Abstract 3852: Obesity is associated with clinical characteristics in African American multiple myeloma patients
Authors: Hwang Amie E. , Ailwadhi Sikander , Huff Carol Ann , Bernal-Mizrachi Leon , Haiman Christopher A. , Peters Edward , Singhal Seema , Pawlish Karen , Bock Cathryn , Zimmerman Todd , Berg David J. Van Den , Conti David V. , Birmann Brenda B. , Mehta Jayesh , Graff John J. , Stram Daniel O. , Brown Niquelle , Yu Yang , Azadian Moosa , Kolonel Laurence , Henderson Brian E. , Mohrbacher Ann , Colditz Graham , Chiu Brian-C , Tomasson Michael , Zonder Jeffrey , Orlowski Robert Z. , Lonial Sagar , Cozen Wendy 
Published: May 2015

Abstract
African-American ethnicity, male sex, older age and obesity are accepted risk factors for multiple myeloma (MM). Obesity early in life is a risk factor for many cancers, including MM; most studies have focused on populations of European origin. African-Americans have a higher prevalence of obesity than other populations, and may have a distinct genetic contribution to this condition. We established a multi-center study to investigate possible explanations for the excess risk of MM among African-Americans. The aim of the present case-case analysis was to determine whether body mass index (BMI) was associated with clinical characteristics at presentation in African-American MM patients.
1,065 patients diagnosed with active MM from January 1, 2009 through September 30, 2013 were recruited through nine outpatient centers at academic medical centers and 3 SEER population-based cancer registries. Information on weight and height at 20 years of age and at 5 years prior to diagnosis was obtained from questionnaires. Clinical information collected from the medical records and interviews included age at diagnosis, stage, percent plasmacytosis on bone marrow biopsy,
B2 microglobulin level, immunoglobulin class and presence of lytic bone lesions. Molecular profiling abstracted from pathology reports included chromosomal gain/deletions (1P-, 1Q+, +3, +5, +7, +9, +11, 12P-, Del(13), +15, Del(17P), Del(17P13)), translocations (4;14), (11;14), and (14;16 ). Analysis of Variance (ANOVA) was used to test the null hypothesis that age at diagnosis was similar across BMI categories. A T-test was used to test the null hypothesis that the mean age at diagnosis in underweight/normal patients was not different than that for overweight and obese patients. The Mantel-Haenszel Chi square test for trend was used to test the null hypothesis that the proportion of cytogenetic and molecular abnormalities was similar across BMI categories.
The study population consists of 306 African American male and 396 African American female MM patients. In both, obesity at 20 years of age was associated with younger age at diagnosis, compared to a normal/underweight (p=0.0015). Among males only, obesity at 5 years prior to diagnosis was also associated with younger age at diagnosis (p=0.03). A trend between increasing BMI and molecular characteristics associated with a poor prognosis was suggested.
We observed a strong association between obesity at age 20 and younger age at diagnosis among males and females, and in males only at 5 years prior to diagnosis. Obesity is one of the few known potentially modifiable risk factors for MM. Younger age at diagnosis reflects an earlier accumulation of either or both genetic and environmental risk factors. We also observed a link between obesity at each of the two time points and specific molecular markers of poor prognosis. Additional studies are needed to determine biological significance of the results.
Citation Format: Amie E. Hwang, Sikander Ailwadhi, Carol Ann Huff, Leon Bernal-Mizrachi, Christopher A. Haiman, Edward Peters, Seema Singhal, Karen Pawlish, Cathryn Bock, Todd Zimmerman, David J. Van Den Berg, David V. Conti, Brenda B. Birmann, Jayesh Mehta, John J. Graff, Daniel O. Stram, Niquelle Brown, Yang Yu, Moosa Azadian, Laurence Kolonel, Brian E. Henderson, Ann Mohrbacher, Graham Colditz, Brian-C Chiu, Michael Tomasson, Jeffrey Zonder, Robert Z. Orlowski, Sagar Lonial, Wendy Cozen. Obesity is associated with clinical characteristics in African American multiple myeloma patients. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3852. doi:10.1158/1538-7445.AM2014-3852