Agent Orange and Multiple Myeloma

What is multiple myeloma?

Multiple myeloma is a form of cancer in specific bone marrow cells called the plasma cell. This form of cancer is characterized by plasma cell tumors in bones in various parts of the body.

Why are Vietnam veterans concerned about multiple myeloma? Does Agent Orange cause it?

Some Vietnam veterans have been diagnosed with multiple myeloma and others have expressed concern about developing this cancer. Some research has suggested that multiple myeloma may be associated with exposure to herbicides, but there is no conclusive scientific evidence that Agent Orange or other herbicides cause this condition.

What did the National Academy of Sciences (NAS) conclude about multiple myeloma in its 1993 report, entitled Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam?

The NAS reviewers found "limited/suggestive evidence" of an association between herbicide exposure and the subsequent development of multiple myeloma.

What was VA's reaction to this NAS finding?

VA found the evidence concerning multiple myeloma convincing. Most of the studies reviewed by the NAS showed an increased risk of this cancer, although in most cases it was not a statistically significant increase. Multiple myeloma is closely related biologically to B-cell non-Hodgkin's lymphoma; consequently, the epidemiological evidence concerning non-Hodgkin's lymphoma gives added weight to the association between herbicide exposure and multiple myeloma.

Based on this clinical consideration and the weight of the epidemiological evidence, VA’s Secretary Brown concluded that there is a positive association between herbicide exposure and multiple myeloma that manifests itself to a degree of ten percent at any time after exposure.

In February 1994, the proposed rule regarding multiple myeloma was published for public comment in the Federal Register. (See 59 Fed. Reg. 5161, February 3, 1994). The final rule was published in the Federal Register in June 1994. (See 59 Fed. Reg. 29723, June 9, 1994).

What did Public Law 103-446 do for Vietnam veterans with multiple myeloma?

Section 505, Public Law 103-446, the Veterans’ Benefits Improvements Act of 1994, enacted November 2, 1994, codified (established in law) presumptions of service connection for certain diseases -- including multiple myeloma manifested to a degree of disability of 10 percent or more -- associated with exposure to certain herbicide agents.

What did the NAS conclude about multiple myeloma in subsequent updates?

New data analyzed for the 1996 update did not change the NAS view that there is a “limited/suggestive association between exposure to herbicides and multiple myeloma.”

The 1998 report included the following statements:

New studies of Vietnam veterans reported lower than expected MM (multiple myeloma) mortality.

The committee has determined that the evidence for this association is limited/suggestive, because individuals in the existing studies (mostly farmers) have, by nature of their occupation, probably been exposed to a range of potentially carcinogenic agents other than herbicides and TCDD.

The new data available on MM do not change the committee’s earlier view that there is a limited/suggestive association between exposure to herbicides and multiple myeloma.

The 2000 update included the following statement:

There is limited/suggestive evidence of an association between exposure to herbicides and multiple myeloma. The evidence regarding association is drawn from earlier occupational and other studies in which subjects were exposed to a variety of herbicides and herbicide components.

The 2002 update concluded there is limited or suggestive evidence of an association between exposure to herbicides and multiple myeloma. The evidence is drawn from similar research to that mentioned above.

Where can a veteran get additional information on this subject?

Information on multiple myeloma and related matters can be obtained at VA medical center libraries, from the Environmental Health Clinician at every VA medical center, or from the Environmental Agents Service (131), Department of Veterans Affairs, 810 Vermont Avenue, N.W., Washington, DC 20420.

Where can a veteran obtain additional information regarding Agent Orange- related issues?

The following Agent Orange Brief fact sheets (including the one you are reading) are available on the World Wide Web at www.va.gov/AgentOrange: A1.Agent Orange - General Information; A2.Agent Orange Class Action Lawsuit; B1.Agent Orange Registry Program; B2.Agent Orange – Health Care Eligibility; B3.Agent Orange and VA Disability Compensation; B4.VA Information Resources on Agent Orange and Related Matters; C1.Agent Orange – The Problem Encountered in Research; C2.Agent Orange and Vietnam Related Research – VA Projects; C3.Agent Orange and Vietnam Related Research – Non-VA Projects; D1.Agent Orange and Birth Defects; D2.Agent Orange and Chloracne; D3.Agent Orange and Non-Hodgkin’s Lymphoma; D4.Agent Orange and Soft Tissue Sarcomas; D5.Agent Orange and Peripheral Neuropathy; D6.Agent Orange and Hodgkin’s Disease; D7.Agent Orange and Porphyria Cutanea Tarda; D8.Agent Orange and Multiple Myeloma; D9.Agent Orange and Respiratory Cancers; D10.Agent Orange and Prostate Cancer; D11.Agent Orange and Spina Bifida; D12.Agent Orange and Diabetes; and D13.Agent Orange and Chronic Lymphocytic Leukemia. Hard copies can be obtained from local VA medical centers or from the VA Central Office at the Environmental Agents Service (131) Department of Veterans Affairs, 810 Vermont Avenue, N.W., Washington, DC 20420.

At the same Web site you will find copies of past and current issues of the “Agent Orange Review” newsletter and other items of interest.

This fact sheet was updated in late October 2003 and does not include any subsequent developments.