Could myeloma be prevented through dietary recommendations, lifestyle changes, and occupational precautions? There is growing evidence that intervention strategies such as these might offer hope—and these ideas will be tested for the first time in the Black Swan Research-funded iStopMM® project in Iceland.

Launched in October 2016—and the subject of reports by CNN and CNBC—the innovative iStopMM project aims to Screen, Treat, Or Prevent Multiple Myeloma in Iceland. Already, the iStopMM project has identified more than 500 new individuals with MGUS (monoclonal gammopathy of undetermined significance, the precursor to multiple myeloma) in Iceland. In the coming months, more than 4,000 new MGUS patients will be identified.

It’s all about the numbers!

Because the iStopMM screening program will identify over 4,000 MGUS patients, this dramatically improves the chances of statistical success for all planned research and treatments. The MGUS patients and the 340,000 individuals in the Iceland population without MGUS all have molecular sequence information available. It is therefore highly likely that any unique or “driving” mutation present only in MGUS patients will be identified. There are already clues about such a sequence in the IgM type of MGUS. For myeloma, we are interested in IgG MGUS and IgA MGUS as well as light chain disease.

In addition to the fantastic advantage that this extraordinarily high number of screening participants ensures, the amazing community spirit and willingness to be involved in such a large effort in Iceland is both essential and appreciated.

Careful evaluation of patients in the new iStopMM clinic, which opened last week, includes dietary and toxic exposure history combined with detailed genetic sequencing information.  This analysis will make it possible to clarify not just which patients progress from MGUS to MM (and why), but also which Icelanders are developing MGUS in the first place and why.

Two recent studies show that both the development of MGUS, the precursor to smoldering myeloma (SMM) and active myeloma (MM), and the risk of progression to MM are linked to diet:

• An abstract (#8032) to be presented at the upcoming American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago, June 2-6, concludes that a higher body mass index (BMI: obesity scale) correlates with a higher risk of early progression of SMM to MM. This study of 306 patients with SMM, followed at the Mayo Clinic in Rochester, Minnesota, showed that the two-year likelihood of progression was 42% with an elevated BMI versus 18% with a normal BMI. The median time to progression from SMM to MM was 36 months (three years) with an elevated BMI versus 64 months (over five years). For the first time, this introduces the notion that an intervention with weight reduction can potentially reduce the risk of progression.
   
• In a previous study (Abstract #3257), presented at the 2016 Annual Meeting of the American Society of Hematology (ASH), both the likelihood of developing MGUS and the risk of progression to MM was linked to diet. This study from Iceland showed that adherence to a traditional Icelandic diet (including salted fish and meats, blood or liver sausage, rye bread and potatoes) reduced the likelihood of developing MGUS, and a high-meat, low-fish diet increased the risk of progression to MM.

Obesity does not cause myeloma!

It is very important to emphasize that obesity in itself does not cause myeloma. If it did, there would be a huge myeloma epidemic in the United States! However, we know that the presence of obesity does change the microenvironment and cell growth factors in the bone marrow and elsewhere. Thus, any preexisting cancer cells or precursor cells such as MGUS can have greater growth potential. This also means that we still need to identify the toxic chemicals or other factors causing the mutations leading to the cancer. This is an important area of focus for the epidemiology aspects of the iStopMM plans.

A shift to healthier eating

The timing of this research supporting the value of a healthy diet is just right. Supermarkets, where most of us buy our food, are in the process of a major transformation, as Michael Ruhlman outlines in his new book “Grocery: The Buying and Selling of Food in America.” There is a strong shift to healthier eating. As Ruhlman explains, “…shoppers are increasingly shunning processed, packaged products that fill most of the shelves in the center of the store.” Customers are buying much more fresh produce and prepared meals. Even cereals are on the decline.

Ruhlman considers “Breakfast: the most dangerous meal of the day,” and devotes a chapter of the book to this idea. Breakfast cereals, he writes, are “stripped carbs,” which our bodies convert into sugar, and contain additional sugar or corn syrup— producing a huge total dosage of sugar. Not a healthy choice!

The internet has also had an impact on grocery shopping. Today, much of the items found in the center of the supermarket can be brought online or delivered. Thus, supermarkets of the near future will be much smaller and healthier, and will focus on fresh produce.

Prevention: A tangible goal?

The combination of exciting new science, especially the iStopMM project, with these new trends toward healthier living really do bode well for prevention as a tangible goal. It becomes more and more likely that Iceland will not only be the first country to cure myeloma, but also to prevent this cancer altogether! And what is achieved in Iceland can be implemented around the globe.

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®.