Correlation of Agent Orange exposure, cytogenetics, and clinical outcomes in multiple myeloma and MGUS.

Authors

null

Pruthali Kulkarni

Baylor Scott & White Health, Temple, TX

Pruthali Kulkarni , Laurel Copeland , James Andy Hall , Jyothi Dodlapati

Organizations

Baylor Scott & White Health, Temple, TX, Veterans Affairs, Temple, TX, Central Texas Veteran Affairs Hosp, Georgetown, TX

Research Funding

No funding received
None

Background: Multiple myeloma (MM) accounts for 1-2% of cancers worldwide. MM and monoclonal gammopathy of unknown significance (MGUS) are associated with Agent Orange exposure (AO) in Vietnam war veterans. Studies show poor outcomes in AO-exposed patients developing MM. No study has evaluated AO exposure and adverse cytogenetics in patients with MM. Methods: We reviewed patients with MGUS and/or MM in the Central Texas Veterans Health Administration system in 2010-2015 to evaluate AO exposure, adverse cytogenetics, transformation from MM to MGUS, and overall survival (OS). Inclusion criteria were active-duty military when AO was used (1961-1971). Presence of 17p13, t(4;14), t(14;16), t(14;20), or Gain 1q by FISH defined high-risk cytogenetics. Poor prognosis per serum free kappa/lambda ratio was defined as < .03 or > 32 K/L (high-risk). Regulatory review approval was obtained. Cox survival models generated hazard rate ratios and their 95% confidence intervals (HR) for AO status (AO, non-AO, undetermined), age, race/ethnicity, transformation, and FISH data. Results: Among 129 veterans, 30% were Black and 12% Hispanic (mean age 74.0 years, SD 6.9, range 59-97). MGUS was diagnosed in 44%, MM 74%, and transformation 19%. FISH abnormalities were rare thus AO association cannot be definitively stated; see table. A subsample with known AO and K/L (n = 81) showed no association: 69% high-risk had AO vs 76% moderate-risk; chi2 = 0.54; p = .46. In the adjusted model, Hispanic patients (HR = 3.3; 1.2-9.1) and those with high-risk cytogenetics (HR = 6.0; 1.1-34.1) had higher mortality; AO was unrelated. Conclusions: Although preliminary analyses find no associations of AO and transformation with OS, ethnicity and FISH abnormality associations are intriguing. Chart review is 50% complete. The paucity of cytogenetics data begs further examination, and continued study is merited to fully recognize what predisposes MM development following AO exposure.

Vietnam Veterans
AO-exposed (n = 72)
Non-AO (n = 22)
Undetermined AO (n = 33)
Hispanic
11 (16%)
0 (0%)
4 (13%)
MGUS
22 (31%)
8 (36%)
3 (9%)
MM
36 (50%)
8 (36%)
27 (82%)
MGUS+MM
14 (19%)
6 (27%)
3 (9%)
High-risk cytogenetics
3 (4%)
1 (5%)
2 (6%)
High-risk K/L ratio
20 (28%)
9 (41%)
7 (21%)

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Hematologic Malignancies—Plasma Cell Dyscrasia

Track

Hematologic Malignancies

Sub Track

Multiple Myeloma

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr e20008)

DOI

10.1200/JCO.2021.39.15_suppl.e20008

Abstract #

e20008

Abstract Disclosures