# Addressing racial disparities in monoclonal gammopathy of undetermined significance and progression to multiple myeloma from a prevention perspective

> **NIH NIH R01** · WASHINGTON UNIVERSITY · 2020 · $360,281

## Abstract

PROJECT SUMMARY/ABSTRACT
Multiple myeloma (MM) is a lethal neoplasm and a common hematologic malignancy. MM is uniformly
preceded by monoclonal gammopathy of undetermined significance (MGUS). Unlike MM, patients with MGUS
are asymptomatic. The current management for MGUS is watchful waiting for disease progression. A marked
racial disparity in this disease area is long-established with a 2 to 3-fold increased risk in African Americans
(AAs) compared to Caucasians. Moreover, obesity is a risk factor for MM independent of race. Obesity is
prevalent in U.S. adults, and particularly more prevalent among AAs than Caucasians. As a result, without any
intervention, racial disparities in this disease will continue to worsen. Metformin, a widely-used, safe, well-
tolerated, and inexpensive medication, induces weight loss and has been found to be more effective in
glycemic control in AAs compared to Caucasians. It has also been used in prospective trials for non-diabetes
indications and solid tumor malignancies. We therefore hypothesize that metformin use in MGUS patients will
prevent MM and reduce MM disparities. This project plans to focus on the precursor condition of MM – MGUS.
The findings from the proposed project will inform biological mechanism studies and MGUS/MM prevention
trials. The long-term goal is to identify intervention strategies to prevent the progression of MGUS to MM,
reduce the overall burden of MM, and reduce MM disparities. We plan to identify whether high body mass
index (BMI) and/or significant change in BMI over the life course are risk factors for MGUS by race (Aim 1),
utilizing linked databases with nearly lifelong follow-up of BMI and other health measures ,as well as utilizing
artificial intelligence, i.e., machine learning approaches, to perform big data analyses. We will then assess
racial differences in the M-protein trajectory after MGUS diagnosis in metformin versus non-metformin users in
a subgroup of MGUS patients diagnosed with diabetes mellitus (Aim 2.1) and the association of metformin use
with the progression of MGUS to MM (Aim 2.2). Last, we will assess racial differences in the M-protein
trajectory in the subgroup of MGUS patients without diabetes mellitus (Aim 3). This project is significant in its
capability to 1) identify perhaps the only modifiable risk factor (high BMI) to inform interventions to prevent MM;
2) identify a dynamic marker for disease progression by race (M-protein concentration), where these
biomarkers can be a surrogate for MM diagnosis in future prevention trials; and 3) reduce MM health
disparities by a) identifying race-specific biomarkers for MGUS and MGUS progression, available through
clinical encounters (as opposed to expensive genetic testing); and b) exploring metformin use as a
chemopreventive measure. It is innovative in its 1) focus on MM prevention rather than treatment and 2)
utilization of artificial intelligence to analyze big data. Successful completion of this study will pro...

## Key facts

- **NIH application ID:** 10055834
- **Project number:** 1R01CA253475-01
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** Su-Hsin Chang
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $360,281
- **Award type:** 1
- **Project period:** 2020-09-25 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10055834

## Citation

> US National Institutes of Health, RePORTER application 10055834, Addressing racial disparities in monoclonal gammopathy of undetermined significance and progression to multiple myeloma from a prevention perspective (1R01CA253475-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10055834. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*