Risk Factors for Development of Myeloma: Role of Smoking and Alcohol
Authors: Nooka Ajay K. , Lonial Sagar , Boise Lawrence H. , Lechowicz Mary Jo , Chen Edward 
Published: November 2019

Abstract
Introduction Multiple myeloma is the second most common hematological malignancy, accounting for 1.4% of all cancers and 1.9% of all cancer deaths in the United States. With advancements in hematological treatments, the 5-year survival rate has increased to 44.9%. Despite tremendous progress in the treatment of this malignancy, the risk factors for developing multiple myeloma are still minimally described. Established risk factors include male sex, advanced age, African ancestry, and obesity. Epidemiologic research concerning alcohol and tobacco as risk factors, however, is highly controversial. Studies suggestive of a protective effect of alcohol consumption are inconsistent and limited in number, and findings of tobacco as a risk factor are inconsistent in magnitude across various meta-analyses. To better understand the relationship of alcohol and tobacco use in the development of multiple myeloma, we conducted a cross-sectional analysis
Methods For this analysis, we reviewed medical records of multiple myeloma patients from the Emory University Winship Cancer Institute under an IRB approved protocol. Data variables collected included sociodemographic information, drinking and smoking history, current drinking and smoking status. Furthermore, using a control population from a previously published pooled analysis, we conducted a case-control study to discern any associations between alcohol use and multiple myeloma. Similar analysis on smoking couldn’t be done due to lack of ideal control population. SPSS software was used for data analysis
Results A total of 1150 patients with known diagnosis of multiple myeloma were included in the analysis. Males (53%), white people (58%), and patients in the age group 55-64 (28%) constituted majority of the cohort. Among the multiple myeloma patients, males have higher smoking rates than females (39% vs 27%; p<0.0001), and whites have higher smoking rates than blacks (37% vs 29%; p=0.01). Similarly, males have higher alcohol consumption rates than females (49% vs 36%; p<0.0001), and whites have higher alcohol consumption rates than blacks (50% vs 36%; p<0.0001). Males in the age group 65-74 have higher rates of smoking (white 45% and black 40%; p=0.01) and alcohol consumption (white 58% and black 44%; p<0.001) than females of the same age group (smoking: white 22% and black 20%; alcohol: white 26% and black 30%). Furthermore, smoking and alcohol consumption rates among white females in the age group 45-55 (49% and 51%) are significantly higher than black females of the same age group (25% and 28%) (p<0.0001;p<0.0001) respectively. Using the control population from a previously published pooled analysis, a case-control study was conducted to determine any associations and to calculate the odds of developing multiple myeloma. In the analysis of ever versus never alcohol consumption, ever consumption was associated with a decreased risk of multiple myeloma for men (OR = 0.27; 95% CI, 0.22-0.32) and women (OR = 0.48; CI, 0.39-0.58).
Conclusion Males and Whites have higher smoking and drinking rates from this cross-sectional analysis. An inverse association exists for alcohol consumption and development of myeloma. This seen effect could be related to findings from literature that moderate alcohol intake may mitigate the proinflammatory cytokines, improve cellular and humoral immune responses, and reinforce the DNA repair capacity.

Disclosures
Lonial: Millennium: The Takeda Oncology Company: Consultancy, Research Funding; Celgene: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding; Onyx Pharmaceuticals: Consultancy, Research Funding.