Myeloma triggers

December 7 2008 post. A blog reader (thanks!) sent me the link (http://tinyurl.com/6cvgnv) to an interesting bit of statistical news. In an attempt to test the hypothesis that increasing obesity (=impaired immunity) might be a reason for the growing number of cases of multiple myeloma and non-Hodgkin’s lymphoma or NHL, the “European Prospective Investigation into Cancer and Nutrition” (EPIC) examined hundreds of cases all over Europe.* The results were published in “Haematologica” in October 2008.

 

The study concluded that height is a multiple myeloma (and NHL) risk factor for women just as weight is for men. Doesn’t that sound peculiar?

 

The full study is available at the above link, so I will quote only some of the relevant bits, as follows: Height was associated with overall non-Hodgkin’s lymphoma and multiple myeloma in women (RR 1.50, 95% CI 1.14–1.98) for highest versus lowest quartile; p-trend < 0.01) but not in men. Neither obesity (weight and body mass index) nor abdominal fat (waist-to-hip ratio, waist or hip circumference) measures were positively associated with overall non-Hodgkin’s lymphoma and multiple myeloma. This part then examines the risk associated with large B-cell lymphoma (heavier women are at risk) and follicular lymphoma (ditto for taller women).

 

MM has also been examined in a number of studies. In contrast to our finding of an elevated risk of MM among taller women, the Iowa women’s cohort study observed no association. Among men, the most prominent MM risk factors were weight, BMI and WC as categorized according to well-established definitions. (BMI=body mass index; WC=waist circumference.)

 

Factors that have been associated with multiple myeloma (MM) include high doses of ionizing radiation, and occupational exposure to products used in farming and petrochemical industries. Not my case, as far as I know.

 

In conclusion, the study found that height was a strong risk factor for NHL and MM risk in women.

 

A strong risk factor, eh? That’s quite a statement. My height would not get me into the book of Guinness World Records, but, growing up, I was always the tallest girl in my class. Always. This did not make me happy, mind you. In all of my (Italian) school photos, I am always stuck in the back with the tallest boys. All of the other girls were much shorter than I. And, come to think of it, so were most of the boys. A nightmare, back then. I am now 1.73 meters tall, which I think is about 5 foot 7 inches. Do I qualify as tall? Not sure. And why is tallness a risk factor for myeloma, anyway? The study doesn’t go into that, unless I missed a crucial part.

 

At any rate, according to this study, you are safe from developing multiple myeloma if you are a short, fat or thin woman, OR a thin, tall or short man…

*The EPIC is a multicenter prospective cohort study designed to examine the association between nutrition and cancer. […] participants were enrolled from the general population between 1993–1998 at 23 centers in ten European countries: Denmark (Åarhus, Copenhagen), France, Germany (Heidelberg, Potsdam), Greece, Italy (Florence, Varese, Ragusa, Turin, Naples), the Netherlands (Bilthoven, Utrecht), Norway (Lund), Spain (Asturias, Granada, Murcia, Navarra, San Sebastian), Sweden (Malmö, Umea) and the United Kingdom (Cambridge, Oxford).

 

March 2 2008 post. Quite a few interesting studies in the April 1 issue of “Blood.” One of them (see abstract: http://tinyurl.com/2sshyj) examines the risk that white and black male U.S. vets with prior autoimmune, infectious, inflammatory and allergic disorders have of developing multiple myeloma or MGUS. The researchers looked at the computerized discharge records of more than four and a half MILLION vets (between 1969 and 1996). They found 4641 patients who were discharged with a diagnosis of myeloma, and 2046 with MGUS. They looked only at the above-mentioned type of patient (some patients, such as women, were excluded due to small percentages; furthermore, those who had cancer at admission or developed cancer or died within the fist year were not included). You can read some of the results in the abstract, so let me have a look at the full study, for which I am indebted as usual to Sherlock.
 
Benign, asymptomatic MGUS is thought to be the first pathogenetic step in the development of most, if not all MM; however, the specific trigger that initiates the progression from MGUS to MM is unknown.
 
Skipping the usual dire statistics, let’s go to a more interesting part: Several studies have investigated the hypothesis that repeated or chronic stimulation of the immune system may lead to MM. Some studies have observed elevated risks for categories of immune-stimulating medical conditions (eg, autoimmune conditions, infections, and allergies) or for specific immune-stimulating medical conditions (eg, rheumatoid arthritis and eczema); however, results have generally been inconsistent. This has been a recurrent topic on the myeloma patient lists: is it a good thing to take immune system stimulators (medicinal mushrooms, e.g.) when our immune systems are already over-stimulated? I confess I haven’t come up with a satisfactory answer yet (although I have a gut feeling about it ), and would be glad to read any and all opinions.
 
Study results: patients with previous autoimmune diseases had an elevated risk of developing myeloma. Statistically elevated risks were also observed for the following specific autoimmune diseases: polymyositis/dermatomyositis, systemicsclerosis, autoimmune hemolytic anemia, pernicious anemia, and ankylosing spondylitis. Where numbers allowed comparison, risks were generally similar for white and black men.
 
And read this: Risks were also significantly elevated for both races combined for prior infectious disorders, specifically pneumonia, hepatitis, meningitis, septicemia, herpes zoster, and poliomyelitis Risk of influenza was significantly elevated for white men, but not for both races combined. The flu, a possible trigger? Yep, the relative risk is 1.18.
 
As for inflammatory ailments and allergies, There was a statistically increased risk of 18% associated with inflammatory disorders, largely due to significantly elevated risks for osteoarthritis (the most commonly reported disorder in our dataset) glomerulonephritis, and nephrotic syndrome. There were no significant elevations in risk for allergies overall or for any specific allergies for both races combined. For the five patients with celiac disease, the relative risk was 2.07. That’s quite high, actually. Compare that to the 34 patients with psoriasis, whose relative risk was 0.86. Ailments of the respiratory system were also considered, from sinusitis (RR: 1.17) to pneumonia (RR: 1.54). Asthma is also mentioned (RR: 0.98). Heck, even having urticaria puts you somewhat at risk!
 
Interesting titbit in the Discussion part: There is also the possibility that treatment for certain conditions rather than the condition itself may increase susceptibility to MM. For example, we previously reported an increased risk of MM among Connecticut women following use of steroids. Hmmm, so the risk of developing myeloma is due in some cases more to the treatment (prednisone, as the study suggests) than the disease itself. How about that?

Another good one: Our observation of an association between MM/MGUS and specific prior bacterial or viral infections suggest that these infectious conditions may be a potential trigger for MM/MGUS development or a manifestation of underlying immune disturbances due to undetected MM or late-stage MGUS. Recurrent infections largely of bacterial origin (septicemia, meningitis, and pneumonia) are often part of the natural history of MM. This study and a previous Danish one found that patients with a history of pneumonia had a more elevated risk of developing MGUS, which suggests that pneumonia could be a precipitating event for the development of MGUS.

The biggest drawback of this study, apart from the focus on a certain population (don’t you just love this sentence: The exclusion of women might limit the generalizability of our results. Just “might,” huh? ), was the fact that the researchers didn’t have access to any medical records. Theirs was a computerized study, period. But I found it interesting, and besides, it gave me a break from another study that is driving me up the wall (I am spending heaps of time looking up the meaning of about a zillion acronyms and medical terms that I do not recognize; sigh, why can’t studies be written in plain English…or Italian?).
 
I would like to add that I am only moderately curious as to how I developed cancer. I have it, I am trying to DO something about it, and life goes on. Only time will tell if what I am doing will keep me stable. But sometimes I wonder: if I could figure out what triggered it…well, could that possibly help me fight the cancer now? (I have excluded a few possible triggers already, such as H. pylori.) Was it triggered by a general weakening of my immune system caused by allergies or by the case of Epstein Barr I had in grad school? Or were these “underlying causes” (see below)? I suppose one could really go berserk thinking about possible triggers blablabla. Therefore, I am just going to forget about the issue. I have better things to do.
 
Study conclusion (RA is rheumatoid arthritis, by the way): In summary, we found significantly elevated risks of MM/MGUS associated with broad categories of autoimmune, infectious, and inflammatory disorders, but not with allergic conditions or RA. We also observed significantly elevated risks for a number of specific autoimmune disorders. Some of these disorders may be a potential trigger for MM/MGUS development, while others may represent underlying conditions due to undetected MM or late-stage MGUS. These results highlight the need to explore the pathologic mechanisms underlying the association of these diseases with MM/MGUS and to consider the diagnosis of MM/MGUS in patients presenting with these conditions.

13 Comments

  1. I was diagnosed with MGUS a year ago. Just recently 7/2/2010 I received the Shingles Vaccine. Two days later I now have Shingles and I am on a antiviral drug. Question: I did not get the “What You Need To Know” pamphlet until after the vaccine had been administered. “Some people should not get the vaccine if you have a history of cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma”. Too late for me, but this might help someone else contemplating having this vaccine. I hope I don’t go from MGUS to MM.

    1. Thanks for posting this. I have MGUS and I was contemplating getting the shingles vaccine but was really hesistant because I have had horrible reactions to other vaccines before I knew I had mgus. So I did the ‘right’ thing and asked my family doctor is it was safe for me with my mgus to get the shingles vaccine. He looked at me as if I was asking a pointless hypochodriac question and said “of course, no problem.” Well, since then I have been considering it more seriously, now looking if my insurer covers it and thought to see if there was any adverse reactions. Then I found first webmd saying if one has a low immune system to not get it. Then I wanted to see if any mgus organization had anything to say. This is how I came across your sad story. Unfortunately, too many times I have had really good doctors I have trusted deny adverse reactions that are actually even published in medical journals as if they don’t exist. Thanks for taking the time to post this as for sure I will not compromise my health. As you know once you end up ‘proving’ the nay-sayers wrong, you alone are the one paying the full price. I suppose that is why it is so easy for them to deny or fail to inform those of us in the risk category that, yes, it is warned not to do so. Sorry you are suffering the price of no one telling you this is a big no for you. At least someone has read it and I stand duly warned and I thank you for sharing this.

  2. I have been asymtomatic MM for almost 4 years with no treatment. Less than a year of diagnosis, I had had shingles. I had a similar reaction to the pnemonia shot last year. Within two months I developed pnemonia and pleurisy then and four months later pnemonia again. Though I get the flu shot every year – this past year I got symtoms that included achy, weak and headache. Would be interested in others experiences.

  3. Does anyone know if shingles/herpes viruses are a cause of MGUS/MM? I have had problems with shingles eve since I got a regular herpes II infection back in 1987. It just gets worse as I age, and now have had dx MGUS for 7 years. I just wonder if there is any connection.

    Also Lyme disease. I am pretty sure I have some sort of systemic Lyme infection, and have had for many years.

    I’m happy to have found this page, as my MGUS is now progressing quickly, last count 2.2, up four numbers from nine months before and I’m looking for answers now. Thanks to everyone here for any help and info.

  4. Joy – your post is interesting. Back in 1994 I contracted Lymes disease. It was caught early and I went through a regiment of antibiotics for a month. Last year I was diagnosed with two autoimmune diseases – one related to skin and the other Lupus. My count shot up to 8.3 but approximately less than half of that was the M protein. I tried a couple of anti-imflamatory meds for three months. Finally my count came down to my normal and the Lupus subsided. My trigger for the Lupus was the sun. My doctor said as I get older my disease(s) will get worst.

  5. Patty,

    I think the Lyme doesn’t go away that easily. It burrows in and replicates inside your immune cells. Interesting that the sun is a trigger for you, as it is for me also, it flares a uveitis (eye inflammation) condition I have, so I religiously avoid it. Hence my D3 levels are like 8, ridiculously low, and all doctors and NDs are screaming at me to supplement, but I get too sick from D supplements. I’m going to try going in the sun a bit this summer and see what happens, but cautiously. I did Marshall Protocol for 1.5 years, where you limit sun exposure totally, and I must say I feel better that way, but my low D levels are concerning. Such a Catch-22. Lupus is a drag, I have friends with Lupus, you have my sympathy. These immune system conditions are really hard to treat and live with.

  6. My daughter is on the Marshall protocol for a couple of rare autoimmune problems, She is having so so much trouble with it. Did it help you,Patty? I hate that she can not have sunshine.
    I have MGUS but am never ever sick,never had the flu etc.

  7. Hight is said to have increased with our ‘modern’ diet of high protein, or increased meat consumption, meat is also thought to be inflammatory, so perhaps including less protein and increasing anti inflammatory foods in the diet for instance green tea, sencha, gout kola herb ( centella asiatica), linseed, dark chocolate, and increasing intake of fresh green vegetables may help, the U.S. Washington Uni have some reports up on the Webb on green tea study for blood cancers, it makes interesting reading. My husband has MM and I believe his trigger was Cellulitis, combined with Nephritis, but his MGUS progressed at a time when a ‘poo’ doctor told me to knock off all his greens as he was making too much gas!

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