse
|
38
|
Wilson CS. The plasma cell dyscrasias. Cancer Treat Res 2004; 121:113-44. [PMID: 15217208 DOI: 10.1007/1-4020-7920-6_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Carla S Wilson
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| |
Collapse
|
39
|
Lee WJ, Baris D, Järvholm B, Silverman DT, Bergdahl IA, Blair A. Multiple myeloma and diesel and other occupational exposures in swedish construction workers. Int J Cancer 2003; 107:134-8. [PMID: 12925968 DOI: 10.1002/ijc.11351] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We examined the relationships between occupational exposures and the risk of multiple myeloma among male construction workers in Sweden. A total of 446 myeloma subjects were identified among 365,424 male workers followed from 1971 to 1999. Occupational exposure was assessed using a semiquantitative job-exposure matrix, based on a survey carried out by the Construction Industry's Organization for Working Environment, Occupational Safety and Health in Sweden. Rate ratios (RRs) in the exposed groups relative to the unexposed groups were estimated by Poisson regression. We found an increased risk (RR = 1.3, 95% CI 1.04-1.71) among construction workers exposed to diesel exhaust. Adjustment for other occupational exposures did not change this estimate (RR = 1.3, 95% CI 1.00-1.77). However, there was no monotonic increase in risk with estimated level of exposure (RR for low = 1.4, moderate = 1.1, high = 1.4). There was no evidence of increased risk associated with the other occupational exposures among these construction workers, including asbestos, asphalt, cement dust, metal dust, mineral wool, organic solvents, stone dust and wood dust. Occupational exposure to diesel exhaust in the Swedish construction industry may present a small risk of multiple myeloma, but lack of an exposure-response trend tempers our ability to draw clear conclusions.
Collapse
Affiliation(s)
- Won Jin Lee
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
| | | | | | | | | | | |
Collapse
|