Multiple myeloma (MM) is a cancer originating in plasma cells, a type of white blood cell located primarily in the bone marrow. Normally, these cells produce antibodies to fight infection. In MM, malignant plasma cells multiply uncontrollably, crowding out healthy blood cells and producing non-functional antibodies. This can lead to bone damage, kidney problems, and anemia. While the precise cause of MM remains unknown, researchers have identified risk factors and precursor conditions, leading to strategies focused on reducing overall risk and preventing progression.
The Current Understanding of Primary Prevention
The concept of primary prevention—stopping the disease from ever starting—is challenging for multiple myeloma because the initial cellular changes are not fully understood. Unlike cancers with a single, clear cause, MM often arises from a complex interplay of genetic and environmental factors. There is currently no single, guaranteed method of prevention, and the disease’s etiology remains elusive.
Current research focuses on identifying the earliest molecular events that trigger malignant transformation in plasma cells. Scientists are studying large groups of individuals to better understand the role of genetics and early exposures in disease development. This work aims to lead to concrete public health recommendations. Until then, prevention efforts center on mitigating known risk factors and closely managing precursor conditions.
Mitigating Specific Environmental and Occupational Exposures
Individuals can take proactive steps by minimizing contact with specific environmental and occupational hazards associated with an elevated risk of multiple myeloma. Specific chemical exposures, including pesticides and herbicides, have shown a consistent link across numerous studies. For example, agricultural workers who use certain pesticides like phenoxyacetic acids have shown an increased risk.
Occupational exposure to organic solvents, such as benzene and methyl chloride, or heavy metals has also been implicated in MM risk. Certain professions, including farming, hairdressing, and firefighting, have a potentially higher incidence due to exposure to these chemicals or engine exhaust. Individuals working in these environments should adhere to safety protocols, use appropriate personal protective equipment, and seek regular health monitoring. Avoiding unnecessary exposure to ionizing radiation is also a prudent step for overall cancer risk reduction.
Managing Precursor Conditions for Secondary Prevention
The most actionable strategy for preventing the progression of multiple myeloma is the management of its precursor conditions, known as secondary prevention.
The earliest stage is Monoclonal Gammopathy of Undetermined Significance (MGUS). This is an asymptomatic condition where abnormal plasma cells are present, affecting over three percent of the population over age 50. MGUS progresses to active multiple myeloma at a rate of approximately one percent per year.
A more advanced precursor is Smoldering Multiple Myeloma (SMM). SMM is also asymptomatic but carries a much higher risk of progression, estimated at about ten percent per year during the first five years following diagnosis. Both MGUS and SMM are defined by the absence of “CRAB” criteria—specific signs of end-organ damage like kidney failure or bone lesions—which characterize active MM. Regular blood tests, including serum protein electrophoresis and free light chain analysis, are necessary for monitoring protein levels and risk stratification in these patients.
For those diagnosed with high-risk SMM, active intervention is now being employed in clinical trials to delay or prevent progression to symptomatic disease. This approach targets the abnormal cells before they cause harm. Some trials utilize standard MM treatments, such as combinations involving lenalidomide and dexamethasone, while others are investigating newer immunotherapies. Individuals with a family history of MM or other plasma cell disorders may consider screening, as they have a two- to four-fold increased risk of developing MGUS or SMM.
General Health Habits for Overall Risk Reduction
General lifestyle choices are not a direct preventative measure for multiple myeloma, but they contribute significantly to overall health and cancer risk reduction. Maintaining a healthy weight is important, as obesity has been identified as a risk factor for developing MGUS, the earliest precursor state of MM. A high body mass index can also worsen the prognosis and treatment outcomes for those who develop the disease.
Adopting a balanced, nutrient-rich diet can support risk reduction. Studies suggest that a diet high in plant-based foods, including fruits, vegetables, and whole grains, is associated with a lower incidence of MM. This eating pattern, often resembling the Mediterranean diet, helps manage inflammation and promotes a healthy metabolic profile. Avoiding tobacco use is a broad cancer prevention measure, as heavy smoking is linked to an increased risk of MGUS.