Epidemiology and Features of Multiple Myeloma in a Cohort of 110 Patients from a Central Area of Israel.

In the last few years there has been a world wide increase in the incidence of multiple myeloma (MM). Epidemiologic studies have suggested that certain occupational and chemical exposures are likely to increase the risk for MM.

We performed a retrospective clinical and epidemiological study of MM on 110 cases diagnosed during 2000–2005 in our area, which is a rural and agricultural zone of approximately 400000 people. The incidence of MM in our population was 5.5 new cases /100000 people / year. 43% were females (n= 48) and 57 % males (n = 63). 22% of the patients were younger than 60. 58 patients were of European descent (52%), the vast majority of them from the former USSR (including people from near-Chernobyl); 40 from Asia (36%) and 16 patients (14%) from Africa. We separated the population into three categories: non exposed (physician, teacher, housekeeper, secretary, shop assistant, employee, scientific), suspected (painting, cleaning, microbiology, engineer, aviation, building-worker), and exposed: (petroleum, agriculture, plastic manufacture, textile, ammoniac, asphalt, Chernobyl). 65 % did not have any evidence of toxic exposure, in 23% we could document a significant exposure and in 12% there was a possible such exposure. 57% of the patients were in ISS stage I (b2m< 3.5 and albumin > 3.5), 33%- ISS stage II (b2m < 3.5 and albumin< 3.5) and 10% -ISS stage III (b2m > 3.5). Only 13% displayed lytic lesions at the time of survey. Fifty five patients requiring treatment received conventional therapy including APSCT and thalidomide for residual disease. In a cohort of 10 patients thal/dex was given as second line after achievement of a plateau with MP. This oral treatment allows a convenient ambulatory management and does not hamper stem cell harvesting made several months after discontinuation of MP. New clinical trials allowed us to include six patients for treatment with bortezomib.

In conclusion: the high incidence of MM in our area is in accordance with the world wide trend, possibly with a relationship with occupational and environmental risk factors. The heterogeneity of the population of Israel including arabs and new immigrants as well as additional data from others centers of Israel will help us to create a larger data base and to gain a better knowledge of MM in Israel.