Workers exposed to World Trade Center site at greater risk for myeloma precursor disease
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Emergency response and recovery workers, law enforcement and construction workers who reported to the World Trade Center site after 9/11 had a twofold higher risk for myeloma precursor disease compared with the general population.
The study findings, published in Blood Cancer Journal, suggest providing these responders with access to screening for the precursor disease, monoclonal gammopathy of undetermined significance (MGUS), could allow for therapeutic interventions that extend survival.
Background
C. Ola Landgren, MD, PhD, professor of medicine, chief of the myeloma program in the division of hematology and leader of the experimental therapeutics program at Sylvester Comprehensive Cancer Center at University of Miami, led the study after having served as chief of myeloma service at Memorial Sloan Kettering Cancer Center for several years.
“In my myeloma outpatient clinic at the center, I saw several individuals who had been exposed to the World Trade Center disaster,” Landgren told Healio. “My observations in the clinic prompted me to contact New York City Fire Department [FDNY] and the World Trade Center Health Program to design a research study to investigate the potential role of exposure to the World Trade Center disaster and subsequent risk of developing multiple myeloma and its precursor disease.”
Landgren and colleagues published the first study in 2018, in which they screened blood from 781 first-responder FDNY firefighters who had been exposed to the World Trade Center disaster.
“In that study, we found a doubling in the rate of myeloma precursor disease compared with rates in the general population,” Landgren said. “Prior work that we published several years ago also showed that all patients who developed multiple myeloma had a prior phase of myeloma precursor disease, and other studies have shown that the rate of conversion from myeloma precursor disease to multiple myeloma is similar across study populations.”
Landgren and colleagues also examined multiple myeloma patterns among the first responders in the initial 2018 study who developed the disease.
“What we found was that compared with multiple myeloma cases in the general population, the first responders were diagnosed between 5 and 10 years earlier and experienced higher rates of more aggressive disease biology,” Landgren said.
For the current study, investigators sought to confirm their findings among the FDNY first-responder cohort (n = 1,482; 96% men; 82.7% white, 8.2% Hispanic, 7.7% Black) with a more heterogeneous cohort of World Trade Center-exposed rescue/recovery workers, dubbed the Stony Brook University-General Responder Cohort (n = 1,181; 96% men; 92% white, 5.3% Hispanic, 1.4% Black).
“We were motivated to confirm our investigations among World Trade Center-exposed individuals who were not firefighters by expanding our work to study these additional individuals who were general responders,” Landgren said.
They screened blood from the responders and compared risk for monoclonal gammopathy of undetermined significance among the two cohorts with published general population estimates from Olmsted County, Minnesota.
Findings
Results showed the Stony Brook University-General Responder Cohort had higher odds of MGUS than the FDNY first-responder cohort (OR = 1.38; 95% CI, 1-1.89).
Researchers identified an age-standardized prevalence of MGUS of 9 per 100 persons (95% CI, 7.5–10.6), which corresponded to a more than twofold higher prevalence compared with the general population (RR = 2.08; 95% CI, 1.72–2.51). They additionally found a 3.5-fold higher age-standardized prevalence of the light-chain-MGUS subtype (RR = 3.54; 95% CI, 2.5–4.9).
Implications
“The findings provide mounting evidence that environmental exposures — and exposure to the World Trade Center disaster in general — are risk factors for the initiation of multiple myeloma, a blood cancer for which the majority of cases there is no known cause,” Landgren said. “Future laboratory experiments designed to study mechanisms of disease initiation in this setting may be able to identify mechanisms which can be used as novel drug targets with the aim to prevent progression and development of multiple myeloma.”
For more information:
C. Ola Landgren, MD, PhD, can be reached at University of Miami, 1120 NW 14th St., Clinical Research Bldg., Room 650D, Miami, FL 33136; email: col15@miami.edu.
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