9/11 firefighters have an increased risk of developing cancer, especially multiple myeloma

I have read that firefighters in general are three times more likely to get cancer because of their exposure to toxic chemicals that they inhale and that also get stuck in their clothing. But it really saddened me last week to read a recently published report about the 9/11 firefighters…

In this NBC News article, multiple myeloma is the first cancer mentioned: goo.gl/XaZJsa

The fact that so many of these brave people were being diagnosed with MGUS and MM is actually not the news of the day. I’ve been reading articles about this for years now. But, as I wrote above, there is a new study, published last week in the Journal of the American Medical Association (JAMA Oncology: ) that officially confirms this terrible trend.

And I quote…The JAMA “study shows that WTC exposure may be a risk factor for the development of multiple myeloma and its precursor disease.”

Here’s the link to the actual (full) study: goo.gl/BcyEqn

My best wishes to them and their families.

“Educate your immune system”

I just finished reading a fascinating New York Times article on the immune system and thought I’d post the link. Remember my April 5 post, “The gut factor,” on the connection between gut bacteria and cancer? Well, this article provides more food for thought in that same area: http://goo.gl/cVDygk

Note: toward the end of the article, there is a reference to the Epstein-Barr virus and the risk of developing multiple sclerosis. No, no mention of multiple myeloma. However, I still think it is of interest to those of us who have had EBV in the past and would like to know about any possible repercussions…

Links, links, links…

P.S. By the way, since I have received a couple of condolence notes, I thought I should mention that my mother is not only alive but is actually doing a bit better these days. She has begun eating a bit more, gaining a bit of weight, and seems more interested in interacting with others. When Stefano and I left the U.S.A. to return to our home in Florence just a few weeks ago, her situation seemed hopeless. I didn’t think she had long to live, to be honest.

But now…who knows?

The history of multiple myeloma

As I was looking through the new edition of “Blood” yesterday, I came across an interesting historical overview of multiple myeloma by Dr. Robert Kyle (with whom I have spoken by phone and been in touch with occasionally since 2005: an extremely nice, kind, reassuring doctor) and Dr. Vincent Rajkumar, Mayo Clinic in Rochester.
 
The full text is available online: http://tinyurl.com/2r7gw3, so I won’t go into any detail. I would like to mention, though, that I am very glad that myeloma is no longer being treated with leeches…
 
Just a few words. The “first well-documented case” of myeloma dates to 1844: a woman, 39 years old. The best known case is that of a 45-year-old man (again in 1844) who was given quinine and steel (?). And a sample of his urine was sent to….Dr. Henry Bence Jones. Ring any bells?

Interesting read. However, I hope it won’t take another 50 years for this history of multiple myeloma to have a chapter on curcumin and other natural, non toxic treatments. Oh, and while we are at it, how about a chapter on the non toxic cures: cyclopamine or DMAPT, the myeloma stem cell terminators?

An impossible dream? Perhaps…

Perhaps not.

Myeloma patients under age 50

Well, so much for giving up research for a few days.  But last night Sherlock sent me a new “Blood” study that perked my interest. You can read the abstract here: http://tinyurl.com/264753 And, as usual, I would be happy to forward the full study to anybody upon request.

A few preliminary remarks:

1. I am always wary of statistics, of which this study is full. Lots of numbers! My head was spinning at one point…

2. The study considers only myeloma patients undergoing conventional treatments.

3. Specifically: “Patients with smouldering (asymptomatic) myeloma, amyloidosis and monoclonal IgM disorders were not included.” 

That said, the study contains some interesting information. As follows.

The International Myeloma Working Group analysed 10,549 myeloma patients for this project. 17 institutions and study groups from North America, Japan and Europe participated in the study, which covers the period 1981-2002. Most of the patients were from Europe.

The authors “report the presenting features and outcome after conventional and high-dose therapy in 10,549 myeloma patients and compare the findings obtained in 1,689 patients less than 50 years of age with those of 8,860 older patients.” 70% of all the patients had participated in clinical trials (7,413 people). Stage of the disease was assessed using the International Staging System, or ISS (see: http://tinyurl.com/2ab8sw), and the Durie-Salmon system, see: http://tinyurl.com/ytcqe9

“Median age of all 10,549 patients combined was 60 years.” 1,689, or 16%, were younger than 50 years of age. Most of these were between 40 and 50. Only 312 were younger than 40, and 27 younger than 30.
 
Younger patients had fewer adverse prognostic factors such as low albumin and high B2M (beta-2 microglobulin). They also scored better than older patients in terms of haemoglobin, C-reactive protein and creatinine. The two groups (a. more than 50 years of age, b. less than 50) had comparable levels of LDH and bone marrow plasma cell infiltration, which indicated “an absence of a major difference in the biology of the myeloma clone between young and older patients.”
 
Interesting bit of information about the <40 group: most of the patients, 67%, were male. The authors speculate further on that it could be due to “increased androgenic sex hormone levels in young males.” No difference, however, between male and female patients.
 
Risk of death was higher in the older patients. Now, excuse me for pointing out the obvious, but had the reverse had been found, i.e. that younger patients died at a higher rate than older ones, that would have made no sense, right? So the following bit of news hardly seems to be earth-shattering: “Better outcome in the younger cohort was seen in all three ISS stages and was independent of gender.”

In particular, “High-dose chemotherapy with autologous stem cell transplantation resulted in a higher relative excess risk of death in the older patients (median survival 5.7 years) compared to the younger patients (7.5 years). Similarly, the observed 10-year survival rate was significantly higher in the younger patients (43% versus 29%, logrank P=.005). Relative survival was similar in the subgroup of patients aged 40 to <50 years versus that of very young patients, both after conventional chemotherapy (4.4 years versus 4.7 years) and after autologous transplantation (7.3 years versus 7.5 years) (relative excess risk estimate: 1.09 and 0.93, respectively). And 10-year survival rates were also similar, both after conventional (21% versus 19%, P=.37) and after high-dose treatment (44% versus 38%, P=.76, by log-rank test).”

Sorry about all these long quotes, but it’s difficult to summarize numbers!

Ah, and what have we here? Another long quote! As follows: “Conventional therapy was given to 994 (58.9%) of the 1,689 patients aged less than 50 years and to 6,771 (76.4%) of the older patients, while high-dose therapy was administered to 695 (41.1%) of the younger and to 2,089 (23.6%) of the older patients, respectively. The percentage of young patients enrolled during different time periods for treatment with conventional therapy decreased from 94.2% in the period between 1981-1987 to 21.3% in the years between 1999-2002 (P<.001) while the proportion of those subjected to high-dose therapy increased from 5.7% to 78.7% (P<.001)(Table 3). The respective figures for older patients were 98.8% to 40.1% (P<.001) for conventional, and 1.2% to 59.9% (P<.001) for high-dose therapy.”

And now we get to the final part of the study (I skipped a lot of the numbers, eh!), and, you guessed it, here is another long quote: “The most important finding in this study on 10,549 patients with multiple myeloma was the significant differences in the presenting features between young and older patients. Young patients presented with significantly lower ISS stage and consequently had less frequently elevation of ß2-microglobulin and reduction of low serum albumin levels. In addition, significantly fewer younger patients presented with poor performance status, anemia, renal impairment, or increased CRP levels. Older patients, in contrast had a greater prevalence of less favorable prognostic factors. Hence, both a lower ISS stage at diagnosis and overall better prognostic factors seem to account for the superior survival in young patients treated with high-dose therapy after correction for differences in life expectancies, with age remaining an independent risk factor for patients treated with conventional therapy.” Another finding was the low number of young patients: only 0,26% were younger than 30 years of age. Young age was associated with longer survival. 

The study concludes that “myeloma patients less than 50 years of age had significantly longer age-adjusted survival both after conventional and high-dose therapy (5.4 and 7.5 years, respectively) in relation to older patients (3.7 and 5.7 years, respectively). Given the fact that thalidomide and other new drugs were not available for the great majority of patients, the 10-year survival rate was remarkably high in young patients after conventional (19%) and high-dose therapy (43%). The major factors accounting for this improved outcome of young patients were presentation with a lower ISS stage at diagnosis and other more favorable prognostic features.”

Even though, as stated above, I am wary of statistics and take them with a grain of salt, I admit that I would really like to read a similar statistical analysis concerning those of us following alternative treatments. Perhaps some day…who knows?