Study Shows 9/11 Workers at Higher Risk for Precursor to Multiple Myeloma, a Type of Blood Cancer

By Jim Stallard,

Thursday, April 26, 2018

MSK hematologic oncologist doctor Ola Landgren pictured with a patient
Summary

Research shows that firefighters who worked at the World Trade Center scene are nearly twice as likely to have a precursor condition that could lead to multiple myeloma, the second most common blood cancer in adults. The study provides more evidence supporting the idea that multiple myeloma can be triggered by environmental factors.

Ever since the September 11 attack on the World Trade Center (WTC), there have been mounting concerns that rescue and recovery workers at the site were exposed to hazardous materials that could cause long-term damage to their health. Now research led by Memorial Sloan Kettering shows that firefighters present at Ground Zero in the immediate aftermath may be at an increased risk for developing a blood cancer called multiple myeloma.

The study, published today in JAMA Oncology, reveals that firefighters at the scene were nearly twice as likely to have a multiple myeloma precursor condition called monoclonal gammopathy of undetermined significance (MGUS). This is the first comprehensive study showing that WTC first responders are at higher risk for MGUS. In addition, the researchers found that they may be at a higher risk for developing multiple myeloma at an earlier age, as well as a more lethal form of the disease.

“Although MGUS will not necessarily lead to multiple myeloma, it is always present as a preliminary stage before someone develops the disease,” says Ola Landgren, Chief of MSK’s Myeloma Service, who led the study. “It can serve as an early warning.”

In 2015, Dr. Landgren published research showing that exposure to Agent Orange, an herbicide that was widely used during the Vietnam War, also increases the risk of having MGUS and multiple myeloma. The new study provides more evidence supporting the idea that multiple myeloma can be triggered by environmental factors.

Rescue and recovery workers may have been exposed to known carcinogens in the dust from the collapsed buildings and from diesel smoke emitted by heavy equipment used in the search. The findings suggest that these first responders should consider being checked for MGUS. The condition, which is marked by elevated levels of a protein called M protein, can be detected with a simple blood test.

“The clinical guidelines for multiple myeloma don’t currently address being tested for MGUS,” Dr. Landgren says. “But for people who spent significant amounts of time around the recovery site, it is reasonable for them to speak with their primary care physician about being checked for this precursor condition. This could apply even to people who didn’t work at the site but lived or worked nearby at the time.”

Most people with MGUS remain well for many years without developing multiple myeloma. But Dr. Landgren says that anyone who learns they have MGUS should have their protein levels monitored going forward through annual blood tests to watch for multiple myeloma. This monitoring can typically be done by a primary care doctor. If multiple myeloma is suspected, further diagnostic tests, including imaging, blood, urine, and bone marrow tests, would be recommended.

Multiple Myeloma: A Slow-Moving But Incurable Cancer

Multiple myeloma, the second most common blood cancer among adults, arises from a type of white blood cell called a plasma cell. The disease usually is treated with chemotherapy, immune-modifying drugs or other medications, or stem cell transplantation. It can be held at bay for many years but there is no cure. When it relapses, it becomes resistant to further treatment.

Although there are currently no drugs approved to treat MGUS, close monitoring could still benefit someone who eventually develops multiple myeloma. A 2015 study led by Dr. Landgren showed that people with MGUS who develop multiple myeloma during clinical monitoring have better overall survival and fewer complications than those who never received an MGUS diagnosis. This is likely because treatment of multiple myeloma begins sooner, which makes it more effective.

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Increased Risk and Earlier Onset

In the study, the researchers screened blood samples from 781 WTC-exposed male firefighters. As a comparison population, they used published data on MGUS from a group of 7,612 men in Minnesota.

Monoclonal Gammopathy of Undetermined Significance (MGUS)
Monoclonal gammopathy of undetermined significance can become myeloma. Most people with the disease remain well for years without treatment.
Learn more

The firefighters had enrolled in the WTC Health Program to receive physical and mental health services and consented to have blood samples analyzed for research. The samples were tested at MSK.

The researchers found that the prevalence of MGUS in this group was approximately twice as high as in the comparison group. The rate in the study group was 7.73 per 100 people compared with 4.34 in the comparison group.

A second part of the study looked at all firefighters at the WTC site who had developed multiple myeloma between September 11, 2001, and July 1, 2017. The median age of onset for the disease was 57 years — about 15 years earlier than the general population. The firefighters also were more likely to have aggressive types of the disease compared with the overall myeloma population.

“It’s possible that specific environmental factors can cause specific subtypes of myeloma — including those that are more or less aggressive,” Dr. Landgren says.

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This work was supported by the V Foundation for Cancer Research, the Byrne Fund for the benefit of Memorial Sloan-Kettering, the Memorial Sloan Kettering Cancer Center Core Grant from the National Cancer Institute (P30 CA008748) the Albert Einstein Cancer Center (P30 CA013330), the National Institute for Occupational Safety and Health (grant 1 U01 OH011475 and contracts 200-2011-39383, 200-2011-39378, 200-2017-93326 and 200-2017-93426.

Comments

Do we know how many people living, working or serving downtown during and after 9/11 have developed myelom and how many are no longer with us? Since about 3000 people died in the attack I am wondering how many more have gotten sick in the aftermath.

Thanks

John

John, thank you for your question.

Unfortunately, we do not have that information at hand, but you might try the World Trade Center Health Program at this link:

https://www.cdc.gov/wtc/

Thank you for this information, it is vital to our community here in Staten Island as we are so close to the attack location of 9-11.

Laura and Charles Mooney
Founders
Staten Island MM Support Group

Interesting. Could butadien possibly be a cause?

David, thank you for reaching out. We consulted with Dr. Landgren, who responds:

The current study had two parts: one was to characterize multiple myeloma among WTC exposed firefighters. This part showed earlier age of onset (10-15 years) compared to the general population. Also features of myeloma were more adverse.

The second part of the study was to determine the prevalence of myeloma precursor disease and compare it to population rates. That part found a doubling of the rate among WTC exposed firefighters.

None of the above parts was designed to determine the potential risk of certain chemicals. Future studies are needed to address such questions.

I worked and lived not far from the site in midtown Manhattan and Jersey City. Would that be considered "nearby"?

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