A Pilot Plant Based Dietary Intervention in MGUS and SMM Patients with Elevated BMI Is Feasible and Associated with Improvements in Metabolic and Microbiome Biomarkers of Progression

Shah, Urvi; Derkach, Andriy; Castro, Francesca; Anuraj, Aishwarya; Blaslov, Jenna; Tran, Linh; Adintori, Peter; Burge, Miranda; Funkhouser, Sharon; Hosszu, Kinga; Cross, Justin R.; Pollak, Michaël; McAvoy, Devin; Nemirovsky, David; Maclachlan, Kylee; Mailankody, Sham; Korde, Neha; Tan, Carlyn; Hultcrantz, Malin; Patel, Dhwani; Hassoun, Hani; Shah, Gunjan L.; Scordo, Michael; Lahoud, Oscar; Chung, David J.; Mayerhoefer, Marius E.; Peled, Jonathan U.; Landau, Heather; D’Souza, Anita; Landgren, Ola; Giralt, Sergío; Iyengar, Neil M.; Usmani, Saad Z.; Brink, Marcel R.M. van den; Lesokhin, Alexander M.

doi:10.1182/blood-2022-163281

Cited by 6 publications

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“…Pharmacological and nonpharmacological measures such as dietary intervention need to be investigated in future studies to improve outcomes in MM. 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 …”

Section: Discussionmentioning

confidence: 99%

Prevalence and impact of diabetes on survival of patients with multiple myeloma in different racial groups

Shah,

Moshier,

Derkach

et al. 2024

Blood Advances

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Multiple myeloma (MM) is twice as common in Black individuals compared to White, and diabetes mellitus (DM) disproportionately affects Black patients. While numerous studies have shown a correlation between DM and MM, this has not been studied in the context of race and in vivo mechanisms. We conducted a retrospective clinical study of 5383 patients with MM of which 15% had DM (12% White and 25% Black). Multivariable Cox models showed reduced overall survival (OS) for patients with DM (HR 1.27; 95% CI 1.11, 1.47; p<0.001). This appeared to be driven by a marked difference in OS between White patients with and without DM, but not Black patients. In contrast, obesity was associated with better OS in Black patients, but not White patients. To complement this analysis, we assessed MM growth in a genetically engineered immunocompromised non-obese diabetic (Rag1-/-/MKR) mouse model to evaluate the mechanisms linking DM and MM. MM.1S xenografts grew in more Rag1-/-/MKR mice and grew more rapidly in the Rag1-/-/MKR mice compared with controls. Western blot analysis found that MM1.S xenografts from Rag1-/-/MKR mice had higher phospho-S6 ribosomal protein(Ser235/236) levels indicating greater activation of the mammalian target of rapamycin pathway. Our study is the first to evaluate racial differences in DM prevalence and survival in MM as well as the effect of DM on tumor growth in mouse models. Our results suggest that DM may contribute to the higher incidence of MM in Black patients, and to improve survival in MM DM management cannot be ignored.

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Section: Discussionmentioning

confidence: 99%

Prevalence and impact of diabetes on survival of patients with multiple myeloma in different racial groups

Shah,

Moshier,

Derkach

et al. 2024

Blood Advances

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“…As the role of gut dysbiosis is being increasingly recognized in the pathogenesis of MM, diet, the largest driver of microbiome composition can no longer be ignored [14]. Preliminary results of a pilot nutrition-based intervention study (NUTRIVENTION) in individuals with precursor plasma cell disorders and BMI ≥25 (NCT04920084) show that a plant-based diet is feasible and leads to improvement in biomarkers associated with progression to MM such as insulin resistance and gut microbiome composition [15]. A larger randomized study of a plant-based diet is currently enrolling (NCT05640843) [16].…”

Section: Manuscriptmentioning

confidence: 99%

Pre-Diagnosis Dietary Patterns and Risk of Multiple Myeloma in the NIH-AARP Diet and Health Study

Castro,

Parikh,

Eustaquio

et al. 2023

Preprint

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Background: Despite patient interest in knowing whether diet is linked to multiple myeloma (MM), there is limited research on dietary patterns and MM risk. Two studies have assessed this risk, albeit with a small number of MM cases. The EPIC-Oxford cohort and Oxford Vegetarian study (65 MM cases) showed that fish eaters, vegetarians and vegans had significantly reduced MM risk compared to meat eaters. The Nurses Health Study and Health Professionals Follow-up Study (478 MM cases) showed a significantly increased MM risk in men with Empirical Dietary Inflammatory Pattern. Methods: The NIH-AARP Diet and Health study is a prospective cohort of 567,169 persons who completed a food frequency questionnaire in 1995-1996 and were followed until December 2011. Healthy Eating Index-2015 (HEI-2015), Healthy Diet Score (HDS), alternate Mediterranean Diet (aMED) and healthful Plant-based Diet Index (hPDI) scores were calculated using a priori defined methods and grouped into quartiles, with higher scores reflecting healthier eating patterns. We prospectively evaluated the association between pre-diagnosis dietary patterns and MM incidence in this cohort. Hazard ratios (HR) and 95% confidence intervals (95%CI) were estimated using multivariate Cox proportional hazards models adjusted for age at study entry, sex, race, body mass index, education, and total energy intake (by residual method). Sensitivity analysis was conducted to assess reverse causality by excluding MM cases diagnosed within one year of follow-up. Results: Among 392,589 participants (after exclusions), a total of 1,366 MM cases (59% males; 92% non-Hispanic whites) were identified during the follow-up period. Analysis revealed a significant association between hPDI scores and reduced MM risk (highest vs lowest quartile, HR 0.85; 95%CI 0.73-1.0; p=0.043) (Table). In sensitivity analysis (1,302 MM cases), the association was no longer significant (HR 0.87; 95%CI 0.74-1.03; p 0.09) but trended in the same direction. This may be due to small sample size, given MM is a rare disease. HEI-2015, HDS and aMED scores were not associated with MM risk. Conclusions: A healthful plant-based diet was associated with reduced MM risk in the NIH-AARP cohort. These results will help oncologists and patients make informed choices about their diet. To our knowledge, this is the largest epidemiologic study to date assessing pre-diagnosis dietary patterns and MM risk.

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“…Social factors such as equitable access to care, including systemic actions taken to remove nancial barriers, are crucial to ensure that vulnerable populations have access to novel therapeutic agents and supportive therapies [18]. For instance, dietary interventions, including meals comprised of whole food plant-based meals, have also been associated with improvements in metabolic and microbiome biomarkers of and MGUS and SMM progression, underscoring the importance of improving access to nutritious food options for MM patients living within food deserts [19].…”

Section: Introductionmentioning

confidence: 99%

Multiple myeloma incidence and mortality trends in the United States, 1999-2020

Zhu,

Park,

Lai

et al. 2024

Preprint

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Multiple myeloma (MM) is a plasma cell disorder accounting for approximately 10% of hematologic malignancies. There is limited epidemiological evidence regarding the long-term trends and disparities in MM in the US. We conducted a multiple time point cross-sectional study using MM incidence rate data from the Surveillance, Epidemiology, and End Results (SEER) database and mortality data from the CDC Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Underlying Cause of Death database between 1999 and 2020. During this period, MM incidence has steadily increased, while MM mortality has steadily decreased, with substantial racial and ethnic disparities. Non-Hispanic Black individuals exhibited the highest incidence rates, which consistently rose from 12.02 (95% CI: 10.54, 13.64) in 1999 to 14.20 (95% CI: 12.93, 15.55) per 100,000 population by 2020. Non-Hispanic American Indian/Native Alaskans and Asian/Pacific Islanders demonstrated the lowest incidence rates of 5.59 (95% CI: 2.69, 10.04) and 3.56 (95% CI: 2.94, 4.27) per 100,000 population in 1999 to 5.76 (95% CI: 3.49, 8.90) and 3.92 (95% CI: 3.46, 4.42) per 100,000 population, respectively, by 2020. Disparities by gender, age, tumor stage, US census region, and rurality were observed, underscoring the importance of targeted, equity-centered interventions and MM screening initiatives for at-risk populations.

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A Pilot Plant Based Dietary Intervention in MGUS and SMM Patients with Elevated BMI Is Feasible and Associated with Improvements in Metabolic and Microbiome Biomarkers of Progression

Cited by 6 publications

References 0 publications

Prevalence and impact of diabetes on survival of patients with multiple myeloma in different racial groups

Prevalence and impact of diabetes on survival of patients with multiple myeloma in different racial groups

Pre-Diagnosis Dietary Patterns and Risk of Multiple Myeloma in the NIH-AARP Diet and Health Study

Multiple myeloma incidence and mortality trends in the United States, 1999-2020

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