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. 2018 Jun 1;4(6):821-827.
doi: 10.1001/jamaoncol.2018.0509.

Multiple Myeloma and Its Precursor Disease Among Firefighters Exposed to the World Trade Center Disaster

Ola Landgren  1 , Rachel Zeig-Owens  2   3   4 , Orsolya Giricz  5 , David Goldfarb  2   3 , Kaznouri Murata  6 , Katie Thoren  6 , Lakshmi Ramanathan  6 , Malin Hultcrantz  1 , Ahmet Dogan  7 , George Nwankwo  5 , Ulrich Steidl  5 , Kith Pradhan  5 , Charles B Hall  8 , Hillel W Cohen  4 , Nadia Jaber  3 , Theresa Schwartz  2   3 , Laura Crowley  9 , Michael Crane  9 , Shani Irby  7 , Mayris P Webber  2   3   4 , Amit Verma  5 , David J Prezant  3   10
Affiliations

Multiple Myeloma and Its Precursor Disease Among Firefighters Exposed to the World Trade Center Disaster

Ola Landgren et al. JAMA Oncol. .

Abstract

Importance: The World Trade Center (WTC) attacks on September 11, 2001, created an unprecedented environmental exposure to known and suspected carcinogens suggested to increase the risk of multiple myeloma. Multiple myeloma is consistently preceded by the precursor states of monoclonal gammopathy of undetermined significance (MGUS) and light-chain MGUS, detectable in peripheral blood.

Objective: To characterize WTC-exposed firefighters with a diagnosis of multiple myeloma and to conduct a screening study for MGUS and light-chain MGUS.

Design, setting, and participants: Case series of multiple myeloma in firefighters diagnosed between September 11, 2001, and July 1, 2017, together with a seroprevalence study of MGUS in serum samples collected from Fire Department of the City of New York (FDNY) firefighters between December 2013 and October 2015. Participants included all WTC-exposed FDNY white, male firefighters with a confirmed physician diagnosis of multiple myeloma (n = 16) and WTC-exposed FDNY white male firefighters older than 50 years with available serum samples (n = 781).

Exposures: WTC exposure defined as rescue and/or recovery work at the WTC site between September 11, 2001, and July 25, 2002.

Main outcomes and measures: Multiple myeloma case information, and age-adjusted and age-specific prevalence rates for overall MGUS (ie, MGUS and light-chain MGUS), MGUS, and light-chain MGUS.

Results: Sixteen WTC-exposed white male firefighters received a diagnosis of multiple myeloma after September 11, 2001; median age at diagnosis was 57 years (interquartile range, 50-68 years). Serum/urine monoclonal protein isotype/free light-chain data were available for 14 cases; 7 (50%) had light-chain multiple myeloma. In a subset of 7 patients, myeloma cells were assessed for CD20 expression; 5 (71%) were CD20 positive. In the screening study, we assayed peripheral blood from 781 WTC-exposed firefighters. The age-standardized prevalence rate of MGUS and light-chain MGUS combined was 7.63 per 100 persons (95% CI, 5.45-9.81), 1.8-fold higher than rates from the Olmsted County, Minnesota, white male reference population (relative rate, 1.76; 95% CI, 1.34-2.29). The age-standardized prevalence rate of light-chain MGUS was more than 3-fold higher than in the same reference population (relative rate, 3.13; 95% CI, 1.99-4.93).

Conclusions and relevance: Environmental exposure to the WTC disaster site is associated with myeloma precursor disease (MGUS and light-chain MGUS) and may be a risk factor for the development of multiple myeloma at an earlier age, particularly the light-chain subtype.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Exclusion Criteria
FDNY indicates Fire Department of the City of New York; MGUS, monoclonal gammopathy of undetermined significance; WTC, World Trade Center.
Figure 2.
Figure 2.. Prevalence of Monoclonal Gammopathy of Undetermined Significance (MGUS) and Light-Chain MGUS in World Trade Center–Exposed Fire Department of the City of New York (FDNY) White Male Firefighters and Comparison Population
aOverall MGUS includes both MGUS and light-chain MGUS cases. bPrevalence rates are age standardized to US 2000 male population age 50 to 79 years.
See this image and copyright information in PMC

Comment in

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