Smoldering MM Study Suggests Deeper Links to Metabolic Syndromes

It has long been understood that patients with multiple myeloma (MM) are at a higher risk of developing metabolic syndromes such as hypertension and diabetes, but a new study suggests the heightened risk is evident even in patients in an asymptomatic precursor phase of the cancer.

The study suggests MM may be impacting patients’ metabolic systems in more complex ways than were previously understood. It was published in the journal BMC Cancer,

The authors, including corresponding author Elena Izkhakov, MD, of Tel Aviv Sourasky Medical Center in Israel, note that most patients with MM are diagnosed in their 60s and 70s, and roughly 1 in 5 of those patients will have already been diagnosed by diabetes at the point of MM diagnosis. MM has also been linked with higher rates of hypertension and obesity.

About 1 in 7 patients who go on to be diagnosed with MM will first go through a phase called smoldering MM (SMM), an asymptomatic clonal plasma cell disorder.

And while patients with MM are seeing better rates of survival thanks to newer therapies, they continue to face risks associated with these metabolic syndromes. One reason appears to be the MM treatments themselves, which can exacerbate metabolic syndromes. However, the investigators wanted to know if there was more to the story.

“The question arises as to whether an increased risk of various components of metabolic syndrome in MM patients is due to the treatment or whether it could be already present at the stage of SMM due to the disease itself,” they write.

In hopes of answering that question, Izkhakov and colleagues used metabolic data from 153 patients at the medical center, 105 of whom had MM, and the remaining 38 of whom had SMM. Those data were compared to 138 control patients. The data in the study are from the years 2008 to 2015, and patients data were evaluated at baseline and at 1, 3, and 5 years.

The results showed patients with SMM had a higher risk of dyslipidemia at each of the follow-up points. Patients with MM likewise had higher risks of dyslipidemia, as well as a higher risk of diabetes at 1 year, and a higher risk of hypertension at 5 years’ follow up.

Notably, the authors found differences between the control group and the SMM/MM groups at baseline, which suggest that some of the conventional wisdom about the links between metabolic syndromes and MM may be wrong.

For instance, Izkhakov and coauthors write that the association between MM and hypertension is often attributed to the relatively older age of patients with MM, the higher prevalence of the disease among men, and the treatment of MM patients with steroids.

“However, the findings of the current study revealed that hypertension was more prevalent among patients with SMM at baseline ─ and therefore not yet treated with steroids ─ than in the control group,” they note.

In sum, the authors conclude that there’s significant reason to further investigate the ways in which the disease of MM itself might impact metabolic systems.

“These findings support the notion that characteristics of MM itself, and not only its treatment, may be associated with an increased risk of various components of metabolic syndrome and call for future prospective research of those components in SMM and MM patient populations,” they conclude.

Reference

Markus, E., Trestman, S., Cohen, Y. et al. Components of metabolic syndrome in patients with multiple myeloma and smoldering multiple myeloma. BMC Cancer. 2020; 20(489). doi:10.1186/s12885-020-06976-1