Epidemiology Of Multiple Myeloma Research Articles

A study to identify novel biomarkers associated with multiple myeloma

Background. multiple myeloma (mm) is a plasma cell cancer that affects white blood cells. plasma cells from the bone marrow grow abnormally, as a consequence of which patients have high amounts of monoclonal immunoglobulin in their blood and urine, poor renal function, and recurring infections due to this condition. osteolytic bone lesions and immunodeficiency also impact multiple myeloma patients’ longevity and quality of life. The disease accounts for 13 % of all hematological malignancies worldwide, making it the second most common blood cancer.Material and Methods. The studies investigating mm biomarkers from 2000 to 2021 are collected from various databases. “multiple myeloma”, “biomarkers”, “genetic markers”, “prognostic markers”, “epidemiology of multiple myeloma”, and “risk factors for multiple myeloma” are the key phrases utilized to gather the articles.Results. The scientific and medical research progressed into mm, and the number of cases increased over time and continues to rise, prompting researchers and clinicians to discover new consequences of the disease and new markers for prognosis, diagnosis, detection, and treatment of cancer in the earliest stages. Prognostic and predictive signs for illness recurrence and response to medication may be detected adequately by innovative potential biomarkers, which are more accurate than current approaches.Conclusion. treatment for multiple myeloma includes a variety of chemotherapeutic medicines, including immune modulators and proteasome inhibitors; however, most patients still experience recurrence after completing treatment. There have been numerous novel techniques for managing multiple myeloma, and this review summarises the most commonly used and the new ones that have appeared in the previously published articles.

Analysis of Recorded Morbidity, Prevalence and Hospital Mortality of Patients with Symptomatic Multiple Myeloma in the Ryazan Region for 10 Years

INTRODUCTION: Multiple myeloma (MM) is a disease whose substrate is plasma cells; it is characterized by the production of monoclonal immunoglobulin. Epidemiology of MM in Russia is insufficiently studied. Of interest is a study of dynamics of the main epidemiological parameters of multiple myeloma in the context of a poor epidemiological prognosis for oncological diseases in the Russian Federation and in the world in general.
 AIM: To analyze the main epidemiological parameters of symptomatic MM in the Ryazan region for 10 years (20102019).
 MATERIALS AND METHODS: A total of 343 medical records of patients with symptomatic MM were analyzed, of them 146 men (age median 65 years), 197 women (age median 64 years). The patients underwent inpatient treatment in the hematology and chemotherapy department of Ryazan Regional Clinical Hospital from 2010 to 2019. The epidemiological analysis consisted in evaluation of the parameters of the registered morbidity, prevalence and hospital mortality. The criterion for inclusion in the study was the existence of symptomatic MM in the patient. For statistical processing, Microsoft information and analytical system, Office package was used.
 RESULTS: The highest amount of new cases of MM were identified in 2018 (4.19 per 100,000 population), the lowest in 2012 (1.83 per 100,000 population). In the analyzed period, the number of cases of newly diagnosed MM per year increased by 30.3%. Most patients at the time of diagnosis were in the age group of 6069 years. Morbidity with MM in the age group of 3049 years was comparable in men and women, however, among the patients 50 years women predominated. Over 10 years, the index of MM prevalence in the Ryazan region increased 1.43 times: from 6.71 to 9.6 per 100,000 population, index of hospital mortality from 1.4% to 3.3%.
 CONCLUSION: The growth of the registered mortality and prevalence of MM in the Ryazan region in 20102019 was identified, which corresponds to the dynamics in other regions of the Russian Federation. Also, during the analyzed period, an increase in hospital mortality of patients with MM was observed in the region.

The Clinical Characteristics and Epidemiology of Extramedullary Multiple Myeloma over the Past Two Decades

Background Extramedullary multiple myeloma (EMM) represents a rare and aggressive manifestation of multiple myeloma (MM) in which plasma cells survive outside of the bone marrow microenvironment, arising from a non-medullary site. EMM affects approximately 30% of MM patients and can be present at diagnosis or develop at any timepoint during the disease course [1,2]. Prior studies have demonstrated a higher incidence of high-risk cytogenetics in patients with EMM including gain 1q, translocation (4;14), translocation (14;16) and deletion 17p [3]. There is a paucity of data on clinical characteristics and overall epidemiology of EMM. The purpose of this study is to evaluate the clinical characteristics of patients with EMM over the past 2 decades, and to identify epidemiologic characteristics that may impact overall prognosis. Methods A population-based retrospective cohort study of patients with EMM was conducted using the publicly available Surveillance, Epidemiology, and End Results (SEER) database. In addition, 18 registries in the November 2020 submission database were also utilized (http://www.seer.cancer.gov). All patient-specific information within the databases have been de-identified, and therefore IRB approval was not needed to conduct this study. A total of 858 patients diagnosed with EMM, between 2000 and 2017, were ultimately enrolled in our study. We analyzed demographics, clinical characteristics, and overall mortality (OM) as well as cancer-specific mortality (CSM) of EMM. Variables with a p-value < 0.1 in the univariate Cox regression were incorporated into the multivariate Cox model to determine the independent prognostic factors, with a hazard ratio (HR) of greater than 1 representing adverse prognostic factors. All tests were two-sided, with a confidence interval set as 95% and p value <0.05 deemed statistically significant. All statistical tests were performed by using Software STATA 16.1. Results From a sample of 858 patients with EMM, male gender (63.25%), age range 60-79 years (51.05%) and non-Hispanic whites (66.78%) were the most represented. Central Nervous System (which includes leptomeningeal, intracranial and intraparenchymal involvement) and vertebral column was the most affected site (33.10%). Multivariate cox proportional hazard regression analyses only revealed higher overall mortality (OM) in age group over 80 years (HR = 9.792, 95% CI 4.403-21.774, p=0) and widowed individuals (HR = 1.609, 95% CI 1.101-2.35, p = 0.014). Multivariate cox proportional hazard regression analyses of cancer specific mortality (CSM) also revealed higher mortality of the same groups. Eyes, mouth, and ENT involvement had the lowest CSM in the multivariate analysis. Conclusions EMM is a relatively rare entity that presents in a minority of patients diagnosed with MM [1]. To our knowledge, there is scarcity of data on the clinical characteristics and epidemiology of patients with EMM. This study found that non-Hispanic whites were the most affected population, which contrasts with the overall epidemiology of Multiple Myeloma without extramedullary disease in which the black population is the most affected [4]. Patients were primarily in the 60-79-year age range, and the most commonly affected sites were CNS/vertebral column (33%), bones/soft tissues of the trunk (12.6%) and pelvis/sacrum (11.3%), and eyes/mouth/ears/nose/throat (11.7%). We found that age was the single most important prognostic factor, with older patients having worse outcomes (Table 2). Marital status and tumor location were also found to be independent prognostic factors, with widowed patients having higher mortality rates and patients with EMM affecting eyes/mouth/ears/nose/throat faring better than those with other sites affected (Table 2). We hope that the results of this study will enhance our overall understanding of the clinical presentation of this rare and aggressive manifestation of MM. In better understanding EMM, we hope to inspire larger prospective studies on the management of this subset of patients, which is particularly important in the era of novel agents including immunomodulatory agents, proteasome inhibitors, monoclonal antibodies, and, more recently, the advent of chimeric antigen receptor T-cell therapy (CAR-T) and bispecific agents.

Improving the global reporting of multiple myeloma: a focus on low-income and middle-income countries

The findings reported by Junjie Huang and colleagues,1 published in The Lancet Haematology, elaborate on the recent trends in the epidemiology of multiple myeloma through several global cancer registries, emphasising the contribution of modifiable risk factors, namely overweight and physical inactivity, towards the development of multiple myeloma. The age-standardised multiple myeloma incidence was 1·78 (95% UI 1·69–1·87) per 100 000 people globally and mortality was 1·14 (95% UI 1·07–1·21) per 100 000 people globally in 2020.

Epidemiology of multiple myeloma and patient distribution analysis in Canada

Epidemiology of multiple myeloma and patient distribution analysis in Canada

Epidemiology of multiple myeloma in Taiwan, a population based study

BackgroundAlthough the incidence of multiple myeloma (MM) in Asia is lower than in Western countries, it is steadily increasing. However, limited data are available that describe the epidemiology of MM in Asia. MethodsWe conducted a retrospective cohort study using the Taiwan National Healthcare Insurance Research database to estimate the disease burden and clinical characteristics of patients with MM in Taiwan. All newly diagnosed confirmed MM patients during 2007–2012 were enrolled. Patients were followed up until death or end of the observation period (December 31, 2013), whichever occurred first. ResultsA total of 2723 newly diagnosed MM patients were included in the cohort analysis, of whom 58.0% (1578/2723) were men. The average age of MM patients was 67.6 years. At the time of diagnosis, the mean Charlson Comorbidity Index was 1.8, 35.3% of patients had anemia, 18.0% had bone fracture, 16.4% had renal disease and 17.3% had pneumonia. The crude annual incidence of newly diagnosed MM increased from 1.74 per 100 000 population in 2007 to 2.27 per 100 000 population in 2012 (p < 0.0001), and the age-adjusted incidence from 1.41 to 1.59 per 100 000 population (p = 0.01). The use of novel treatments expanded over the study period. The crude and age-adjusted annual MM mortality rate did not change significantly over time. Case fatality decreased from 25.5% in 2007 to 19.4% in 2012 (p < 0.0001). ConclusionThe age-adjusted incidence of MM in Taiwan increased by 13% between 2007 and 2012. Despite the introduction of new treatments, MM remains largely incurable with 19.4% mortality.

Epidemiology of multiple myeloma in 17 Latin American countries: an update

The objective of this study was to describe incidence, mortality rates, and trends for multiple myeloma (MM) in Latin America (LA), contributing to better knowledge on the epidemiology of MM in this continent. Incidence data were extracted from the International Agency for Research on Cancer (IARC), for the period 1990–2007. Mortality data were obtained for 17 countries from the World Health Organization, for the period 1995–2013. Annual average percentage change (AAPC) and 95% confidence interval (95% CI) were calculated for incidence and mortality. The average incidence rate of MM was higher in Cali (Colombia). For the age‐group over 60 years old, rates were 14.2 and 12.8 per 100,000 inhabitants for men and women, respectively. Increasing incidence trends were verified for Cali (Colombia). Mortality rates were higher among men; most countries presented increasing trends, and the highest increments were observed in Guatemala (12.5% [95% CI: 10.6; 14.5] in men; 8.8% [95% CI: 7.8; 9.8] in women), Ecuador (5.5% [95% CI: 5.0; 6.0] in men; 3.7 [95% CI: 3.1; 4.3] in women), Paraguay (2.9% [95% CI: 2.3; 3.5] in men; 3.2% [95% CI: 2.1; 4.3] in women), and Brazil (1.4% [95% CI: 1.3; 1.5] in men; 0.9% [95% CI: 0.8; 1.0] in women). Multiple myeloma presented heterogeneous incidence patterns in Cali (Colombia), Quito (Ecuador), and Costa Rica. Increasing mortality trends were verified for most Latin American countries and could be related to limited access to diagnosis and new therapies.

Epidemiology of Multiple Myeloma in the Czech Republic

Multiple myeloma (MM) is a cancer of plasma cells with an incidence of 4.8 cases per 100,000 population in the Czech Republic in 2014; the burden of MM in the Czech Republic is moderate when compared to other European countries. This work brings the latest information on MM epidemiology in the Czech population. The Czech National Cancer Registry is the basic source of data for the population-based evaluation of MM epidemiology. This database also makes it possible to assess patient survival and to predict probable short-term as well as long-term trends in the treatment burden of the entire population. According to the latest Czech National Cancer Registry data, there were 504 new cases of MM and 376 deaths from MM in 2014. Since 2004, there has been a 26.9% increase in MM incidence and an 8.3% increase in MM mortality. In 2014, there were 1,982 persons living with MM or a history of MM, corresponding to a 74.4% increase when compared to MM prevalence in 2004. The 5-year survival of patients treated in the period 2010-2014 was nearly 40%. The available data make it possible to analyse long-term trends in MM epidemiology and to predict the future treatment burden as well as treatment results.Key words: multiple myeloma - epidemiology - Czech National Cancer Registry - Registry of Monoclonal Gammopathies - Czech Republic.

Risk Factors for Multiple Myeloma: A Systematic Review of Meta-Analyses.

The epidemiology of multiple myeloma (MM) is an increasingly investigated field, with many controversies. This systematic review aims to synthesize meta-analyses examining risk factors for MM so as to provide a comprehensive, parsimonious summary of the current evidence. Eligible meta-analyses were sought in PubMed adopting a predefined algorithm, without any restriction of publication language; end-of-search date was October 10, 2014. The selection of eligible studies and data extraction were performed by working in pairs, independently and blindly to each other; in case of disagreement, consensus with the whole team was reached. Among the 22 ultimately included meta-analyses, 9 examined occupational factors, 4 assessed aspects of lifestyle (smoking, alcohol, body mass index), 5 evaluated the presence of other diseases, and 4 addressed genetic factors as potential risk factors of MM. A vast compendium of significant associations arose, including farming, occupation as a firefighter, occupation as a hairdresser, exposures to chemicals or pesticides, overweight and obesity, patterns of alcohol intake, pernicious anemia, ankylosing spondylitis, gene promoter methylation, and polymorphisms. In conclusion, MM is a multifactorial disease, encompassing a wide variety of risk factors that span numerous life aspects. Further accumulation of evidence through meta-analyses is anticipated in this rapidly growing field.

Place de l’arcthérapie modulée et de la chimiothérapie concomitante dans la prise en charge des cancers du canal anal localement évolués

The epidemiology of multiple myeloma (MM) is an increasingly investigated field, with many controversies. This systematic review aims to synthesize meta-analyses examining risk factors for MM so as to provide a comprehensive, parsimonious summary of the current evidence. Eligible meta-analyses were sought in PubMed adopting a predefined algorithm, without any restriction of publication language; end-of-search date was October 10, 2014. The selection of eligible studies and data extraction were performed by working in pairs, independently and blindly to each other; in case of disagreement, consensus with the whole team was reached. Among the 22 ultimately included meta-analyses, 9 examined occupational factors, 4 assessed aspects of lifestyle (smoking, alcohol, body mass index), 5 evaluated the presence of other diseases, and 4 addressed genetic factors as potential risk factors of MM. A vast compendium of significant associations arose, including farming, occupation as a firefighter, occupation as a hairdresser, exposures to chemicals or pesticides, overweight and obesity, patterns of alcohol intake, pernicious anemia, ankylosing spondylitis, gene promoter methylation, and polymorphisms. In conclusion, MM is a multifactorial disease, encompassing a wide variety of risk factors that span numerous life aspects. Further accumulation of evidence through meta-analyses is anticipated in this rapidly growing field.

Epidemiology of multiple myeloma and the role of M-band detection on serum electrophoresis in a small developing country. A retrospective study

Objective: The objective of the study was to determine the role of M-band component on serum protein electrophoresis and bone marrow biopsy in the diagnosis.Methods: Data was collected on 34 patients with MM diagnosed and/or treated.Results: There were equal numbers of men 17 (50%) and women 17 (50%). All patients were first screened for the presence of M-Band using serum protein electrophoresis (SPE) followed by bone marrow biopsy as the confirmatory test. Only two patients screened negative by SPE. On the other hand six patients who tested positive by SPE were negative on biopsy. Thus the sensitivity of the SPE was 96% and specificity 71%. This means that 29 patients had an established diagnosis of MM. There was a slight male predominance when compared to females.Conclusion: The data showed that the SPE and bone biopsy are the important tools in the diagnosis of multiple myeloma in a small developing country.

Myeloma therapy: pursuing the plasma cell

Sagar Lonial is to be heartily congratulated on having brought together an impressive array of established leaders in the field of multiple myeloma (MM) to produce a comprehensive review of this difficult disease and its management. The book is divided into seven sections dealing with all the major areas relevant to MM. The first section addresses ‘Biological considerations and multiple myeloma'. The chapter relating to the ‘Epidemiology of MM' (A Langston and D Francis) is a thoughtful summary of current understanding of this topic and discusses the intriguing issue of familial predisposition to MM, which is, as yet, unexplained, but clearly has significant importance to the pathophysiology of MM. The chapter that focuses on the tumour microenvironment (M Raab and K Anderson) nicely summarises the current state of knowledge concerning the inter-dependency of MM tumour cells and the bone marrow microenvironment. This is a current paradigm, championed by Professor Anderson's group at the Dana-Farber that has underpinned the development of the so-called ‘novel therapies', which has led to the significant advances in MM treatment. The chapter on cytogenetics (E Braggio, M Sebag and R Fonseca) is a detailed and thorough overview of the cytogenetic abnormalities found in MM and of their prognostic significance. The second section of the book addresses ‘conventional' cytotoxic treatments. The chapters by J-L Harousseau and A Palumbo are typically authoritative and logical overviews of the function of autologous stem cell transplantation and therapies for non-transplant eligible patients, respectively. A chapter by S Ailawadhi and A Chanan-Khan discusses the function of anthracyclines in MM and reminds us that ‘conventional' drugs still have activity in this disease and should not be discarded from the anti-MM armamentarium. The third section addresses the immune-based therapies in MM as well as comprehensive reviews about immunotherapy and antibody-based approaches, and the function of allogeneic transplantation is discussed (F Wang and E Waller). This issue remains, arguably, one of the most important in the treatment of MM. The chapter summarises the current data and we are left in no doubt that further work is required to define the role of this treatment in MM. Section four, in over 60 pages, comprises a ‘state of the art' overview of the data concerning the ‘novel agents': thalidomide, lenalidomide and bortezomib. Each chapter is authored by recognised experts in the field and describes the early development and later definitive clinical trial data that has led to the establishment of these agents into frontline MM care. Population-based data have shown that coincident with the advent of the ‘novel agents', there has been the single most important increment in outcome for patients with MM. Clearly, the next questions will involve issues concerning the most appropriate sequencing of these drugs, the most effective combinations, the continuing role for ASCT in the ‘novel agent era' and the best selection of therapy for specific groups of patients. Section five addresses ‘Current and Future Targets'. This is arguably the most stimulating section of the book and different chapters discuss, among others, hsp90, PI3K/Akt, mTOR, FGFR3 and HDAC inhibitors. Each chapter has been written by experts in the field and offer clear and insightful reviews of these emerging potential targets for therapy. For example, the chapter by C Mitsiades on hsp90 ranges from scientific rationale to early phase clinical trials in the area. The authors offer the hope that new-targeted therapies will be developed and describe the strong rationale for combining these agents with pre-existing ones (e.g. hsp90 inhibitors with bortezomib). Let us hope that these scientifically designed combinations will further improve outcomes for patients with MM. Section six addresses the most important area of supportive care in MM. The issues discussed include bone disease and its treatment with kyphoplasy and vertebroplasty, anaemia, functional imaging and renal impairment. The final section addresses ‘Other Plasma Cell Disorders'. These chapters comprise authoritative reviews on Waldenstrom's Macroglobulinemia, AL Amyloidosis, the mysterious POEMS syndrome and MGUS. Penned by recognised experts in the field, these chapters represent an excellent resource and reference. Overall, the book is an outstanding resource for clinicians working in the area of MM, which will have long-lasting value and relevance.

Epidemiology of multiple myeloma in Taiwan

The incidence of multiple myeloma (MM) is lower in Asia than in western countries. However, no data are available on descriptive epidemiology of MM in Chinese. From 1979 to 2003, 3602 MM patients were registered in the Taiwan National Cancer Registry. The annual incidence and mortality were calculated and age-standardized to the world standard population in the year 2000. Age-period-cohort effects on incidence were analyzed. The salient clinical data of 526 MM patients in a single institute were also investigated. From 1979 to 2003, the average age-adjusted incidence per 100,000 population was 0.75. The incidence increased with age to a peak of 5.2 in those aged 75-79 years. In addition to age, remarkable period and birth cohort effects were found to contribute to increased incidence of MM. The age-adjusted mortality also increased, which accounted for an average of 0.59 per 100,000 deaths; however, the fatality rate was steady at 80%. Clinical and laboratory characteristics and treatment outcomes of the 526 MM patients were similar to those reported elsewhere. Remarkably, extramedullary myeloma (extra-MM) at diagnosis was more common in patients younger than 55 years of age than in others (43% vs 13%, P < .001). Incidence of MM in Taiwan has dramatically increased in recent years and is associated with a birth-cohort effect. There are no apparent differences in treatment outcome between MM patients in Taiwan and in other countries. However, prevalence of extra-MM is higher in patients younger than 55 years of age.

Epidemiology of Multiple Myeloma in Spain: An Analytic Review.

Introduction: Justification and ObjectivesThere are little epidemiologic data about Myeloma Multiple in Spain. The heterogeneity and complexity of this pathology, and the several sociodemographic factors, justify the interest of this type of studies. On the other hand, this disease needs a high assignement of welfare and therapeutic resources, and besides new strategies have arisen for its treatment. The Spanish Leukaemia and Lymphoma Foundation (FLL)has analyzed the actual situation of Myeloma Multiple in Spain, compiling several epidemiologic and welfare parameters about the disease in a Multiple Myeloma “White Book” for Spain.Patients and MethodsThe period of analysis was 10 years, from 1.991 to 2.001. The information was compiled from a Hospital Based Survey about MM and the following official sources:International Agency for Research on Cancer (IARC): “Cancer incidence in Five continents” and “Incidence and Mortaliity for Cancer In Spain, Patterns and Tendences”Data Base of EUCAN and GLOBOCAN (Cancer Incidence, Mortality and Prevalence Worldwide)EUROCARE III study, (IARC Cancer Base Number 5, Lyon, IARCPress).“Natural Changes of Population and Demography. Spanish National Statistic Institute (INE) and National Spanish Center for Epidemiology (CNE.)Official Records for Mortality Rates by MM in Spain in Spanish Regions (CCAA) (death records Demograhy Records of INE). INE Hospital Case Rate Inquest.CMBD Data Base of Department of Health (Inmunoproliferative Neoplasm and Multiple Myeloma, CIE-9 Diagnosis Code: 203.0)The indicators used were: Deaths number, median of age, proportional mortality, mortality rates, mortality rates adjusted by age, gender and potential years of life lost due to multiple myeloma, (item 203 of ICD-10, OMS) during the last ten years in Spain.ResultsThe incidence rates of MM, adjusted to the European population were: 3,54 cases by 100.000/year for men and 2,54 cases by 100.000/year for women. The global incidence rate were 4,44 cases by 100.000/year for men and 4,22 cases by 100.000/year for women. These rates were similar in all geographic regions. Performed predictions show a prevalence increase during the following five years, which means more than 2.400 cases in men and more than 2.100 in women MM cases per year. Regarding mortality, rates, myeloma is a very slightly frequent cause of death: 3.23 cases by 100.000/years of men and 2.3 cases of women. A whole an increase of mortality of 45.2 per cent was observed for the period of time between 1992 and 2001.Comments and ConclusionsThe MM incidence and mortality rates in Spain for this period were lower than expected in comparison with other European epidemiology studies. Nevertheless we observed that the MM mortality and prevalence rates present a continuous and uniform increment in the last years. Part of these increases can be due to the incorporation of new technologies, more sensitive for diagnosis, and to the increase of aging of the population. Furthermore certain occupational and chemical exposures and other environmental changes could explain these trends.

Is there a causal relationship between exposure to diesel exhaust and multiple myeloma?

This article presents a comprehensive critical review of the epidemiology of multiple myeloma in relation to occupational diesel exhaust exposure. The review includes cohort and proportional mortality studies of workers exposed to diesel exhaust, and population-based case-control studies of multiple myeloma. None of the cohort or proportional mortality studies reported a significant increase of multiple myeloma in relation to diesel exhaust, with the exception of a study of Danish truck drivers. Several limitations in this Danish study (such as inadequate cohort identification, small number of multiple myeloma deaths and inappropriate analytical method) made the result unreliable. Furthermore, the data in this study of Danish truck drivers were part of and, hence, superseded by a large study in Denmark, which did not find any increased risk of multiple myeloma. Similarly, none of the case-control studies reported a significant increase of multiple myeloma in relation to diesel exhaust, with the exception of the smallest case-control study based on multiple myeloma patients in central and southeast Sweden. The result of this small Swedish study was not reliable because of incomplete case ascertainment, inappropriate controls and confounding. Furthermore, the data in this small Swedish study were part of and, hence, superseded by a large national study of workers exposed to diesel exhaust in Sweden, which did not find any increased risk of multiple myeloma. Other than the study of Danish truck drivers and the small case-control study of multiple myeloma patients in central and southeast Sweden, all other epidemiological investigations consistently reported no increase of multiple myeloma in relation to occupational diesel exhaust exposure. Furthermore, none of the studies reported a positive exposure-response relationship between diesel exhaust and multiple myeloma. Several studies that analysed data by jobs or occupations according to level of exposure and by duration of exposure did not find any upward trend. In addition to the review, a formal causation analysis based on an application of the Hill criteria confirms that there is no causal relationship between diesel exhaust and multiple myeloma.

Epidemiology of Multiple Myeloma in the Texas Golden Triangle

Epidemiology of Multiple Myeloma in the Texas Golden Triangle