At the recent American Society of Clinical Oncology (ASCO) meeting in Chicago, the idea of preventing the progression of high-risk smoldering multiple myeloma to active myeloma using lenalidomide was a topic of active discussion. In this study that was presented at ASCO, the onset of active disease was clearly delayed. But is this “prevention” of myeloma? 

Not really. A recent publication in Blood examines the conditions that produce “dormant myeloma cells,” cells in an MGUS-type state. As the authors explain, achieving and maintaining dormancy, and thus preventing progression to myeloma, are complex processes. Understanding these processes will require much more research and the development of very specific therapies to address them. 

True prevention of disease versus prevention of progression

Myeloma develops from MGUS (monoclonal gammopathy of undetermined significance). To truly prevent myeloma, one needs to prevent the development of MGUS. The development of MGUS has been linked to toxic exposures that occurred at the World Trade Center attack in New York and from the use of the defoliant Agent Orange in Vietnam

Two recent reports draw attention to the environmental triggers for cancer. “Around half of cancers could be prevented,” declared Christopher Wild, director of the International Agency for Research on Cancer (IARC), at a meeting on cancer’s environmental causes covered by NPR (National Public Radio). Margaret Kripke, of the MD Anderson Cancer Center, pointed out that over 80,000 chemicals are in use in the U.S., yet only a handful have been tested to assess their potential to cause cancer. 
Measurements of the levels of toxic chemicals in patients are critical in making the connection between cancer and toxic exposure. In addition, we must study what Allain Balmain, a geneticist at the University of California, San Francisco, calls the “mutational signatures” of cancer. Those distinctive signatures are caused when a chemical damages the DNA in a way that produces a unique signature that remains after toxic exposure. 

Examples of potential exposures cited at the cancer meeting included the contamination of drinking water at Camp Lejune, North Carolina and exposures from fracking and plastics production in Pennsylvania. The participants issued a call to action for expanded research on all fronts to move towards the achievement of true cancer prevention. 

Environmental and climate factors

New research highlights the impact of extreme weather, fires, and flooding. These disasters stir up a toxic stew of chemicals. Prof. Naresh Kumar from the University of Miami notes that “We are sitting on a pile of toxic poison,” and “whenever we have natural disasters, they are stirred up.” 

Prof. Kumar studied the spread of PCBs (polychlorinated biphenyls, toxic chemicals linked to myeloma and other cancers) in Puerto Rico after Hurricane Maria in 2017. Testing found that PCBs were not only in the soil, but also in 50 Puerto Rico residents who were tested, at 2 to 3 times the expected level. He speculated that the toxic chemicals entered the food chain through contaminated local fish. 

In a study of soil and ash near homes burned in the recent California wildfires, close to 2,000 toxic chemicals were identified. Obviously, in the case of the World Trade Center attacks, the occurrence of toxic chemicals has been strongly linked to both cancer and other ailments. We are hoping that the U.S. Senate will vote this week to confirm authorization of funding for the healthcare costs of exposed individuals, which was the subject of recent emotional testimony on Capitol Hill.

The struggle to maintain fiscal solvency for the 9/11 victim fund highlights the difficulties in obtaining support—not only for research into cancer’s causes, but for appropriate and well-deserved medical care! 

Global concerns

Extreme weather and pollution of land, air, and oceans are major concerns around the word. But some good news comes from a recent report on a novel approach to combatting global warming. Planting more trees (2.5 billion acres of forest) can remove two-thirds of the 300 gigatons of carbon added to the atmosphere since 1800. At a cost of 30 cents per tree, ecologist Thomas Crowther of the Swiss Federal Institute of Technology and his study co-authors calculate that a global restoration project can have a major impact for roughly $300 billion. But the types of foliage used to combat global warming are crucial.  A recent episode of “60 Minutes”  focused on Siberia’s need for grasslands, as dense forests trap too much heat and can melt the permafrost. Scientist Sergey Zimov proposes genetically engineering the return of the now-extinct wooly mammoths, who, he says, will trample the Siberian snow and seal the permafrost, along with reducing the number of trees and creating open space savannahs. Sergey, a geophysicist, has done the math and believes this will have a global impact. 

Interestingly, a completely separate analysis in Africa shows that large elephants can have a major impact on forests by promoting the emergence of fewer large trees and reducing smaller trees, bushes and brush (above-ground “biomass” that fosters carbon release). So, more trees are good, but not too many in a given area. And give them time to grow! Something very positive to be considered.

Bottom line

The Earth is a complex biologic system that we have polluted with innumerable toxic chemicals. The consequences are severe. We must work together to prevent disease and save lives. 
 


Image of Dr. Brian G.M. DurieDr. Brian G.M. Durie founded and now serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.

 

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