Multiple Myeloma in World Trade Center Responders: A Case Series

Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine (Impact Factor: 1.63). 08/2009; 51(8):896-902. DOI: 10.1097/JOM.0b013e3181ad49c8
Source: PubMed


We report on cases of multiple myeloma (MM) observed in World Trade Center (WTC) responders registered in the WTC Medical Program.
Possible cases of MM diagnosed between September 11, 2001, and September 10, 2007, in responders were confirmed if they met the World Health Organization and Mayo Clinic diagnostic criteria.
Among 28,252 responders of known sex and age, eight cases of MM were observed (6.8 expected). Four of these cases were observed in responders younger than 45 years at the time of diagnosis (1.2 expected). A slight deficit of MM cases was observed in responders older than 45 years (4 observed, 5.6 expected).
In this case series, we observe an unusual number of MM cases in WTC responders under 45 years. This finding underscores the importance of maintaining surveillance for cancer and other emerging diseases in this highly exposed population.

Download full-text


Available from: Benjamin Luft
  • Source
    • "Of our 18 unmatched cases, 7 were prostate cancers and 6 were hematological malignancies. Moline et al. (2009) reviewed all cases of multiple myeloma diagnosed between September 11 th 2001 and September 10 th , 2007 among responders enrolled in the WTCHP that were confirmed by medical record review, irrespective of whether they were reported to state cancer registries, and identified eight cases of among 28,252 responders. The authors noted that the incidence of this cancer (N=4) was greater than expected (1.0 as determined by SEER rates) in responders under the age of 45. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: World Trade Center rescue and recovery workers were exposed to a complex mix of pollutants and carcinogens. The purpose of this investigation was to evaluate cancer incidence in responders during the first seven years after September 11, 2001. Methods: Cancers among 20,984 consented participants in the WTC Health Program were identified through linkage to state tumor registries in New York, New Jersey, Connecticut, and Pennsylvania. Standardized incidence ratios (SIRs) were calculated to compare cancers diagnosed in responders to predicted numbers for the general population. Multivariate regression models were used to estimate associations with degree of exposure. Results: A total of 575 cancers were diagnosed in 552 individuals. Increases over registry-based expectations were noted for all cancer sites combined (SIR 1.15; 95% CI: 1.06, 1.25), thyroid cancer (SIR 2.39; 95% CI: 1.70, 3.27), prostate cancer (SIR 1.21; 95% CI: 1.01, 1.44), combined hematopoietic and lymphoid cancers (SIR 1.36; 95% CI: 1.07, 1.71) and soft tissue cancers (SIR 2.26; 95% CI: 1.13, 4.05). When restricted to 302 cancers diagnosed six or more months after enrollment, the SIR for all cancers decreased to 1.06 (95% CI: 0.94, 1.18), but thyroid and prostate cancer diagnoses remained greater than expected. All cancers combined were increased in very highly exposed responders and among those exposed to significant amounts of dust compared with responders who reported lower levels of exposure. Conclusion: Estimates should be interpreted with caution given the short follow-up and long latency period for most cancers, the intensive medical surveillance of this cohort, and the small numbers of cancers at specific sites. However, our findings highlight the need for continued follow up and surveillance of WTC responders.
    Full-text · Article · Apr 2013 · Environmental Health Perspectives
  • Source
    • "There is no systemic or comprehensive roster of all responders similar to the existing records of responders from the New York City uniformed services, such as the Fire Department of New York (FDNY) or New York Police Department, which frequently include their previous health condition . Estimates of the number of responders given by different sources range from 50,000 to 90,000 in total; we believe that the total, including FDNY workers, is likely to have been between 60,000 and 70,000 (Moline et al. 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: After the collapse of the World Trade Center (WTC) on 11 September 2001, a dense cloud of dust containing high levels of airborne pollutants covered Manhattan and parts of Brooklyn, New York. Between 60,000 and 70,000 responders were exposed. Many reported adverse health effects. In this report we describe clinical, pathologic, and mineralogic findings in seven previously healthy responders who were exposed to WTC dust on either 11 September or 12 September 2001, who developed severe respiratory impairment or unexplained radiologic findings and underwent video-assisted thoracoscopic surgical lung biopsy procedures at Mount Sinai Medical Center. WTC dust samples were also examined. We found that three of the seven responders had severe or moderate restrictive disease clinically. Histopathology showed interstitial lung disease consistent with small airways disease, bronchiolocentric parenchymal disease, and nonnecrotizing granulomatous condition. Tissue mineralogic analyses showed variable amounts of sheets of aluminum and magnesium silicates, chrysotile asbestos, calcium phosphate, and calcium sulfate. Small shards of glass containing mostly silica and magnesium were also found. Carbon nanotubes (CNT) of various sizes and lengths were noted. CNT were also identified in four of seven WTC dust samples. These findings confirm the previously reported association between WTC dust exposure and bronchiolar and interstitial lung disease. Long-term monitoring of responders will be needed to elucidate the full extent of this problem. The finding of CNT in both WTC dust and lung tissues is unexpected and requires further study.
    Full-text · Article · Apr 2010 · Environmental Health Perspectives

  • No preview · Article · Dec 2009 · Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine
Show more