ASH 2023: Can You Slow Your Myeloma Progression by Eating a Plant-Based Diet?

Through her extensive (and continuing) research, Dr. Urvi Shah, a multiple myeloma specialist at Memorial Sloan Kettering Cancer Center, is determined to find answers to the often-asked question by patients with precursor myeloma conditions, “What diet is best for me?” 

In Abstract 4771 presented at ASH 2023, Dr. Shah and colleagues detailed results from the first dietary intervention trial conducted in patients with plasma cell disorders. This research was selected as an ASH Scholar Award.  

Past research revealed that overweight patients with monoclonal gammopathy (MGUS) or smoldering myeloma are twice as likely to progress to myeloma. Additionally, research has shown that myeloma patients have imbalanced microbiomes, and it is known that an intervention of whole food plant-based diets can improve modifiable biomarkers.

These factors are the rationale for studying if losing weight with a whole food plant-based diet would reduce progression for participants with MGUS or smoldering myeloma. 

Study Details

The study included 23 patients diagnosed with either MGUS or smoldering myeloma with body mass indexes (BMI) equal/greater than 25. During this pilot trial, patients ate prepared frozen lunch and dinner options they pre-selected which were provided by Plantable for 12 weeks.

Participants were counseled on appropriate breakfast and snack options and had no calorie restrictions. Additionally, they received health coaching for 24 weeks from a Plantable coach as well as a research dietitian. Twenty patients completed the 12-week study, and 16 continued participating in the longer 1-year study.

The primary endpoint of the initial study was feasibility which was determined by two measures at week 12. First, data was analyzed to determine if a whole food plant-based weight loss intervention program helped patients lose weight.

Study Outcomes 

Would participants reduce their body mass indexes (BMIs) by greater than or equal to 5%? Yes!

This was achieved with 8.3% mean and 6.6% median BMI reduction at 12 weeks. For those who continued in the study, an even greater 8.6% median reduction was achieved at 24 weeks. 

The second primary endpoint evaluated participants’ adherence to a whole food plant-based regimen. The endpoint was set at participants eating unprocessed plant food for at least 70% of their calories consumed.

Did they stick to the diet? Again, the answer was yes. The study met this endpoint, with 90% mean and 92% median adherence during 12 weeks, and 77% median for those who continued to 24 weeks. 

Secondary endpoints for this trial included quality of life scores using the standard accepted questionnaire (EORTC QLQ 30) that is traditionally used in cancer clinical trials and by research groups.

Additionally, the study looked at metabolic markers such as plasma insulin, gut microbiome, peripheral blood immune profile, secreted biomarkers, and changes in monoclonal (M)-spike concentrations. 

At the conclusion of the initial 12 weeks, researchers noted improvement in global health status and quality of life with less shortness of breath and decreased fatigue. Additionally, there were improvements in metabolic markers and an increase in the alpha-diversity in the microbiome. While the results at 12 weeks showed measurable change in the immune subsets, further immune and microbiome analysis is desired.

Fourteen patients participated in a voluntary post-intervention survey. All reported an improvement in their dietary habits and that the intervention was easy to follow, with 7 reporting very easy, 7 reporting somewhat easy, and zero reporting difficult.

Additionally, and perhaps most significantly, all patients reported that they would sign up for the intervention again. Beyond improvements in body weight indexes and diabetes and cholesterol-related lab markers, patients reported more self-confidence and more energy among the greatest added benefits of the dietary intervention. 

More Information on Diet-Related Impacts

Another study presented at ASH 2023 (Abstract 3294) provided additional microbiome research and analysis for patients who have progressed to a myeloma diagnosis. Rena Feinman, PhD, from Hackensack Meridian Health and colleagues concluded that “distinct gut microbiota signatures are associated with high risk and standard risk disease.”

They report their “findings provide the rationale for microbiota-centered interventions to improve immune-mediated control of myeloma and overturn resistance to therapy.” 

In the trial at Memorial Sloan Kettering, of the 16 participants who were followed for the longer one-year time frame, two of the individuals with significant body mass index (BMI) reduction also significantly improved their monoclonal (M)-spike trajectories.

Conversely, the two individuals with less than 5% reduction in their BMIs, had rising M-spikes. For the 12 remaining patients, they had a significant median 7.5% BMI reduction, and their M-spikes were stable.

Dr. Shah and colleagues' research was a first-of-its-kind study to determine if whole-food plant-based diets would delay myeloma disease progression and the results were significant enough to warrant larger and more inclusive studies.

Participate in Dr. Shah's Research

The Nutrition Prevention (NUTRIVENTION-3) Study is an ongoing study at Memorial Sloan Kettering, enrolling MGUS and smoldering patients. For more information, go to MSKCC Clinical Trial.

Additionally, the NUTRIVENTION-4 Study will evaluate the change in gut microbiome in myeloma patients on lenalidomide or daratumumab maintenance with and without a whole food plant-based diet intervention. For more information go to: MSKCC Clinical Trial. 

While the data continues to be collected and analyzed, people with precursor myeloma conditions are typically stuck in a stressful “wait and see holding pattern,” with no treatment recommended.

For some, inaction increases stress. The results from this trial suggest that there may be actions patients can take -- losing weight with a whole food plant-based diet may offer real hope of slowing the progression of myeloma. 

For those who want more information, HealthTree University offers a variety of videos to better understand the research surrounding plant-based diets and microbiomes.

We continue to be amazed by Dr. Shah, thank her for her research, and congratulate her on winning the ASH Scholar award for this abstract. 

Resources

Please click on the following links for more information:  

HealthTree University 

What is a Plant-Based Diet? Will It Help Improve My Myeloma?

What is Gut Microbiome?

Studying The Relationship Between Myeloma Progression and Diet

Microbiome 101: Learning about Gut Health for Myeloma Patients and Caregivers

Nutrition and Wellness Webinars 

N+W Webinars

ASH 2023 Resources

Would you like to watch ASH 2023 myeloma research interviews from the investigators themselves? Click "ASH 2023" here: HealthTree University Conference Coverage

To read other ASH 2023 articles, click here: HealthTree 2023 ASH Articles