Myeloma Precursor Disease Among WTC Responders

Details

• Personal Author:
  Landgren CO ; Prezant DJ ; Zeig-Owens R
• Description:
  Background: Hazardous materials including known and suspected carcinogens, were present at the World Trade Center (WTC) disaster site. In a screening study for multiple myeloma precursor disease, we found WTC exposure was statistically significantly associated with the overall prevalence of monoclonal gammopathy of undetermined significance (MGUS) (RR=1.76; 95% CI=1.34, 2.29) for MGUS and light-chain (LC)-MGUS combined among Fire Department of the City of New York (FDNY)WTC-exposed white male firefighters compared with the general population; this association was particularly elevated in light-chain MGUS (RR=3.13; 95% CI=1.99, 4.93). Additionally, we found WTC-exposed firefighters compared with the general population had higher proportions with light chain disease and CD20 positive plasma cells. Further investigation was needed to determine if MGUS findings were reproducible in a more heterogeneous cohort of WTC-exposed rescue/recovery workers, the Stony Brook University-General Responder Cohort GRC (SBU-GRC). The study aims were to 1) to analyze the precursor state of multiple myeloma, MGUS, among WTC-exposed SBU-GRC participants and to compare the prevalence to FDNY participants; and 2) to compare the prevalence of MGUS among the combined WTC-exposed responder cohorts (both FDNY and GRC-SBU) to published estimates in population-based studies. Methods: Conducted a collaborative effort between the Albert Einstein College of Medicine, FDNY, GRC-SBU, University of Miami and Memorial Sloan Kettering Cancer Center. We screened for MGUS WTC-exposed rescue-recovery workers using sensitive immunophenotyping. Logistic regression was used to estimate the MGUS odds ratio (OR) comparing FDNY rescue-recovery workers and GRC-SBU rescue-recovery workers, as well as the MGUS odds ratio for WTC dust cloud exposure. Finally, age-standardized prevalence rates were calculated for white males aged 50-79 for each cohort and the combined WTC-exposed cohort (FDNY and GRC-SBU); risk ratios (RR) were estimated by comparing risk in the WTC-exposed cohort with the Olmsted County, MN screened cohort. The entire Olmsted County cohort was assumed unexposed. Analyses were conducted for MGUS (M-spike and light-chain-MGUS combined), M-spike, and light-chain-MGUS. Results: The SBU-GRC had elevated odds of MGUS compared to the FDNY cohort (OR=1.37; 95% CI=1.00-1.88). The OR for WTC dust cloud exposure was non-significantly elevated (OR=1.15; 95% CI=0.78-1.70). Among white male participants aged 50-79, the age-standardized prevalence of MGUS was 9.0 per 100 persons (95% CI=7.5-10.6), over two-fold higher than the risk from the comparison unexposed Olmsted County cohort (RR=2.08; 95% CI=1.72-2.51). The age-standardized prevalence of light-chain-MGUS was more than three times higher than the same comparison population (RR=3.54; 95% CI=2.52-4.97). Conclusions: By expanding MGUS screening beyond white male firefighters, we were then able to establish that the association between WTC exposure and MGUS applies to a more demographically heterogeneous population. As such, this study adds to a mounting body of evidence supporting an association of environmental exposures at the WTC disaster site and myeloma precursor disease among rescue/recovery workers. Augmented access to MGUS screenings for the entire WTC-exposed cohort could allow for early treatment interventions that improve cancer survival. [Description provided by NIOSH]
• Subjects:
  Blood Cohort Studies Dust Emergency Responders Firefighters Occupational Health Safety September 11 Terrorist Attacks
• Keywords:
  Blood Disorders Cohort Studies Dust Exposure Fire Fighters First Responders Myeloid Tissue World Trade Center WTC
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Final Cooperative Agreement Report
• Place as Subject:
  Florida ; New York ; OSHA Region 2 ; OSHA Region 4
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-29
• NIOSHTIC Number:
  nn:20069547
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, U01-OH-011869, 2023 Sep; :1-29
• Federal Fiscal Year:
  2023
• Performing Organization:
  Albert Einstein College of Medicine
• Peer Reviewed:
  False
• Start Date:
  20200701
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20230630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:70adad2f5afdd64bec432e384f07b351d8245e30e3aff23c099ed962ff2d8bb13043d2784d8d700098357be00781bbafdd825e938218b73f0d475c6bc87fb5b6
• Download URL:
  https://stacks.cdc.gov/view/cdc/219238/cdc_219238_DS1.pdf
• File Type:
  [PDF - 428.00 KB ]