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Guiding Dietary Choices During Multiple Myeloma Treatment With Richa Parikh, MD

In this interview from the 2023 American Society of Hematology Annual Meeting, Richa Parikh, MD, a third-year Hematology/Oncology Fellow at Karmanos Cancer Institute, discusses her team's study investigating the role of diet in multiple myeloma and how its findings can be used to help guide dietary decisions for patients.  

Oncology Data Advisor: Welcome to Oncology Data Advisor. Today, we're here live at the ASH Annual Meeting, and I'm joined by Dr. Richa Parikh. Thanks so much for coming on the show today.

Richa Parikh, MD: Thank you for giving me the opportunity to talk about our study assessing the role of diet in multiple myeloma patients.

Oncology Data Advisor: Of course. To start off, would you like to introduce yourself and share what you do?

Dr. Parikh: Yes, I'm Richa Parikh. I'm one of the third-year Hematology/Oncology Fellows at Karmanos Cancer Institute in Detroit, Michigan. I have been collaborating with Dr. Urvi Shah at Memorial Sloan Kettering (MSK) and her fantastic team. We have a study that is almost about to be published. We just submitted the revised manuscript and had some interesting findings that I would like to share today.

Oncology Data Advisor: Awesome, I'm really eager to learn about this study. Would you like to start off by telling us a little bit about the basis for it and why you decided to investigate this?

Dr. Parikh: Sure. We all know that multiple myeloma incidence is rising globally, so focused efforts to modify the risk factors or intercept the incidence of myeloma are really important. Obesity, diet, and other metabolic risk factors are very important in that way, as they can be modified. In doing so, the risk for myeloma could be modulated.

Then the other interesting factor is that Dr. Shah's team recently conducted a study wherein they sent a survey to about 421 patients with plasma cell disorders and found that 82% of the patients had a diet-related question after their diagnosis with their oncologist. About 57% of them reported that their questions were not adequately addressed by their oncologist. Then amongst the ones that actually did receive dietary guidance from their oncologist, 94% attempted to follow it. This tells us that there is a keen interest among patients to find an answer as to how their diet or dietary habits could be related to multiple myeloma risk and how it could be modulated to improve outcomes.

Oncology Data Advisor: Great. How did you go about conducting your study?

Dr. Parikh: We conducted this study in a cohort, which is called the National Institutes of Health–American Association of Retired People (NIH-AARP) Diet Health Study Cohort. Back in 1995 and 1996, the principal investigators of this study cohort sent out a food frequency questionnaire to about 3.5 million participants in AARP, and they received about half a million completely filled-out food frequency questionnaires. That formed the basis of this diet and health study cohort.

We looked at four dietary indices, which were the Healthy Eating Index (HDI) 2015, the Healthy Diet Score (HDS), the Alternate Mediterranean Diet (AMD), and then the Healthful Plant-Based Dietary Index (HPDI) in this particular cohort and how they were associated with the risk of multiple myeloma. Based on consumption of individual dietary components, we calculated these four dietary indices and grouped them into quartiles, with the highest quartile reflecting the highest consumption of these individual dietary components. We then evaluated the association with multiple myeloma risk.

On multivariate analysis, we found that there was a statistically significant reduction in multiple myeloma risk with the HPDI, the Healthful Plant-Based Dietary Index, which confirms the findings from other studies that plant-based diets are protective for myeloma risk. The basis for this is that plant-based diets contain a lot of fiber and phytochemicals which help to reduce BMI, reduce inflammation, reduce insulin, reduce insulin-like growth factor (IGF) levels, and improve the quality of the stool microbiome. These are all the various mechanisms by which we think it modulates the overall risk for multiple myeloma.

Oncology Data Advisor: That's very exciting. It's so interesting to hear about how diet affects multiple myeloma risk.

Dr. Parikh: Yes, and we are hoping that our findings can help oncologists guide their patients in making appropriate dietary choices to influence their myeloma risk.

Oncology Data Advisor: Absolutely. Do you have any next steps planned for this study or other research in this area?

Dr. Parikh: You should look out for Dr. Shah's poster that's going to be presented at ASH. These are results from a pilot intervention study that she led with her team. The findings show that a plant-based diet is feasible, and it did lead to improvement in outcomes in patients with precursor plasma cell disorder states. So, make sure to follow her abstract results this evening at ASH and look out for our manuscript from this study.

Oncology Data Advisor: I'm looking forward to reading it when it's published. Anything else you'd like to mention about your research?

Dr. Parikh: I would just like to thank Dr. Shah and her fantastic team—Francesca Castro, who's my co-first author, then Andriy Derkach who is a Biostatistician at MSK, and all the rest of our authors. And thank you, Oncology Data Advisor, for giving me an opportunity to speak about our research study today.

Oncology Data Advisor: Absolutely, thanks so much for stopping by. It's wonderful to hear about your work.

About Dr. Parikh

Richa Parikh, MD, is a third-year Hematology/Oncology Fellow at Karmanos Cancer Institute and Detroit Medical Center. Her clinical and research interests focus on plasma cell dyscrasias and how dietary factors can impact patients' risk and outcomes.

For More Information

Castro F, Parikh R, Eustagiuo, JC, et al (2023). Pre-diagnosis dietary patterns and risk of multiple myeloma in the NIH-AARP Diet and Health Study. Leukemia. [Epub ahead of print] DOI:10.1038/s41375-023-02132-3

Shah UA, Parikh R, Castro F, et al (2023). Dietary and microbiome evidence in multiple myeloma and other plasma cell disorders. Leukemia, 37(5): 964–980. DOI:10.1038/s41375-023-01874-4

Shah UA, Castro F, Derkach A, et al (2023). A whole foods plant-based weight loss intervention improves quality of life, metabolic, microbiome and immune profile in MGUS/SMM as well as progression trajectory in a subset – the NUTRIVENTION trial. Presented at: 2023 American Society of Hematology Annual Meeting. Abstract 4771. Available at: https://ash.confex.com/ash/2023/webprogram/Paper182878.html

Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor. 


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