Modifiable lifestyle risk factors and survival after diagnosis with multiple myeloma

ABSTRACT

Background

While remaining incurable, median overall survival for MM now exceeds 5 years. Yet few studies have investigated how modifiable lifestyle factors influence survival. We investigate whether adiposity, diet, alcohol, or smoking are associated with MM-related fatality.

Research design and methods

We recruited 760 incident cases of MM via cancer registries in two Australian states during 2010–2016. Participants returned questionnaires on health and lifestyle. Follow-up ended in 2020. Flexible parametric survival models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for lifestyle exposures and risk of all-cause and MM-specific fatality.

Results

Higher pre-diagnosis Alternative Healthy Eating Index (AHEI) scores were associated with reduced MM-specific fatality (per 10-unit score, HR = 0.84, 95%CI = 0.70–0.99). Pre-diagnosis alcohol consumption was inversely associated with MM-specific fatality, compared with nondrinkers (0.1–20 g per day, HR = 0.59, 95%CI = 0.39–0.90; >20 g per day, HR = 0.67, 95%CI = 0.40–1.13). Tobacco smoking was associated with increased all-cause fatality compared with never smoking (former smokers: HR = 1.44, 95%CI = 1.10–1.88; current smokers: HR = 1.30, 95%CI = 0.80–2.10). There was no association between pre-enrollment body mass index (BMI) and MM-specific or all-cause fatality.

Conclusions

Our findings support established recommendations for healthy diets and against smoking. Higher quality diet, as measured by the AHEI, may improve survival post diagnosis with MM.

KEYWORDS:

• Multiple myeloma
• survival
• diet
• alcohol
• tobacco
• adiposity
• fatality

Declaration of Interests

SJ Harrison declares consultancy and advisory board membership for AbbVie; consultancy and advisory board membership for and honoraria from Amgen; consultancy, honoraria, and advisory board membership for and research funding from Bristol Myers Squibb/Celgene, Janssen-Cilag, Novartis; consultancy for and research funding and honoraria from GSK; consultancy, advisory board membership, and is an investigator on studies for and honoraria from Roche/Genetec; consultancy and advisory board membership for and honoraria from Takeda; scientific advisory board membership for and research funding from Haemalogix; and consultancy and an advisory role for Sanofi.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

A reviewer on this manuscript has received grants from the NIH/NCI Cancer Center Support (Grant P30CA008748), MSK Paul Calabresi Career Development Award for Clinical Oncology (K12CA184746), the Paula and Rodger Riney Foundation, the Allen Foundation Inc, the Parker Institute for Cancer Immunotherapy at MSK, the HealthTree Foundation, and the International Myeloma Society as well as non-financial support from the American Society of Hematology Clinical Research Training Institute, TREC Training Workshop R25CA203650. They have also received research funding support from Celgene/BMS, Janssen, Plantable, Sabinsa pharmaceuticals, VeggieDoctor and M and M labs to their institution, as well as personal fees from ACCC, MashUp MD, Janssen Biotech, Sanofi, BMS, MJH LifeSciences, Intellisphere, Phillips Gilmore Oncology Communications, and RedMedEd.

Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Author contributions

GG Giles, SJ Harrison, CM Vajdic, D Joshua, H Prince, N Wong Doo, J Hopper, MT van Leeuwen, and MC Southey contributed to the design and concept of the study; F Bruinsma and GG Giles contributed to the data acquisition; JK Bassett contributed to the statistical analysis; S Cheah performed the statistical analysis; S Cheah, GG Giles, RL Milne, DR English, SJ Harrison, RJ Milne and H Jayasekara interpreted data; S.C. drafted the manuscript with RL Milne, DR English, SJ Harrison and GG Giles. All authors contributed to critical review of the manuscript, approved the final version, and agree to be accountable for all aspects of the work.

Acknowledgments

The authors thank all patients and their family members who participated in this study. We also wish to thank Wendy Cozen and Gianluca Severi for their contributions to the study design and execution.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17474086.2023.2255747

Additional information

Funding

This study was supported by funding from a research grant from the National Health and Medical Research Council [NHMRC: 1029885], an NHMRC Postdoctoral Fellowship [1012141] awarded to MT van Leeuwen, and an Australian Government Research Training Program Scholarship (S Cheah), and a Cancer Council Victoria Studentship (S Cheah).The funders had no role in the study design; in the collection, analysis, and interpretation of the data; in the writing of the report, or the decision to submit the paper for publication.