Incidence Of Myeloma Research Articles

Multiple myeloma risk in relation to long-term air pollution exposure - A pooled analysis of four European cohorts

BackgroundAir pollution is a growing concern worldwide, with significant impacts on human health. Multiple myeloma is a type of blood cancer with increasing incidence. Studies have linked air pollution exposure to various types of cancer, including leukemia and lymphoma, however, the relationship with multiple myeloma incidence has not been extensively investigated. MethodsWe pooled four European cohorts (N = 234,803) and assessed the association between residential exposure to nitrogen dioxide (NO2), fine particles (PM2.5), black carbon (BC), and ozone (O3) and multiple myeloma. We applied Cox proportional hazards models adjusting for potential confounders at the individual and area-level. ResultsDuring 4,415,817 person-years of follow-up (average 18.8 years), we observed 404 cases of multiple myeloma. The results of the fully adjusted linear analyses showed hazard ratios (95% confidence interval) of 0.99 (0.84, 1.16) per 10 μg/m³ NO2, 1.04 (0.82, 1.33) per 5 μg/m³ PM2.5, 0.99 (0.84, 1.18) per 0.5 10−5 m−1 BCE, and 1.11 (0.87, 1.41) per 10 μg/m³ O3. ConclusionsWe did not observe an association between long-term ambient air pollution exposure and incidence of multiple myeloma.

Cancer incidence in World Trade Center rescue and recovery workers by race and ethnicity.

It is unclear whether differences in health outcomes by racial and ethnic groups among World Trade Center (WTC) rescue and recovery workers reflect those of the population of New York State (NYS) or show distinct patterns. We assessed cancer incidence in WTC workers by self-reported race and ethnicity, and compared it to population figures for NYS. A total of 61,031 WTC workers enrolled between September 11, 2001andJanuary 10, 2012were followed to December 31, 2015. To evaluate the association between race/ethnicity and cancer risk, Poissonregression analysis was used to estimate hazard ratios (HR) adjusted for WTC exposure, age, calendar year, sex and, for lung cancer, cigarette smoking. In comparison to Whites, Black workers had a higher incidence of prostate cancer (HR = 1.99, 95% CI = 1.69-2.34) and multiple myeloma (HR = 3.57, 95%CI = 1.97-6.45), and a lower incidence of thyroid (HR = 0.41, 95%CI = 0.22-0.78) and colorectal cancer (HR = 0.57; 95%CI = 0.33-0.98). Hispanic workers had a higher incidence of liver cancer (HR = 4.03, 95%CI = 2.23-7.28). Compared with NYS population, White workers had significantly higher incidence of prostate cancer (HR = 1.26, 95%CI = 1.18-1.35) and thyroid cancer (HR = 1.80, 95%CI = 1.55-2.08), while Black workers had significantly higher incidence of prostate cancer (HR = 1.22, 95%CI = 1.05-1.40). Cancer incidence in WTC workers generally reflects data from the NYS population, but some differences were identified that merit further investigation.

Recent advances in the treatment and prevention of peripheral neuropathy after multiple myeloma treatment.

The incidence of multiple myeloma (MM) is increasing year by year, requiring chemotherapy drugs to control the condition. With the advent of new proteasome inhibitors, immunomodulators, and monoclonal antibodies, the prognosis of patients has improved significantly. However, peripheral neuropathy caused by drugs limits the dose and duration of treatment, which seriously affects patients' quality of life and treatment outcome. Although the neuropathies induced by chemotherapy drugs have attracted much attention, their mechanism and effective prevention and treatment measures are not clear. Therefore, how to alleviate peripheral neuropathy caused by drugs for treatment of MM is a key issue in improving patients' quality of life and prolonging their survival time, which have some clinical value. In this paper, we review the current research on the pathogenesis, pharmacological and nonpharmacological treatment, and prevention, which expects to present instruction for peripheral neuropathy after treatment of MM.

Ethnic disparities in presentation but not outcome in multiple myeloma patients: a multicenter retrospective study in Northern Israel

Several studies showed ethnic disparities in multiple myeloma (MM) incidence and prognosis. In order to compare prognosis and overall survival between different ethnic groups, a multicenter retrospective study was conducted in Northern Israel. A total of 145 patients suffering from MM were included (72% Jewish, and 28% Arabs) who were treated between 2008–2018. A difference was found in the stage of the disease at the time of diagnosis, patients of Arab origin were diagnosed at a more advanced stage (III), (53.7% vs. 33.7%, respectively). A mortality rate of 48.9% was found in the study, regardless of population ethnic origin. No significant differences in rates of MGUS, MM symptoms, treatments, or progression-free survival (PFS) and overall survival (OS) were observed between ethnic groups. This suggests that raising awareness of MM may result in an earlier diagnosis, especially among patients of Arab origin, preventing unnecessary suffering from these patients.

Further analysis of incidence of multiple myeloma among atomic-bomb survivors, 1950 to 1994.

Multiple myeloma (MM) predominantly occurs in older persons and its diagnosis depends on pathological and laboratory findings. Epidemiological studies have provided inconsistent results on relationship between radiation exposure and MM. The Life Span Study (LSS) of atomic bomb (A-bomb) survivors has not shown a statistically significant radiation risk for MM. We studied previously reported MM cases diagnosed between 1950 and 1994 in the LSS and assessed diagnostic certainty based on histological and clinical features. Among 122 incident MM cases, 67 were classified as definite, 23, probable and 32, undetermined. The incidence rate increased with attained age and was highest in the oldest age group of over 70 years. For definite MM, Poisson regression dose response analysis showed an elevated, though not statistically significant, radiation risk with an estimated excess relative risk (ERR) per Gy of 0.44 (95%CI:<-0.02, 2.4), which was markedly higher than the previously reported ERR/Gy of -0.02 (95% CI: -0.24,0.75) that included cases with undetermined diagnostic certainty. The present case series included 24 persons with MM diagnosed after participating in M-protein screening offered to a clinical subset of the LSS members. Exclusion of screen-detected cases led to a higher radiation risk estimate, which was not statistically significant. A large number of young survivors exposed before age 20 years were younger than 70 years in the current follow-up period, but will reach ages with rapidly increasing MM rates. Future follow-up data with improved diagnostic certainty will improve understanding of long-term effects of radiation exposure on MM in this cohort.

Association between type 2 diabetes mellitus and multiple myeloma: Fact or fiction

Multiple myeloma is a plasma cell cancer causing bone and marrow damage, resulting in hypercalcemia, anemia, and renal insufficiency. Diabetes mellitus occurs in 6-24% of multiple myeloma cases, associated with immunosuppression, inflammation, and lymphocyte dysfunction, possibly contributing to multiple myeloma development. Insulin and insulin-like growth factor-1 also contribute to multiple myeloma pathogenesis. The incidence of both multiple myeloma and diabetes mellitus is expected to rise due to the aging population, lifestyle changes, genetic predisposition, and improved diagnostic methods. Although the link between diabetes mellitus and hematological malignancy risk is less conclusive, insulin resistance and growth factors may promote tumor cell proliferation. Genetic variants linked to type 2 diabetes mellitus (T2DM) influence multiple myeloma risks. The insulin like growth factor 1 (IGF1) gene triggers malignant plasma cell proliferation. Additionally, poorly managed T2DM-induced acidosis creates a favorable environment for cancer cell growth, including multiple myeloma. T2DM and metabolic syndrome (MetS) increase multiple myeloma risks through insulin resistance, hyperinsulinemia, inflammation, and dyslipidemia. Inflammatory cytokines [interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), and interleukin-1β (IL-1β)] contribute to insulin resistance, chronic inflammation, and multiple myeloma cell survival too. The coexistence of diabetes and multiple myeloma presents challenges in managing complications like neuropathy, nephropathy, and retinopathy. In conclusion, the association between T2DM and multiple myeloma has been established, with a discernible influence from distinct genetic variations. Notably, IL-6, TNF-alpha, and IL-1β exert significant influence on the development of insulin resistance and the proliferation of cancer cells, and also their viability. Consequently, the involvement of inflammatory cytokines, dyslipidemia, and IGF1 in the progression of MM among patients with T2DM and MetS is noteworthy.

Racial bias in multiple myeloma clinical trials: Racial minorities continue to miss out on treatment advances.

e20009 Background: Adequate representation of participants based on race and ethnicity in a clinical trial helps ensure the results' generalizability. There is a disparity in the participation of minorities in oncology clinical trials despite higher incidence and disease burden in them. The incidence of Multiple Myeloma (MM) in AA (African American) is twice as compared to White, and they are twice as likely to die from MM compared to White. Methods: We queried ClinicalTrials.gov in February 2023 for all completed interventional trials with the published results for Multiple Myeloma in the US. Demographic data were collected from all the studies. If not available, the primary manuscript was searched using the trial number. We excluded the studies involving other malignancies and conducted outside of the USA. Trials on prevention, diagnostics, supportive care, and antibiotics were also excluded. Incidence data of Multiple myeloma was obtained from the SEER database for each ethnicity and race. Results: Out of 194 trials included in our study, 133 (68.56%) reported at least either race or ethnicity. Of these trials, 83 (42.78) reported race, 124 (63.91) reported ethnicity, and 77 (39.69) reported both race and ethnicity. 5.67% of the trial participants were reported as Hispanic race. White, AA, and Asian represented 79.82%, 11.36%, and 3.10% of the trial participants, respectively. The number of trials reporting race or ethnicity has increased when comparing the trials conducted between 2001-2011 and 2012-2022 (58.3% vs. 90.3%); OR 6.4; 95% CI 2.77-17.98; p&lt;0.001. Participation of Asians increased (2% vs. 5.5%; p&lt;0.0005), while there were slight changes among AA (11.7% vs. 10.6%, p=0.1475), Hispanic (5.4% vs. 6%; p=0.3863), and White (80.8% vs. 77.8%, p=0.208) between 2001-2011 and 2012-2022. Conclusions: Despite ongoing efforts to improve the diversity of minorities in oncology trials, they are still under-enrolled in multiple myeloma. More studies and interventions are needed to address this disparity. [Table: see text]

Identifying associations between race and gender in the incidence and mortality of patients with multiple myeloma.

e20052 Background: Multiple Myeloma (MM) is a plasma cell malignancy due to proliferation of malignant clonal plasma cells. Prior studies have shown that overall incidence of MM was 8.47 per 100,000 individuals. It has also been seen that the incidence of MM has trended upwards in non-Hispanic white (NHW) males and non-Hispanic blacks (NHB) across all age groups. This retrospective, database-driven population study sought to further assess racial and gender-based differences in the trends of the incidence of MM and mortality from MM. Methods: Data obtained from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) registry 17 were available to assess trends of multiple myeloma incidence and mortality from 2000 to 2019. Trends were described as average annual percentage change (APC) rates. Results: A total of 102,467 MM patients were identified in this data set; 56,508 (55.1%) were males and 45,949 (44.8%) were female. The distribution of MM by race was as follows (in order from highest to lowest): Non-Hispanic White [NHW] patients was 63.2% (N = 64,776), Non-Hispanic Black [NHB] patients was 18.6% (n = 19,099), Hispanic patients was 11.6 % (11,841), Non-Hispanic Asian [NHA] patients was 5.6% (5,769), and Non-Hispanic American Indian [NHAI]/Alaska Native patients was 0.5% (523). Incidence of MM (cases per 100,000 persons) was highest in males (7.5; 95% CI: 7.5, 7.6) and blacks (13; 95% CI: 12.8, 13.2). Overall trend in the incidence of MM has increased significantly for all gender and ethnicity groups over the period from 2000-2019, except for NHA patients. The incidence-based mortality of MM was highest in male (5.2; 95% CI: 5.2, 5.3) and black (8.7; 95% CI: 8.5, 8.8) patients. The overall incidence-based mortality increased significantly in males APC 4.1% (95% CI: 2.2,5.9; p &lt; 0.001), females APC 3.6% (95% CI, 1.8,5.5; p &lt; 0.001) and all ethnicities - NHW patients APC 4.1%, (95% CI, 2.2,6.0; p &lt; 0.001), NHB (APC 4.2%, 95% CI, 2.1,6.3; P &lt; 0.001), NHAI (APC 4.7%, 95% CI, -2.2,7.2; p &lt; 0.001), NHA (APC 3.0%, 95% CI: 0.8,5.2; P = 0.009) and Hispanic (APC 2.9, 95% CI:1.1,4.7; P = 0.003). Conclusions: Population-based trends in MM incidence and mortality, as reported in this study, were increased commensurate with prior reports. Of note, mortality was noted to be highest amongst the NHB and male populations, indicating a need for further research focused efforts in this potentially high-risk population.

Association of serum 25-hydroxyvitamin D with the incidence of 16 cancers, cancer mortality, and all-cause mortality among individuals with metabolic syndrome: a prospective cohort study.

The relationship between vitamin D levels and cancer incidence and mortality in individuals with metabolic syndrome (MetS) remains poorly explored. Herein, we aimed to determine the association between 25-hydroxyvitamin D [25(OH)D] concentrations and the risk of 16 cancer incidence types and cancer/all-cause mortality in patients with MetS. We enrolled 97,621 participants with MetS at recruitment from the UK Biobank cohort. The exposure factor was baseline serum 25(OH)D concentrations. The associations were examined using Cox proportional hazards models, which were displayed as hazard ratios (HRs) with 95% confidence intervals (CIs). Over a median follow-up period of 10.92years for cancer incidence outcomes, 12,137 new cancer cases were recorded. We observed that 25(OH)D concentrations were inversely related to the risk of colon, lung, and kidney cancer, and HRs (95% CI) for 25(OH)D ≥ 75.0 vs. < 25.0nmol/L were 0.67 (0.45-0.98), 0.64 (0.45-0.91), and 0.54 (0.31-0.95), respectively. The fully adjusted model revealed a null correlation between 25(OH)D and the incidence of stomach, rectum, liver, pancreas, breast, ovary, bladder, brain, multiple myeloma, leukemia, non-Hodgkin lymphoma, esophagus, and corpus uteri cancer. Over a median follow-up period of 12.72years for mortality outcomes, 8286 fatalities (including 3210 cancer mortalities) were documented. An "L-shaped" nonlinear dose-response correlation was detected between 25(OH)D and cancer/all-cause mortality; the respective HRs (95% CI) were 0.75 (0.64-0.89) and 0.65 (0.58-0.72). These findings emphasize the importance of 25(OH)D in cancer prevention and longevity promotion among patients with MetS.

Systematic Review and Meta-Analysis of the Impact of Bariatric Surgery on Future Cancer Risk.

The study aimed to perform a systematic review and meta-analysis of the evidence for the prevention of future cancers following bariatric surgery. A systematic literature search of the Cochrane Library, Embase, Scopus, Web of Science and PubMed databases (2007-2023), Google Scholar and grey literature was conducted. A meta-analysis was performed using the inverse variance method and random effects model. Thirty-two studies involving patients with obesity who received bariatric surgery and control patients who were managed with conventional treatment were included. The meta-analysis suggested bariatric surgery was associated with a reduced overall incidence of cancer (RR 0.62, 95% CI 0.46-0.84, p < 0.002), obesity-related cancer (RR 0.59, 95% CI 0.39-0.90, p = 0.01) and cancer-associated mortality (RR 0.51, 95% CI 0.42-0.62, p < 0.00001). In specific cancers, bariatric surgery was associated with reduction in the future incidence of hepatocellular carcinoma (RR 0.35, 95% CI 0.22-0.55, p < 0.00001), colorectal cancer (RR 0.63, CI 0.50-0.81, p = 0.0002), pancreatic cancer (RR 0.52, 95% CI 0.29-0.93, p = 0.03) and gallbladder cancer (RR 0.41, 95% CI 0.18-0.96, p = 0.04), as well as female specific cancers, including breast cancer (RR 0.56, 95% CI 0.44-0.71, p < 0.00001), endometrial cancer (RR 0.38, 95% CI 0.26-0.55, p < 0.00001) and ovarian cancer (RR 0.45, 95% CI 0.31-0.64, p < 0.0001). There was no significant reduction in the incidence of oesophageal, gastric, thyroid, kidney, prostate cancer or multiple myeloma after bariatric surgery as compared to patients with morbid obesity who did not have bariatric surgery. Obesity-associated carcinogenesis is closely related to metabolic syndrome; visceral adipose dysfunction; aromatase activity and detrimental cytokine, adipokine and exosomal miRNA release. Bariatric surgery results in long-term weight loss in morbidly obese patients and improves metabolic syndrome. Bariatric surgery may decrease future overall cancer incidence and mortality, including the incidence of seven obesity-related cancers.

Vitamin D and Multiple Myeloma: A Scoping Review

As the global incidence of multiple myeloma (MM) increases, the identification of modifiable risk factors for disease prevention becomes paramount. Maintaining optimal vitamin D status is a candidate for prevention efforts, based on pre-clinical evidence of a possible role in disease activity and progression. A structured scoping review was performed to identify and describe human-level research regarding the association between vitamin D and MM risk and/or prognosis. Searches of three databases (OVID-Medline, OVID-Embase, and OVID-Cochrane Library) yielded 15 included publications. Vitamin D deficiency is fairly common among patients with MM, with 42.3% of participants in the studies identified as having a vitamin D deficiency. No included publication reported on vitamin D status and the risk of developing or being newly diagnosed with MM. Possible associations with vitamin D that warrant future exploration include the incident staging of MM disease, the occurrence of peripheral neuropathy, and survival/prognosis. Vitamin D receptor (VDR) polymorphisms associated with MM also warrant further investigation. Overall, this scoping review was effective in mapping the research regarding vitamin D and MM and may help support new hypotheses to better describe this association and to better address identified knowledge gaps in the literature.

Deep Transcriptome Profiling of Multiple Myeloma Using Quantitative Phenotypes.

Transcriptome studies are gaining momentum in genomic epidemiology, and the need to incorporate these data in multivariable models alongside other risk factors brings demands for new approaches. Here we describe SPECTRA, an approach to derive quantitative variables that capture the intrinsic variation in gene expression of a tissue type. We applied the SPECTRA approach to bulk RNA sequencing from malignant cells (CD138+) in patients from the Multiple Myeloma Research Foundation CoMMpass study. A set of 39 spectra variables were derived to represent multiple myeloma cells. We used these variables in predictive modeling to determine spectra-based risk scores for overall survival, progression-free survival, and time to treatment failure. Risk scores added predictive value beyond known clinical and expression risk factors and replicated in an external dataset. Spectrum variable S5, a significant predictor for all three outcomes, showed pre-ranked gene set enrichment for the unfolded protein response, a mechanism targeted by proteasome inhibitors which are a common first line agent in multiple myeloma treatment. We further used the 39 spectra variables in descriptive modeling, with significant associations found with tumor cytogenetics, race, gender, and age at diagnosis; factors known to influence multiple myeloma incidence or progression. Quantitative variables from the SPECTRA approach can predict clinical outcomes in multiple myeloma and provide a new avenue for insight into tumor differences by demographic groups. The SPECTRA approach provides a set of quantitative phenotypes that deeply profile a tissue and allows for more comprehensive modeling of gene expression with other risk factors.

Geospatial analysis of population-based incidence of multiple myeloma in the United States

BackgroundWe investigated the spatial patterns of multiple myeloma (MM) incidence in the United States (US) between 2013 and 2017 to improve understanding of potential environmental risk factors for MM. MethodsWe analyzed the average county-level age-adjusted incidence rates (“ASR”) of MM between 2013 and 2017 in 50 states and the District of Columbia using the U.S. Cancer Statistics Public Use Databases. We firstly divided the ASR into quintiles and described spatial patterns using a choropleth map. To identify global and local clusters of the ASR, we performed the Spatial Autocorrelation (Global Moran’s I) analysis and the Anselin’s Local Indicator of Spatial Autocorrelation (LISA) analysis. We compared the means of selected demographic and socioeconomic factors between the clusters and counties of the whole US using Welch one-sided t-test. ResultsWe identified distinct spatial dichotomy of the ASR across counties. High ASR were observed in counties in the Southeast of the US as well as the Capital District (metropolitan areas surrounding Albany) and New York City in the state of New York, while low ASR were observed in counties in the Southwest and West of the US. The ASR showed a significant positive spatial autocorrelation. We identified two major high-high local clusters of the ASR in Georgia and Southern Carolina and five major low-low local clusters of the ASR in Alabama, Arizona, New Hampshire, Ohio, Oregon, and Tennessee. The racial population distribution may partly explain the spatial distribution of MM incidence in the US. ConclusionFindings from this study showed distinct spatial distribution of MM in the US and two high-high and five low-low local clusters. The non-random distribution of MM suggests that environmental exposures in certain regions may be important for the risk of MM.

Abstract C125: Multiple myeloma incidence, mortality and survival differences at the intersection of sex, age, and race/ethnicity in the United States and Puerto Rico: 2015-2019

Abstract Background: Multiple myeloma (MM) is an incurable malignancy of plasma cells. Overall 5-year survival rate has increased in recent years due to new treatments. However, this improvement has not been equal across sociodemographic groups. Older adults, males, and non-Hispanic Blacks (NHB) are at higher risk of developing and dying from MM. Therefore, this study investigated the intersectionality among age, sex, and race/ethnicity to better understand the patterning of MM incidence, mortality, and survival. These groups are usually considered separately, which may mask the inequities experienced among them. Methods: The sources of information for this study were the Puerto Rico (PR) Central Cancer Registry database and the US Surveillance, Epidemiology, and End Results (SEER) Program database. We analyzed incidence and mortality trends of MM from 2001 to 2019 using joinpoint regression models to calculate Annual Percent Change (APC). Age-standardized rate ratios (SRR) for MM incidence and mortality were used to compare PR with US racial/ethnic groups from 2015 to 2019. The SRRs were stratified by two age groups (&amp;lt;65, ≥65) and sex. Furthermore, 5-year survival analyses of MM were performed. Results: Regardless of age and race/ethnicity, males have higher incidence and mortality rates of MM than females. In terms of trends, PR had a higher increase in MM incidence rates than other racial/ethnic groups, regardless of sex and age (PR annual percent change [APC] = 4.3 among males &amp;lt;65, 3.1 among males ≥65, 6.3 among females &amp;lt;65, and 2.6 among females ≥65 years old). No significant change in mortality APCs (p&amp;gt;0.05) was observed in PR during the study period when stratified by age or sex. Across categories of age and sex, NHB had higher MM incidence and mortality rates than the other racial/ethnic groups. Nevertheless, when comparing males &amp;lt;65 years, PR has significantly higher incidence rates than non-Hispanic Whites (NHW) and US Hispanics (USH). However, PR has significantly lower mortality rates than NHW, NHB, and USH in the ≥65 age group. In terms of survival, PR showed the lowest observed 5-year survival rate among males &amp;lt;65 years (54.6%, 95% CI: 47.2-61.5) and males ≥65 years (33.8%, 95% CI: 28.5-39.1). Among females, USH showed the lowest observed 5-year survival for the age group &amp;lt;65 years (59.4%, 95% CI: 55.2-63.4) and NHW showed the lowest observed 5-year survival for the age group ≥65 years (37.0%, 95% CI: 35.4-38.6). In most categories, the highest observed 5-year survival rates were similar between two or more racial/ethnic groups. Conclusion: The incidence of MM increased in every racial/ethnic group over the study period, with PR having the highest APCs in all categories. Despite the introduction of new therapies, the mortality rates in PR have remained stable while the other racial/ethnic groups show significant decreases across categories of sex and age. These results highlight the need for more research in MM to better understand these disparities. Citation Format: Carlos R. Torres-Cintrón, Tonatiuh Suárez-Ramos, Maira A. Castañeda-Avila, Mara M. Epstein, Guillermo Tortolero-Luna, Karen J. Ortiz-Ortiz. Multiple myeloma incidence, mortality and survival differences at the intersection of sex, age, and race/ethnicity in the United States and Puerto Rico: 2015-2019 [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C125.

Comparative analysis of the associations between solar activity and trends in the incidence of haemoblastoses in Russia, the USA and Canada

Background. Identification of the links between hemoblastoses and environmental factors is necessary for the development of preventive measures.&#x0D; Aim. Comparative analysis of the link between hemoblastosis trends in Russia, the USA and Canada and solar activity.&#x0D; Material and methods. The open data on the incidence of hemoblastoses in Canada (19832012), the USA (19982012) and Russia (19932018) was used. To estimate solar activity, the average annual number of sunspots (Wolff numbers) was taken. The relationship between the frequency of hemoblastoses and solar activity was studied using the Pearson correlation analysis in 11 iterations (lag 010 years). The results obtained are compared with the data of an earlier study on Russia.&#x0D; Results. In Canada, an association with Wolf numbers was found in the frequency of Hodgkin's lymphoma in men (r=0.431, p=0.017, lag 2 years), multiple myeloma in women (r=0.542, p=0.037, lag 1 year), non-Hodgkin's lymphomas in men (r =0.538, p=0.038, lag 5 years) and women (r=0.750, p=0.001, lag 5 years), leukemia in men (r=0.707, p=0022, lag 7 years) and women (r=0.817, p=0.004, lag 7 years). In the United States, a relationship with solar activity was established for fluctuations in the incidence of Hodgkin's lymphoma in men (r=0.577, p=0.050, lag 5 years) and women (r=0.641, p=0.025, lag 5 years), non-Hodgkin's lymphomas in men (r=0.809, p 0.001, lag 3 years) and women (r=0.844, p 0.001, lag 2 years), leukemia in men (r=0.619, p=0.032, lag 1 year). In the Russian population, a relationship between solar activity and the frequency of all forms of hemoblastoses, was previously revealed. Fluctuations in the frequency of leukemia and non-Hodgkin's lymphomas in the populations of Russia, the USA and Canada have a strong positive relationship with solar activity. The strength of this association in Hodgkin's lymphoma and multiple myeloma ranges from moderate to significant. In all the countries studied, an increase in the incidence of multiple myeloma and leukemia was found, and an increase in the incidence of non-Hodgkin's lymphomas was found in Russia and Canada. The trend in the incidence of Hodgkin's lymphoma in Russia and Canada has a significant downward trend.&#x0D; Conclusion. Trends in hemoblastoses in Russia, the USA and Canada are strongly related to solar activity.

Retrospective Analysis of Prognostic Factors and Survival in Multiple Myeloma Patients Aged 65 Years or Older at Diagnosis in a Real-Life Setting and a Proposed New Staging System

Introduction: The incidence of multiple myeloma (MM) increases with age. Novel agents provide better treatment results. However, adults >65 years of age are often underrepresented in clinical trials making it difficult to assess treatment outcomes in older patients. Appropriate strategies are necessary and treatment must be individualized in this heterogeneous population. Methods: We retrospectively reviewed the charts of 534 patients diagnosed with MM between January 2010 and January 2020 who presented to our department. One hundred twenty-three of them were aged 65 years or older at diagnosis and were included in the study. Clinical and laboratory data were collected and potential prognostic factors of overall survival (OS) were evaluated by univariate and multivariate analyses. Results: Of 123 patients analyzed 54.5% (67) were male and 45.5% (56) were female. The median age was 71 years and 32.5% of patients were equal or older than 75 years. Median follow-up time was 28 months (1-117). Median OS and progression free survival (PFS) were 46 and 17 months, respectively. Of the patients 63.4% (78) died during the study period. The patients were divided into 3 groups according to age: 65-69 (47 patients, median OS 68 months), 70-74 (36 patients, median OS 45 months) and ≥75 (40 patients, median OS 36 months) years old (p: 0.022). International Staging System (ISS) stage could be defined in 117 patients (19 had ISS I, 40 ISS II and 58 had ISS III disease). Revised ISS (R-ISS) could also be defined in 117 patients (17 R-ISS I, 82 R-ISS II and 18 R-ISS III). Both ISS and R-ISS could not identify statistically significant differences regarding OS and PFS. Chromosomal abnormalities were detected by fluorescence in situ hybridization (FISH) and conventional cytogenetics in 56 and 39 patients respectively. Eleven of 56 patients and 4 of 39 patients had unfavorable genetic features and due to the small number these patients are not included in the survival analyses. Bortezomib based doublet and triplet induction regimens were given in 86% of patients. Univariate analysis revealed that age, hemoglobin, creatinine, calcium, albumin, extramedullary disease and bone marrow plasma cell (BMPC) percentage were strongly associated with OS. Receiver operating curve (ROC) analysis determined the optimal cut-off value of BMPC 26.5%. On multivariate analysis albumin, extramedullary disease and BMPC ratio retained prognostic value. Presence of none, one, two or all three of these factors could identify 4 patient subgroups showing median OS rates of 108, 55, 25 and 12 months, respectively (p: <0.001) (Figure). Conclusions: MM primarily affects older adults. Hence, there is a need for simple and reliable staging systems for elderly MM patients. We propose a prognostic scoring method for outcome incorporating easy to use variables such as albumin, extramedullary disease and BMPC ratio. Hypoalbuminemia (≤ 3.5 g/dl), presence of extramedullary disease and BMPC ratio ≥ 26.5% predicted different OS ratios in the study population. A validation of the score in an independent series of patients is planned. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

MM-364 A Retrospective Study of Tobacco Use and Multiple Myeloma: Evidence Against an Association Between Smoking and Incidence/Outcome

The importance of the association between smoking and multiple myeloma was the main objective of this retrospective study. This study examined the relationship between smoking cigarettes and other tobacco products and the incidence of multiple myeloma in a cohort of 304 alive patients (out of 405) during a period of 10 years as well as the relationship between smoking and achievement of remission/stable disease. This observational retrospective study included patients diagnosed between 2012 and 2022. Patients were recruited from the University Clinic for Hematology-Skopje. This study includes 304 patients (156 male, 148 female) who were subdivided into three groups based on their smoking habits: active smokers, former smokers, and non-smokers. They were further subcategorized into groups based on whether they had achieved remission/stable disease or were undergoing treatment. The hypotheses of this study were made before collecting any of the data and stated that i) the incidence of multiple myeloma is not higher in patients who are smokers/tobacco users than in non-smoking patients and ii) remission/stable disease and multiple myeloma are not related to smoking. The collected data showed that 156 patients were male and 148 were female. Fifty-eight (19.1%) of the patients were active smokers, 50 of whom were in complete remission; 62 (20.4%) were former smokers, 56 of whom were in complete remission; and 184 (60.5%) were non-smokers, 160 of whom were in complete remission. Seventy-six smokers and ex-smokers were male and 44 were female, for a total of 120. Of the 184 non-smokers, 80 were male and 104 were female. The data collected confirmed that multiple myeloma incidence is not related to smoking/using other tobacco products. Also, it is not related to achieving complete remission; in contrast, smokers and ex-smokers easily achieve remission.

Cancer Stem Cells as a Prognostic Biomarker and Therapeutic Target Using Curcumin/ Piperine Extract for Multiple Myeloma.

Multiple myeloma (MM) is a hematological bone marrow malignancy that can be treated but is usually fatal. Medication resistance is the major cause of relapses due to cancer stem cells (CSCs). As a result, this study aimed to identify multiple myeloma cancer stem cells (MMCSCs) in the bone marrow of twelve MM patients with pathological complete response (pCR) after chemotherapy and to investigate the potential effect of Curcumin/Piperine (C/P) extract as an anti-MMCSCs treatment in twenty newly diagnosed patients. This study included twenty bone marrow (BM) samples from newly diagnosed MM patients and twelve BM samples from pCR patients after a year of treatment. The MTT test was performed to assess the treatment's effective dosage. A flow cytometer was used to identify MMCSCs, cell cycle profile, extract's apoptotic activity, and proliferation marker in the selected samples. Also, a colony formation test and stemness protein were investigated. In newly diagnosed MM patients, the C/P extract suppressed MMCSCs by 64.71% for CD138-/CD19- and 38.31% for CD38++. In MM patients' samples obtained after one year of treatment, the MMCSCs inhibition percentage reached 44.71% (P < 0.008) for CD138-/CD19- and 36.94% (P < 0.221) for CD38++. According to cell cycle analyses, the number of cells treated with C/P extract was significantly reduced in the S and G0/G1 phases (87.38%: 35.15%, and 4.83%: 2.17% respectively), with a rapid increase in the G2/M phases (1.1%: 2.2%.). MMCSCs apoptosis was identified using a flow cytometer and Annexin-V. Multiple myeloma stem cell (MMCSC) proliferation was inhibited. Clonogenicity was suppressed by 60%, and stemness protein expression was reduced by 70%. MMCSCs in the bone marrow of MM-pCR patients can be utilized as a prognostic tool to predict recurrent multiple myeloma incidence. Also, the therapeutic potential of C/P extract as a prospective anti-MM drug targeting MMCSCs.

Light-Chain Multiple Myeloma Presenting as a Bone Tumor in the Right Knee Joint – a Case Report

Myeloma is the neoplastic proliferation of plasma cells. The peak age of onset of this disease is the seventh decade, and it is rare in young patients. Myeloma usually presents as lytic lesions in axial bones and rarely present as a joint disease. Usually, the tumor cells secrete monoclonal immunoglobulins. Non-secretory myeloma is a rare clinical entity. The incidence of light-chain myeloma is 16 – 20 % among all multiple myelomas, and the more common subtype is the lambda chain type. We present a case of kappa light chain-type myeloma in a 29-year-old male with the presenting lesion in the right knee joint. The case is presented for its rarity due to the age of patient, presentation, and type of myeloma.

Spectrum of Bone Complications in Newly diagnosed Multiple Myeloma patients

Abstract Multiple myeloma is a malignant disorder of plasma cells that seed throughout the bone marrow and usually produce a monoclonal immunoglobulin in the blood, urine, or both, cause lytic bone lesions. A total of 159 newly diagnosed multiple myeloma patients aged 24 to 85 were included in this study. The median age of 159 patients was 56 years. Highest incidence of multiple myeloma was found in 50-59 years age group and P value was statistically significant. Male patient was 103 (65%) and female patient was 56 (35%). The median age of male patients was 56 years and the female patients was 57 years. There was no statistically significant age difference between male and female patients. 76.1% patients had bone involvement. Lytic bone lesions were found in 45.9% cases. Among them 15.1% patient had single lytic lesion and 30.8% patient had multiple lytic lesions. Most common site of lytic lesion was skull (33.3%).Pelvis was the second most common site of lytic lesion (15.7%).The prevalence of fracture was 44.7%, among them vertebral fracture was in 37.1% cases, rib fracture was in 9.4% cases, humerus fracture was in 3.1%, femur fracture was in 3.8%, fracture of neck of femur in 0.6%. Nerve root compression found in 12.6% cases. Lytic lesion and fracture are most common features of bone involvement in multiple myeloma patients. MRI study instead of radiographic study may increase the detection of bone lesion especially in the thoraco-lumber spine, pelvis and proximal femurs. Further studies incorporating MRI study are necessary to determine skeletal changes of MM patients.