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Cited by 55Multiple Myeloma Research and TreatmentsOccupational Health and PerformanceMultiple and Secondary Primary Cancers

Multiple Myeloma and Its Precursor Disease Among Firefighters Exposed to the World Trade Center Disaster

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Landgren, Ola, Zeig-Owens, Rachel, Giricz, Orsolya, Goldfarb, David, Murata, Kaznouri, Thoren, Katie, Ramanathan, Lakshmi, Hultcrantz, Malin +14 more·2018·JAMA Oncology
DOI 10.1001/jamaoncol.2018.0509PMC PMC6145680
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Abstract

Importance: The World Trade Center (WTC) attacks on September 11, 2001, created an unprecedented environmental exposure to known and suspected carcinogens suggested to increase the risk of multiple myeloma. Multiple myeloma is consistently preceded by the precursor states of monoclonal gammopathy of undetermined significance (MGUS) and light-chain MGUS, detectable in peripheral blood. Objective: To characterize WTC-exposed firefighters with a diagnosis of multiple myeloma and to conduct a screening study for MGUS and light-chain MGUS. Design, Setting, and Participants: Case series of multiple myeloma in firefighters diagnosed between September 11, 2001, and July 1, 2017, together with a seroprevalence study of MGUS in serum samples collected from Fire Department of the City of New York (FDNY) firefighters between December 2013 and October 2015. Participants included all WTC-exposed FDNY white, male firefighters with a confirmed physician diagnosis of multiple myeloma (n = 16) and WTC-exposed FDNY white male firefighters older than 50 years with available serum samples (n = 781). Exposures: WTC exposure defined as rescue and/or recovery work at the WTC site between September 11, 2001, and July 25, 2002. Main Outcomes and Measures: Multiple myeloma case information, and age-adjusted and age-specific prevalence rates for overall MGUS (ie, MGUS and light-chain MGUS), MGUS, and light-chain MGUS. Results: Sixteen WTC-exposed white male firefighters received a diagnosis of multiple myeloma after September 11, 2001; median age at diagnosis was 57 years (interquartile range, 50-68 years). Serum/urine monoclonal protein isotype/free light-chain data were available for 14 cases; 7 (50%) had light-chain multiple myeloma. In a subset of 7 patients, myeloma cells were assessed for CD20 expression; 5 (71%) were CD20 positive. In the screening study, we assayed peripheral blood from 781 WTC-exposed firefighters. The age-standardized prevalence rate of MGUS and light-chain MGUS combined was 7.63 per 100 persons (95% CI, 5.45-9.81), 1.8-fold higher than rates from the Olmsted County, Minnesota, white male reference population (relative rate, 1.76; 95% CI, 1.34-2.29). The age-standardized prevalence rate of light-chain MGUS was more than 3-fold higher than in the same reference population (relative rate, 3.13; 95% CI, 1.99-4.93). Conclusions and Relevance: Environmental exposure to the WTC disaster site is associated with myeloma precursor disease (MGUS and light-chain MGUS) and may be a risk factor for the development of multiple myeloma at an earlier age, particularly the light-chain subtype.

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  • Patients exposed to certain agents (Agent Orange, pesticides, 9/11 World Trade Center dust) or suffering from specific conditions (HIV or Gaucher) have a higher prevalence of clonal populations.

    “Importantly, it has also been demonstrated that patients exposed to certain agents (e.g. Agent Orange in Vietnam veterans, pesticides in agricultural worker, or 9/11 World Trade Center dust in first responders) or those suffering from specific conditions (such as HIV or Gaucher) have a higher prevalence of these clonal populations. 37-39 40,41 42”

    From Evolution of Multiple Myeloma from a Genomic Perspective (2026) · cites this paper as [37]

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Authors
Landgren, O., Zeig-Owens, R., Giricz, O., Goldfarb, D., Murata, K., Thoren, K., Ramanathan, L., Hultcrantz, M., Dogan, A., Nwankwo, G., Steidl, U., Pradhan, K., Hall, C. B., Cohen, H. W., Jaber, N., Schwartz, T., Crowley, L., Crane, M., Irby, S., Webber, M. P., Verma, A., & Prezant, D. J.
Affiliations
  • Memorial Sloan Kettering Cancer Center (US)
  • Department of Medicine, Montefiore Medical Center, Bronx, New York
  • Albert Einstein College of Medicine (US)
  • New York City Fire Department (US)
  • Department of Hematopathology, Memorial Sloan Kettering Cancer Center, New York, New York
  • Icahn School of Medicine at Mount Sinai (US)
Corresponding author
Landgren, Ola
ORCID
Venue
JAMA Oncology
Publisher
American Medical Association (AMA)
Published
2018-06-01
Volume
4
Issue
6
Pages
821
ISSN
2374-2437 (ISSN-L)
DOI
10.1001/jamaoncol.2018.0509
PMC
PMC6145680
OpenAlex
W2800401622
Cited by
55
References
2
Citations by year
2026: 5 · 2025: 7 · 2024: 1 · 2023: 8 · 2022: 8 · 2021: 10 · 2020: 8 · 2019: 5 · 2018: 3
FWCI
4.66
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Oncology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • Memorial Sloan-Kettering Cancer Center
  • Albert Einstein Cancer Center
  • National Cancer Institute (P30CA008748)
  • National Institute for Occupational Safety and Health (U01 OH011933)
Topics
  • Health Sciences › Medicine › Hematology › Multiple Myeloma Research and Treatments
  • Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Performance
  • Health Sciences › Medicine › Epidemiology › Multiple and Secondary Primary Cancers
Keywords
multiple myeloma, monoclonal gammopathy of undetermined significance, firefighters, World Trade Center disaster, occupational exposure, monoclonal protein, free light chains, CD20 expression, seroprevalence, environmental carcinogens
MeSH terms
Adult, Aged, Air Pollutants, Disasters, Humans, Immunoglobulin Light Chains, Male, Middle Aged, Minnesota, Monoclonal Gammopathy of Undetermined Significance, Multiple Myeloma, Myeloma Proteins, New York City, Risk Factors, Prevalence, Age of Onset, Age Distribution, Rescue Work, Antigens, CD20, September 11 Terrorist Attacks, Environmental Restoration and Remediation, Firefighters

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