ASH 2023 | Carcinogen exposure as a cause of elevated MGUS levels in US service members

I’ve been involved in many different studies trying to understand what could potentially cause multiple myeloma and its precursor monoclonal gammopathy, and also smoldering myeloma. I was involved several years ago in a large interagency study when I worked for the NIH. We worked together with the CDC, United States Air Force, and also the Veterans Administration, the VA. In that study, we screened a large number of servicemen that had participated in spraying with Agent Orange in Vietnam. We compared them to servicemen who were not involved with Agent Orange, and we showed that there was an increased risk for monoclonal gammopathy. That study led to monoclonal gammopathy being approved as a medically supported by VA condition for veterans that had been exposed. I’ve also been involved in studies looking at other types of exposures; pesticide exposure in the United States, and also people who are exposed to the World Trade Center attack in New York City. 

This study builds on the work we have done when people are exposed to different types of carcinogens. So we looked at U.S. military that were deployed to different sites outside the United States, and they were exposed to burn pits. And burn pits have been proposed to be a risk factor for initiation of different types of malignancies and also other types of conditions. So what we see in this study, is that there is a higher rate of monoclonal gammopathy in the individuals that are exposed at different levels. But if you look very carefully at the results of the presentation from this ASH, there is also a higher rate for people who had very minimal exposure to this, so it has made me a little bit confused on what this really means. Could it be other things that individuals in the military could potentially be exposed to during these types of deployments? So what we are doing right now is that we are also evaluating individuals that have not been deployed, and we are also very carefully dissecting out other potential risk factors. We want to make sure that this is not a bias that’s driving this, that there are some other factors that we don’t know. So this study that we presented is not the final study. We are already working, and we have samples where we are evaluating non-deployed US military, but we hope to have all the results in 2024 and we will get back and communicate as soon as we have these important results.