Tuesday, August 18, 2009

Precancers 3: All Myeloma Preceded by MGUS

Precancers are the lesions from which cancers develop. Precancers can be easily treated, and when we eliminate precancers, we eliminate the cancers that would have developed from the precancers. This is the message in Precancer: The Beginning and the End of Cancer.

One of the most important questions in precancer research is whether all cancers arise from precancers, or whether some cancers can arise ab initio (from the beginning) as fully malignant clones, without first passing through a precancer phase.

There are many different types of cancer, and most cancers of humans have a putative precancer precursor. Multiple myeloma, and its precursor, MGUS (monoclonal gammopathy of undetermined significance) are discussed in some detail in my recently published book, Precancer: The Beginning and the End of Cancer. Briefly, multiple myeloma is a cancer of plasma cells. Plasma cells are the specialized blood cells that produce gamma globulin antobody molecules. Cancerous plasma cells produce a monoclonal spike of gamma globulins that can be detected by looking at samples of blood. MGUS, the precursor of multiple myeloma, produces a similar monoclonal spike in gamma globulins, but it is not associated with clinically detectable masses of cancer cells.

In a recent paper by Langren et al, the authors answered a simple, fundamental question in tumor biology: Are all cases of myeloma preceded by MGUS?

The paper was published in the journal Blood.

Landgren O, Kyle RA, Pfeiffer RM, et al. Monoclonal gammopathy of undetermined significance (MGUS) consistently precedes multiple myeloma: a prospective study. Blood 113:5412-5417, 2009.

The paper is available as an open access document at:


The authors used data and serum samples from enrollees in the large PLCO (prostate lung colon and ovary) trial currently underway through the National Cancer Institute. They looked specifically at enrollees in the trial who developed multiple myeloma during the trial. All enrollees in the PLCO trial have blood drawn during the multi-year trial. When they looked at prior blood samples for newly diagnosed cases of multiple myeloma, they found MGUS in every instance. Therefore, at least for the 71 examined cases in their study, MGUS always preceded the myeloma.

It is extremely important to have studies (such as this study for multiple myeloma) that indicate that precancer is an obligatory step in carcinogenesis. If only a portion of cancers developed from precancers, we would never be able to eradicate all cancers [by treating their precancers]. On the other hand, if every case of cancer is preceded by a precancer, then we can be certain that if we successfully treat all of the precancers, then no cancers will follow.

-© 2009 Jules J. Berman

tags: precancers, precancer, pre-cancerous condition, precancerous condition, preneoplastic lesions, preneoplasia, ien, intra-epithelial neoplasia, intraepithelial neoplasia, intra-epithelial neoplasm, intraepithelial neoplasm, in situ carcinoma, carcinoma in situ, cis, dcis, din, pin, panin, cin, dysplasia, adenoma, preneoplastic, pre-cancer, pre-cancerous, precancerous, rare disease, orphan disease, orphan drugs, complex disease, disease genetics, genetics of disease, common disease, pathology of disease
In June, 2014, my book, entitled Rare Diseases and Orphan Drugs: Keys to Understanding and Treating the Common Diseases was published by Elsevier. The book builds the argument that our best chance of curing the common diseases will come from studying and curing the rare diseases.

I urge you to read more about my book. There's a generous preview of the book at the Google Books site.