Plant-based diet may improve outcomes for patients with multiple myeloma
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A plant-based diet appeared associated with sustained minimal residual disease negativity among a cohort of patients with multiple myeloma, according to study results.
The findings, published in Clinical Cancer Research, provide rationale to further assess a prospective dietary intervention in this patient population, researchers concluded.
Background and methods
Preclinical studies have suggested a potential link between the microbiome and myeloma natural history, according to Alexander M. Lesokhin, MD, associate attending physician at Memorial Sloan Kettering Cancer Center.
“This, as well as microbiome-focused studies at our center in the transplant setting that showed strong signals in several myeloma patient cohorts, indicated that microbial features were relevant in myeloma disease biology and led to an interest in exploring this further,” Lesokhin told Healio. “An ongoing natural history trial among a uniformly treated patient cohort receiving maintenance lenalidomide [Revlimid, Bristol Myers Squibb] seemed like an ideal opportunity to evaluate the microbiome in a longitudinal study.”
Lesokhin and colleagues examined possible associations between dietary factors, stool metabolites and the stool microbiome with sustained minimal residual disease (MRD) negativity among patients with multiple myeloma treated with lenalidomide maintenance. They used the food frequency questionnaire to calculate flavonoid nutrient values and the Healthy Eating Index 2015 score.
Findings
Results showed an association between sustained MRD negativity at 3 months and higher stool butyrate concentration (P = .037), butyrate producers (P = .025) and alpha diversity (P = .0035).
Researchers additionally observed an association between healthier dietary proteins from seafood and plants and butyrate at 3 months (P = .009) and sustained MRD negativity (P = .05).
Moreover, consumption of plant nutrients with antioxidant effects correlated with stool butyrate concentration (anthocyanidins, P = .01; flavones, P = .01; flavanols, P = .02).
“While this is a small study that needs further validation, we were pleasantly surprised that the findings correlated with our initial hypothesis,” Urvi A. Shah, MD, hematologist-oncologist at Memorial Sloan Kettering Cancer Center, told Healio. “There is evidence that diet is one of the major drivers of gut microbiome composition and that the microbiome may influence cancer outcomes, but there isn’t much evidence directly linking diet, the microbiome and myeloma outcomes such as sustained MRD negativity in a study simultaneously. This is the first trial to show such an association in multiple myeloma.
Implications
The findings support a rationale for both continued evaluation of the microbiome as a potential contributor to disease natural history in myeloma and evaluation of dietary manipulation to modify the microbiome and potentially impact disease, as well as treatment response, Lesokhin told Healio.
“These and other preclinical data support the notion that the microbiome interacts with myeloma disease biology,” Lesokhin continued. “We have undertaken several translational studies in patients with myeloma precursor conditions and newly diagnosed myeloma to evaluate how patients’ microbiomes are related to the genetic features of the diseased plasma cell, as well as the immune microenvironment at the disease site. Our goal is to identify additional microbial features that may be targeted to improve overall patient outcomes.”
Although patients have often been told to eat healthier for the benefit of their overall health, evidence on how healthy plant-based diets may influence outcomes in multiple myeloma has been limited to epidemiologic studies, Shah told Healio.
“The findings in our study provide early mechanistic evidence that oncologists may use to empower patients to make healthier plant-based dietary changes to influence sustained MRD negativity,” Shah said. “To further validate these findings prospectively, we are designing interventional dietary studies in myeloma and its precursor conditions, smoldering myeloma and monoclonal gammopathy of undetermined significance. We will evaluate the impact of dietary changes on the gut microbiome and disease outcomes.”
For more information:
Alexander M. Lesokhin, MD, can be reached at lesokhia@mskcc.org.
Urvi A. Shah, MD, can be reached at shahu@mskcc.org.
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