Dietary and microbiome evidence in multiple myeloma and other plasma cell disorders

Abstract

Multiple Myeloma (MM) remains an incurable plasma cell neoplasm. Although little is known about the etiology of MM, several metabolic risk factors such as obesity, diabetes mellitus, diet, and the human intestinal microbiome have been linked to the pathogenesis of MM. In this article, we provide a detailed review of dietary and microbiome factors involved in the pathogenesis of MM and their impact on outcomes. Concurrent with treatment advancements that have improved survival in MM, focused efforts are needed to reduce the burden of MM as well as improve MM specific and overall outcomes once MM is diagnosed. The findings presented in this review will provide a comprehensive guide on the evidence available to date of the impact of dietary and other lifestyle interventions on the gut microbiome and on MM incidence, outcomes, and quality of life. Data generated from such studies can help formulate evidence-based guidelines for healthcare providers to counsel individuals at risk such as those with Monoclonal Gammopathy of Undetermined Significance (MGUS) and Smoldering Multiple Myeloma (SMM) as well as MM survivors with respect to their dietary habits.

Fig. 1. A beneficial dietary pattern may improve outcomes through modifying the microbiome, metabolome, and immune microenvironment in plasma cell disorders.

A beneficial diet, outlined in the figure consists of regular consumption of a variety of whole grains, fiber, beans and legumes fruits and vegetables, especially cruciferous vegetables, while limiting intake of animal products. The hypothesized mechanism is outlined above, showcasing that a beneficial diet modifies the gut microbiome and immune microenvironment and thus influences outcomes related to progression and survival in plasma cell disorders as well as reduces toxicities and comorbidities. With consumption of a beneficial diet, the composition and diversity of the gut microbiome improves with increasing short-chain fatty acid producers and decreasing nitrogen producing bacteria and bile-tolerant bacteria. Created with BioRender.com.