Several historic events occurred this week: It has been 22 years since the 9/11 attacks happened in New York City; FDA approval and CDC endorsement/recommendation of the use of updated COVID-19 vaccines against current and active variants; and significant new findings in myeloma research as well as the FDA approval of motixafortide (Aphexda™) in combination with G-CSF in mobilizing ASCT for myeloma patients.

The 9/11 Anniversary

As Americans commemorated the 9/11 tragedy with solemn remembrance, it also put a harsh reality into the spotlight: cancer-related deaths among the 9/11 survivors continue to rise. 

FOX News Digital reported that “as of 2022, approximately 4,343 survivors and first responders died from toxic exposure, far exceeding the number that lost their lives on the day of the attacks, according to the World Trade Center Health Program.” 

For the past 22 years, so much work has gone into investigating the aftermath of the toxic exposures. In the weeks after 9/11 happened, a research team was established by the New York City Fire Department (FDNY) and the World Trade Center (WTC), headed by David J. Prezant, MD, the Chief Medical Officer at the FDNY Office of Medical Affairs and professor at the Albert Einstein College of Medicine.

The FDNY research team noted that multiple and considerable exposures to asbestos, arsenic, polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), furans, and dioxins occurred in the aftermath of the 9/11 attacks. Most of these toxic exposures have been linked to the increased incidence of multiple myeloma among survivors and first responders. 

WTC Health Program Findings

Along with the research team, the WTC Health Program was also put in place to cover medical costs for victims with medical issues related to 9/11 toxic exposure. However, in order to access funds, correlations needed to be established. 

In relation to multiple myeloma, a study conducted from 2013-2015 showed that FDNY firefighters had an increased risk of monoclonal gammopathy of unknown significance (MGUS)— a condition where the body produces abnormal protein in the blood (called paraprotein). 

In particular, the risk of light chain MGUS was higher by three-fold. By using biobank samples from the MGUS study, investigators were able to detect the occurrence of gene mutations and discovered an increase in clonal hematopoiesis (CH) associated mutations among exposed individuals. 

Genomic alterations were also observed in mice that were exposed to WTC particulate materials.

The Bottom Line

The increased occurrence of multiple myeloma among 9/11 survivors who were exposed to toxins has scientific basis; cases of MGUS, smoldering multiple myeloma (SMM), and multiple myeloma are covered by the WTC Health Program. 

As I have noted in my previous blogs, it took a lot of work from compassionate advocates to establish funding for the WTC Program and to include MGUS/SMM/MM cases in the program. 

A Myeloma Patient Success Story

In August 2010, Gerard Vanderberg was diagnosed with multiple myeloma. Since then, he has been receiving treatments from Dr. David Siegel at the Hackensack Meridian  John Theurer Cancer Center in New Jersey. 

At the time of the 9/11, Gerard was a 47-year-old bond trader working in a building across the street from the Twin Towers. 

An International Myeloma Working Group (IMWG) Member and a recognized myeloma expert, Dr. Siegel feels that Gerard’s myeloma diagnosis was brought about by the effects of toxic exposure. 

In an interview with FOX News Digital, Gerard recalled coming across a large amount of “white dust” when he went to his office a few days after 9/11  to gather his belongings. 

“The white stuff was all over the place—in my computer, on my desk, in my books. It wasn’t until later that I realized it was asbestos,” he recalled. 

It took 9 years before Gerard started developing unusual symptoms. In 2009, he felt pain on his side and knees and then developed plasmacytoma. Toxins breathed in through the lungs were most likely responsible for the tumor of plasma cells that developed outside of Gerard’s right lung.

He has remained steadfast about fighting this blood cancer as much as he could. Gerard considers himself “lucky to be alive.”

According to Dr. Siegel, “there has been a significant increase in the risk of myeloma among people who worked in the World Trade Center, as well as first responders and construction workers who returned to the area after the attack. I suspect that the people at the World Trade Center inhaled materials that got into their lungs.” 

“It didn’t necessarily cause an injury in the lungs that turned into a cancer, although that could happen as well—but these materials got encapsulated in the immune cells, and the immune system just couldn’t rid itself of this chronic exposure,” Dr. Siegel told Fox News Digital.

A study published in the Journal of the National Cancer Institute revealed that, “the collapse of the World Trade Center sent many toxic carcinogens into the air, including asbestos, silica, heavy metals, and combustion products,” Fox News Digital further reported.

While unusual, there are younger-than-average individuals who do get diagnosed with multiple myeloma. 

Gerard decided to take an aggressive approach to get the myeloma under control—through chemotherapy, radiation, and autologous stem cell transplant (ASCT). After arduous months of therapy, Gerard achieved remission—a true testament to his resilience. Currently, Gerard is “doing fine.”

He is  truly grateful to the WTC Health Program for shouldering all medical expenses that were not covered by his insurance.

“If it weren’t for that program, I would have had to sell my home, and it would have been a much more difficult route,” said Gerard.

He is still dealing with scleroderma (a condition where skin and connective tissues harden and tighten) but overall, he is “grateful for being able to do what he loves” (i.e., exploring Big Sky and Yellowstone National Park with his wife.)

“I am going to fight to live. I could have given up, but that’s just not who I am. I have no complaints —I’m just happy to be here,” said Gerard.

Coming Soon: Updated COVID-19 Vaccines 

An even bigger news this week— updated Pfizer-BioNTech and Moderna COVID-19 vaccines have been approved by the FDA for use on individuals 12 years and older and authorized for emergency use for children ages 6 months to 11 years; this was immediately followed by the CDC’s endorsement and recommendation of the updated vaccines for U.S.-based individuals ages 6 months and older. 

Despite earlier concerns (the vaccine was originally developed to fight the XBB.1.5 variant), the updated monovalent vaccines are “formulated to more closely target currently circulating variants [i.e., BA.2.86 and EG.5] and to provide better protection against serious consequences of COVID-19, including hospitalization and death,” said the FDA in a press release. 

The updated COVID-19 vaccines will be immediately available after CDC Director Mandy Cohen, MD, MPH signs off on the recommendation. 

Major drugstore chains have reported that updated COVID-19 vaccines will become available at their stores this week.

“Most Americans can still get a COVID-19 vaccine for free. For people with health insurance, most plans will cover COVID-19 vaccine at no cost to you. People who don’t have health insurance or with health plans that do not cover the cost can get a free vaccine from their local health centers; state, local, tribal, or territorial health department; and pharmacies participating in the CDC’s Bridge Access Program. Children eligible for the Vaccines for Children program also may receive the vaccine from a provider enrolled in that program,” stated the CDC in a press release.

New Insights and Findings from Myeloma Research Studies

CSI Institute, National University of Singapore Study

AMN Clinical Trials Lead Prof. Wee Joo Chng led his team at the Cancer Science Institute of Singapore (National University of Singapore) as the principal investigator of an important study, “Histone Methyltransferase NSD2 Activates PKCα to Drive Metabolic Reprogramming and Lenalidomide Resistance in Multiple Myeloma,” that was published in Cancer Research.

This study revealed that the histone methyltransferase NSD2 and its epigenetic target, PKCα are very much involved in the development of the t[4;14 ] translocation a key mutation in myeloma cells linked to higher risk disease.

This, as pointed out by Prof. Chng, can lead to new medicines and non-invasive diagnostic testing for this subgroup of patients. These options are very encouraging, as we strive to achieve tailored interventions and personalized care. 

Study on Mezigdomide plus Dexamethasone in Relapsed/Refractory Multiple Myeloma

Published in the New England Journal of Medicine, with IMWG Member Dr. Paul Richardson as one of the authors, the study, "Mezigdomide plus Dexamethasone in Relapsed/Refractory Multiple Myeloma" showed very promising results with this novel E3 ubiquitin ligase modulator (a CELMoD) when combined with dexamethasone in 77 patients (phase 1) and 101 (phase 2) with relapsed/refractory multiple myeloma (RRMM).

The overall response rate (ORR) was 41% in this heavily pretreated population of patients and toxicities were manageable, and as anticipated, neutropenia and infections were the main side effects. These early results encourage further ongoing evaluation.

Bee Glue Being Tested to Treat Myeloma

University of New Brunswick St. John (UNBSJ) researchers have “discovered what they call a ‘miracle cure’ for a rare form of blood cancer [myeloma], and it is based on a naturally occurring substance known as bee glue,” as reported by Canada-based Country 94.1.

According to the report, “Bee glue, or propolis, is created by bees as they collect sticky sap from trees and mix it with their saliva. It’s an antimicrobial agent and they us it to protect their hives and support their overall health. Dr. Alli Murugesan, a UNBSJ biomedical and translational researcher, says that a synthetic version of bee glue has been found to effectively stop the growth of myeloma cancer cells.”

FDA Approval of Motixafortide

Motixafortide (Aphexda™) was recently approved by the FDA, in combination with G-CSF to mobilize hematopoietic stem cells for use in autologous stem cell transplant (ASCT). This provides an important new option which is safe and very effective.

Cancer Moonshot Update

On September 14, the White House made several important announcements from the Biden Cancer Moonshot which includes: 

• A $240 million in additional investment will be awarded by the Advanced Research Project Agency for Health (ARPA-H) for 2023 to accelerate new ways to prevent, detect, treat, and survive cancer.
• ARPA-H announced that its nationwide health innovation network (ARPANET-H) will be deployed “to accelerate clinical trials for cancer and other diseases.”
• A new award recognizing community health centers for exceptional performance and high clinical quality in cancer screenings, called the National Quality Leader (NQL) – Cancer Screening Badge.

It was, most certainly, an action-packed week in the field of myeloma—filled with great news for the myeloma community.