Presentation is loading. Please wait.

Presentation is loading. Please wait.

Support for pesticides playing a role in onset of multiple myeloma September 10, 2014 Ola Landgren, M.D., Ph.D. Chief, Myeloma Service Memorial Sloan-Kettering.

Similar presentations


Presentation on theme: "Support for pesticides playing a role in onset of multiple myeloma September 10, 2014 Ola Landgren, M.D., Ph.D. Chief, Myeloma Service Memorial Sloan-Kettering."— Presentation transcript:

1 Support for pesticides playing a role in onset of multiple myeloma September 10, 2014 Ola Landgren, M.D., Ph.D. Chief, Myeloma Service Memorial Sloan-Kettering Cancer Center, New York

2 What is multiple myeloma?

3 Second most common blood cancer in the U.S.; over 83,000 affected in 2014 Bone marrow cancer (plasma cells) No established curative treatment; average survival 5-7 years Multiple myeloma

4 Multiple myeloma: abnormal plasma cells in the bone marrow

5 Hillengass and Landgren. Leuk Lymphoma 2013 Multiple myeloma: lytic bone lesions

6 Multiple myeloma: genetic heterogeneity within each patient Lohr et al. Cancer Cell 2014

7 Multiple myeloma and its precursor “MGUS”

8 “Monoclonal gammopathy of undetermined significance” (MGUS) Kyle, Am J Med 1978; Turesson et al. Blood 2014 Risk of developing multiple myeloma (0.5-1% per year) Cumulative risk (%) of myeloma Year of follow-up

9 Myeloma consistently preceded by precursor state “MGUS” Landgren et al. Blood 2009 Multiple myeloma (n=71) Multiple myeloma (n=71) >77,000 cancer free men and women; stored annual blood tests Up to 10 years of follow-up

10 Risk factors for multiple myeloma; what are the causes?

11 Older age Male gender Family history of myeloma African American descent Obesity Farming/pesticides Risk factors for multiple myeloma; what are the causes?

12 Rusiecki et al, Env Health Perspect 2009

13 Agricultural Health Study Rusiecki et al, Env Health Perspect 2009 Cancer incidence among pesticide applicators exposed to permethrin Permethrin: synthetic pyrethroid insecticide widely used in agriculture and many U.S. homes and gardens Prospective cohort 49,093 licensed pesticide applicators in Iowa and North Carolina Self-administered questionnaires; average follow-up 9 years

14 Agricultural Health Study: myeloma Rusiecki et al, Env Health Perspect 2009 No excess risk for non-Hodgkin lymphoma, leukemia, melanoma, cancers of the colon, rectum, lung, or prostate 6-fold excess risk of multiple myeloma, compared with applicators reporting never used permethrin Results based on 15 exposed cases Findings similar across variety of alternative exposure metrics, exposure categories, and reference groups; warrants further evaluation

15 Agricultural Health Study: MGUS Landgren et al, Blood 2009

16 Agricultural Health Study: MGUS 678 pesticide applicators (30-94 years) participated to assess risk of MGUS Serum samples analyzed by electrophoresis; discrete or localized band subjected to immunofixation Age-adjusted prevalence compared with MGUS prevalence in 9469 controls from Minnesota Landgren et al, Blood 2009

17 Agricultural Health Study: MGUS 38 had MGUS (prevalence 6.8%); age-adjusted prevalence 2-fold higher in pesticide applicators Excess risk of MGUS associated with chlorinated insecticide dieldrin, the fumigant mixture carbon- tetrachloride/carbon disulfide, and the fungicide chlorothalonil These findings support hypothesis that specific pesticides causatively linked to myelomagenesis Landgren et al, Blood 2009

18 National Health and Nutritional Examination Survey (NHANES) Landgren et al, Leukemia 2014

19 NHANES Study Stored serum samples from 12,482 individuals >50 years (NHANES III and NHANES 1999–2004) Serum samples analyzed by electrophoresis; discrete or localized band subjected to immunofixation Define prevalence and risk factors of MGUS in large cohort representative of US population Landgren et al, Leukemia 2014

20 Prior study from Olmsted County, Minnesota, found 3.2% MGUS prevalence NHANES overall MGUS prevalence was 2.4% (2.3% in whites) Interestingly, MGUS prevalence was 3.1% in North/Midwest and 2.1% in South/West, respectively (P=0.052) Landgren et al, Leukemia 2014 NHANES Study

21 According to SEER; death rates from multiple myeloma much higher in Minnesota than other regions of the country The observed strong geographic disparity in prevalence of MGUS between the North/Midwest versus the South/West regions of U.S. has etiologic implications Landgren et al, Leukemia 2014 NHANES Study

22 Summary and conclusions

23 Studies show pesticide exposure associated with MGUS and multiple myeloma Geographic disparity of MGUS/multiple myeloma: high prevalence in North/Midwest Ongoing studies to confirm findings and better understand underlying mechanisms Summary and conclusions

24 Agricultural Health Study: part II (NCI) Agent Orange exposed veterans (CDC/VA) World Trade Center rescue workers (FDNY/Albert Einstein College of Medicine) Selected ongoing studies (collaborators)

25 Thank you for your attention! Ola Landgren, M.D, Ph.D. Chief, Myeloma Service Memorial Sloan-Kettering Cancer Center 1275 York Avenue, New York, NY 10065, USA Phone:


Download ppt "Support for pesticides playing a role in onset of multiple myeloma September 10, 2014 Ola Landgren, M.D., Ph.D. Chief, Myeloma Service Memorial Sloan-Kettering."

Similar presentations


Ads by Google