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Can Certain Medications Raise the Risk for Developing Myeloma?

Posted on March 16, 2022
Medically reviewed by
Todd Gersten, M.D.
Article written by
Maureen McNulty

Multiple myeloma is not a common cancer. People in the United States only have about a 1 in 132 chance of developing this condition at some point over the course of their life. However, certain myeloma risk factors can increase or decrease someone’s chance of being diagnosed with the disease.

So far, researchers have conducted only a few studies to analyze whether medications can increase a person’s chances of developing myeloma. They have found some links between certain drugs and this blood cancer. Some drugs may lead to a higher myeloma risk, while others may lower it.

How Does Multiple Myeloma Develop?

Myeloma develops from a type of white blood cell called the plasma cell. These cells live in the bone marrow, the soft, spongy tissue found inside certain bones. When one plasma cell becomes damaged, it can multiply, forming many copies of itself. These abnormal plasma cells can grow quickly.

When that happens, the dysfunctional plasma cells:

  • Damage bones
  • Cause bone pain
  • Crowd out normal blood cells
  • Make M protein (an abnormal protein made by myeloma cells)

Certain medications may damage plasma cells or cause problems with a person’s immune system, either of which can lead to multiple myeloma.

Medications That May Increase Myeloma Risk

The use of certain medications can make the development of myeloma more likely. These include:

  • Insulin
  • Deltasone (prednisone)
  • Gout medication
  • Erythromycin
  • Phenytoin

Because multiple myeloma is rare to begin with, a person’s risk of having this cancer — even if they use these drugs — remains small. People who need to take these medications to treat other health conditions may want to talk to their doctor about the risks and benefits of the treatments and ask about potential long-term side effects.

Insulin

Insulin is a hormone that is normally made by the body. It helps cells use the sugar that we eat. However, in people with diabetes, their bodies either don’t make enough insulin or their cells can’t use it very well. Those who have been diagnosed with diabetes often need to take laboratory-made insulin as a medication in order to properly metabolize food.

In one study of more than 800 women living in Connecticut, researchers found that those who used insulin were three times more likely to be diagnosed with multiple myeloma. Additionally, other research has shown that people with myeloma who take insulin are more likely to have a poor outcome.

Researchers don’t yet understand the link between insulin and myeloma. They speculate that insulin can activate proteins in myeloma cells that help the cells resist treatments like chemotherapy. It’s also possible that other unknown factors are involved.

People with diabetes who are diagnosed with myeloma may want to have a conversation with their healthcare team about which diabetes treatments may be a good fit. Although taking insulin can lead to a worse myeloma prognosis (outlook) for people with diabetes, using other diabetes treatments such as Fortamet (metformin) may improve outcomes.

Prednisone

Deltasone (prednisone) is a corticosteroid — a medication used to treat medical conditions caused by inflammation or abnormal immune system reactions. These conditions may include arthritis, allergic reactions, asthma, inflammatory bowel disease, and autoimmune diseases like lupus.

In the study of women in Connecticut, researchers concluded that those using prednisone were more than five times as likely to be diagnosed with myeloma, compared to those who didn’t take the drug. The same study noted prednisone may also lead to an increased risk of developing another blood cancer, non-Hodgkin lymphoma.

More research is needed to understand whether prednisone and myeloma are linked, and, if so, how? Additionally, prednisone and other corticosteroids like Decadron (dexamethasone) are usually used to help treat multiple myeloma. These medications can help fight cancer cells, reduce swelling, and decrease chemotherapy side effects.

Gout Medication

Gout is a disease of the joints. It is a type of arthritis in which the joints become painful, red, hot, or swollen. Gout develops when too much uric acid builds up in the body. This causes painful urate crystals to form within the joints.

Treatment for gout can include:

  • Aloprim (allopurinol), Uloric (febuxostat), Probalan (probenecid), or Krystexxa (pegloticase) — To reduce uric acid levels in the body
  • Colcrys (colchicine) — To remove urate crystals and lessens gout pain
  • Non-steroidal anti-inflammatory drugs (NSAIDs) — To reduce pain and swelling during gout attacks
  • Corticosteroids (like prednisone) — To decrease swelling

Older studies have noted a possible link between gout medications like colchicine and blood disorders, including myeloma.

Additionally, the study of Connecticut women found that those using gout treatments (not including NSAIDs or corticosteroids) were 6.7 times more likely to have myeloma. However, these results are based only on the few individuals in the study who were taking gout treatments. More research is needed to know for sure whether gout medication is linked to myeloma risk.

There’s something else to consider: It’s possible that myeloma can lead to gout, rather than the other way around. The beginning stages of multiple myeloma may — rarely — cause increased levels of uric acid in a person’s body. Some people with myeloma may be more likely to be placed on gout medications, which could explain the link between the two.

Erythromycin

Erythromycin is an antibiotic. It can treat certain infections, such as:

  • Pneumonia and other respiratory infections (those caused by bacteria)
  • Pertussis (whooping cough)
  • Ear infections
  • Urinary tract infections
  • Sexually transmitted infections (caused by bacteria)

A few studies have suggested there may be a link between this medication and myeloma. In an older study, researchers looked at pharmacy records from nearly 14,000 people. They found that those using erythromycin were 2.7 times more likely to be diagnosed with myeloma.

In a more recent study, researchers collected data from 278 people with myeloma and 278 people without it. They found that men who used erythromycin were 3.77 times more likely to develop myeloma. However, erythromycin use didn’t affect myeloma risk for women.

It’s not entirely clear how erythromycin may be linked to myeloma. Erythromycin blocks an enzyme called CYP3A4, which breaks down toxins and medications so that they can be removed from the body.

Researchers speculate that if CYP3A4 is blocked, certain substances may build up in the body, which could damage plasma cells and lead to myeloma. However, more research is needed to confirm this idea.

Phenytoin

Dilantin (phenytoin) is an anti-epileptic drug — a medication that helps stop or prevent seizures. Phenytoin helps slow down the abnormal brain signals that occur during seizures.

Some doctors have published reports describing cases in which a person who took phenytoin for a long period of time developed myeloma. However, other studies of people with myeloma have not found that the condition is more likely to occur in people who use this treatment. At the moment, there is not a strong link between phenytoin and multiple myeloma.

Medications That May Decrease Myeloma Risk

On the positive side of things, researchers have also identified certain medications that could lead to a lower risk of being diagnosed with myeloma.

Statins

Statins, including Lipitor (atorvastatin), Crestor (rosuvastatin), and Zocor (simvastatin), are prescribed to treat hypercholesterolemia (high cholesterol levels).

In the study of women in Connection, researchers found that those who took anti-lipid statin therapy were 60 percent less likely to be diagnosed with myeloma. Additionally, people with multiple myeloma who use statins may be more likely to have less severe disease and a better prognosis.

Statin medications have also been found to decrease breast, prostate, lung, and colorectal cancer risk in some studies. However, other studies have not found different cancer rates in people who use these drugs, compared to people who don’t. It’s not yet entirely clear what role statins play in a person’s risk of developing different types of cancer.

Estrogen Replacement Therapy

Estrogen replacement therapy is a form of hormone replacement therapy (HRT), in which hormone treatments are used in order to reduce symptoms of menopause such as hot flashes or vaginal dryness.

Drugs that contain different forms of estrogen include:

  • Pills — Cenestin, Estrace, Premarin
  • Vaginal rings — Estring, Femring
  • Vaginal inserts — Imvexxy, Vagifem
  • Creams — Estrace, Premarin
  • Patches — Alora, Climara, Estraderm, Vivelle

Women who took HRT medications containing estrogen were 40 percent less likely to develop myeloma in the Connecticut study. This may be because estrogen can block an immune system molecule that helps abnormal plasma cells grow.

Talk With Others Who Understand

On MyMyelomaTeam, the social network for people with multiple myeloma and their loved ones, more than 14,000 members come together to ask questions, give advice, and share their stories with others who understand life with myeloma.

Are you worried that you may have a higher risk of multiple myeloma? Share your experience in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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