Dr. C. Ola Landgen, MD, PhD
Researchers at Memorial Sloan Kettering (MSK) report that firefighters at the World Trade Center (WTC) scene in September 2001 were nearly twice as likely as the general population to have a multiple myeloma precursor condition called monoclonal gammopathy of undetermined significance (MGUS). This new research was published online today in JAMA Oncology. The study was also conducted by researchers at Albert Einstein College of Medicine, Montefiore Health System, and the New York City Fire Department.
In the study, researchers screened blood samples from 781 WTC-exposed male firefighters. The firefighters had enrolled in the World Trade Center Health Program to receive physical and mental health services and consented to have their blood samples analyzed for research. The samples were analyzed by researchers at MSK.
“This study provides more evidence that environmental exposures can be a risk factor for multiple myeloma,” said Ola Landgren, MD, PhD, Chief of MSK’s Myeloma Service, who led the study. “Although MGUS will not necessarily lead to multiple myeloma, it is always present as a preliminary stage before someone develops the disease and so can serve as an early warning.”
The researchers found that the prevalence of MGUS in this group was approximately twice as high as in the general population. Earlier studies have suggested that this twofold rate will likely remain for the development of multiple myeloma in the same group, although it could be a decade or more to prove this for certain.
A second part of the study looked at 16 firefighters who had developed multiple myeloma between September 11, 2001, and July 1, 2017. Researchers found that the firefighters’ average age of onset for multiple myeloma was about 15 years earlier than the general population. The firefighters were also more likely to have aggressive types of the disease compared with the overall myeloma population.
Not everyone with MGUS will develop multiple myeloma, but researchers recommend that first responders exposed to the WTC site be screened for both conditions. MGUS, marked by moderately elevated levels of an abnormal immunoglobulin protein called M protein, can be detected with a blood test.
“The clinical guidelines for multiple myeloma don’t currently address being tested for MGUS,” Dr. Landgren says. “But for people who spent significant amounts of time around the recovery site, it is reasonable for them to speak with their primary care physician about being checked for this precursor condition. This could apply even to people who didn’t work at the site but lived or worked nearby at the time.”
Doctors advise that people diagnosed with MGUS have their protein levels monitored through annual blood tests. This monitoring can typically be done by a primary care doctor. If multiple myeloma is suspected, further diagnostic tests, including imaging, blood, urine, and bone marrow tests, would be recommended.
About Multiple Myeloma
Multiple myeloma is a cancer that arises from a type of white blood cell called a plasma cell. Plasma cells originate in the bone marrow and play an important role in the immune system. Multiple myeloma is the second most common blood cancer diagnosis, with more than 30,000 new cases diagnosed per year and more than 120,000 people living with the disease.
Multiple myeloma develops when a normal plasma cell changes into a myeloma cell because of changes in the bone marrow or genetic mutations. These cancerous cells can then multiply uncontrollably. People with multiple myeloma develop tumors in more than one location in the bone marrow and sometimes outside the bone marrow.
As myeloma cells take over space in the bones where bone marrow typically grows, they prevent the marrow from producing essential blood cells. This includes red blood cells, which carry oxygen, and certain types of white blood cells, which fight infection.
Although there are currently no drugs approved to treat the precursor MGUS state, close monitoring could still benefit someone who develops multiple myeloma. A 2015 study led by Dr. Landgren showed that people with MGUS who develop multiple myeloma during clinical monitoring have better overall survival and fewer complications than those who never received an MGUS diagnosis.
This work was supported by grants from the V Foundation for Cancer Research, the Byrne Fund, the Albert Einstein Cancer Center, and the National Institute for Occupational Safety and Health, as well as a Memorial Sloan Kettering Core Grant.