Have we found the cause of myeloma? Not really!
A report this week issued by Yale News announced “Yale researchers discover underlying cause of myeloma,” citing an article published today in the New England Journal of Medicine entitled, “Clonal Immunoglobulin against Lysolipids in the Origin of Myeloma.” This is an article about what triggers the development of MGUS and myeloma in patients with a rare metabolic disease called Gaucher’s disease. The article is thus about how myeloma may be caused in a rare and unusual circumstance – not the average case of myeloma.
Thus, although this is interesting and illustrative, it is not identifying what causes myeloma overall. Quite the contrary. It is a specialized example of how various body components can trigger an “autoimmune” reaction and these reacting plasma cells can give rise to myeloma. There are many famous examples of this phenomenon. In the NEJM, a case of myeloma-associated monoclonal protein was reported in a patient with AIDS. The monoclonal protein was directed against the p24 protein of the AIDS virus. This is a well-established mechanism both in patients and in the laboratory. The problem has been to identify which lipids, proteins or other components trigger myeloma for the average patient?
This is a lingering question as yet unanswered. The idea that lysolipids (in the case of Gaucher’s disease something called glycosylceramide and complex glycosphingolipids) can be part of that answer is interesting, but it is a huge leap from this special case to the broad answer. This special case also involves activation of natural killer cells, which then secondarily trigger the plasma cell response.
So there you have it: interesting, but much more research is needed to learn how this information applies more broadly to the causation of myeloma.
Dr. Brian G.M. Durie 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®.