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ASH 2025 | Metabolic and lifestyle influences and interventions in smoldering multiple myeloma progression
Alexander Lesokhin, MD, Memorial Sloan Kettering Cancer Center, New York, NY, discusses emerging research linking metabolism, the gut microbiome, and disease progression in smoldering multiple myeloma, including the potential role of lifestyle and dietary interventions in modifying risk. This interview took place at the 67th ASH Annual Meeting and Exposition, held in Orlando, FL.
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Transcript
Our patients with smoldering myeloma, you know, are always asking us, well, is there something I can do to change my overall risk, to change my diet, essentially? It’s a very frequently asked question. And so I think, you know, we’ve been investigating as an institution, actually, my colleague, Dr Urvi Shah, has been driving this work of nutritional intervention studies that prescribe a plant-based diet...
Our patients with smoldering myeloma, you know, are always asking us, well, is there something I can do to change my overall risk, to change my diet, essentially? It’s a very frequently asked question. And so I think, you know, we’ve been investigating as an institution, actually, my colleague, Dr Urvi Shah, has been driving this work of nutritional intervention studies that prescribe a plant-based diet. We’ve just recently published our first pilot study that has shown that, you know, a 12-week plant-based diet prescription is very feasible. The majority of patients can maintain that diet and then can continue on a similar diet even a year out. When we look at microbiome diversity, we see an increase in microbiome diversity. We see a drop in adiponectin levels, a drop in insulin resistance, a significant weight loss. You know, patients can stop some of the medications that they’re using. The study was a pilot study. It was 20 patients, but several of those patients had, prior to enrollment, had rising paraprotein levels and stabilized with the intervention. The others, these are all precursor diseases, were stable going in, so hard to judge. There’s now a randomized study evaluating the plant-based diet versus supplements or placebo in 150 patients, randomized one-to-one to the supplements placebo versus the nutritional intervention that will hopefully help us address the question of whether or not diet can delay the progression of a precursor disease to multiple myeloma. Epidemiological data suggests that diet is a factor in that people that eat more fruits who have precursor disease are less likely to progress to myeloma and actually less likely to have precursor disease from the get-go. So lifestyle factors seem to matter epidemiologically and these new prevention series of studies will hopefully help us understand whether or not we can prescribe something to our patients as a way to mitigate disease progression.
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