Increased risk of myeloma in rescue workers exposed to smoke and toxins after 9/11

C. Ola Landgren, MD, PhD, from the Memorial Sloan Kettering Cancer Center, New York City, NY, discusses the role of population-based studies in myeloma research at the American Society of Hematology (ASH) Congress 2016 in San Diego, CA. He describes that the September 11, 2001 terrorist attack in New York City resulted in an unprecedented environmental exposure to smoke and toxins including numerous known and suspected carcinogens. For multiple myeloma (MM), the risk factors are not known, but there is some evidence of higher myeloma rates in farmers and firefighters. A registry study of 25 000 people after 9/11 found threefold increase in myeloma risk, and a separate study of myeloma diagnosis in rescue workers found a disproportionately high rate of 4 out of 8 cases of myeloma diagnosis at a younger age (less than 45 years of age), while myeloma in the general population usually occurs around 70 years of age. He explains how these facts all contributed to the rationale for the current study which he is carrying out with the New York City (NYC) fire department and Albert Einstein Medical College, New York City. By using the World Trade Center Health Study, which is offered by the NYC fire department to both active and retired fire fighters and rescue workers who were involved in the response to the World Trade Center attacks. 50 cases of multiple myeloma have been diagnosed in this cohort, all of which Dr Landgren and colleagues have characterized. Additionally, 1000 members of this cohort have participated in a study screening for myeloma precursor disease. Preliminary result show an increased risk of myeloma precursor disease in those rescue workers who took part in the 9/11 response, as well as an evidence of an increased incidence of rarer subtypes of myeloma. He concludes that this is the first study focusing on a high-risk exposed large population, whose final results will be published soon. The next steps will be to further characterize the biology of these cases, as well as expanding the screening study to people living in Lower Manhattan at the time who may also have been exposed to smoke and toxins.

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