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Abstract
Genome-wide association studies (GWAS) have transformed our understanding of susceptibility to multiple myeloma (MM), but much of the heritability remains unexplained. We report a new GWAS, a meta-analysis with previous GWAS and a replication series, totalling 9974 MM cases and 247,556 controls of European ancestry. Collectively, these data provide evidence for six new MM risk loci, bringing the total number to 23. Integration of information from gene expression, epigenetic profiling and in situ Hi-C data for the 23 risk loci implicate disruption of developmental transcriptional regulators as a basis of MM susceptibility, compatible with altered B-cell differentiation as a key mechanism. Dysregulation of autophagy/apoptosis and cell cycle signalling feature as recurrently perturbed pathways. Our findings provide further insight into the biological basis of MM.
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1 Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
2 German Cancer Research Center, Heidelberg, Germany; Center for Primary Health Care Research, Lund University, Malmo, Sweden
3 Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, Lund University, Lund, Sweden
4 Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
5 Division of Molecular Pathology, The Institute of Cancer Research, London, UK
6 Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
7 deCODE Genetics, Reykjavik, Iceland
8 German Cancer Research Center, Heidelberg, Germany
9 deCODE Genetics, Reykjavik, Iceland; School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
10 Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
11 German Cancer Research Center, Heidelberg, Germany; National Centre of Tumor Diseases, Heidelberg, Germany
12 University Clinic of Würzburg, Würzburg, Germany
13 Clinical Trials Research Unit, University of Leeds, Leeds, UK
14 Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
15 Institute of Human Genetics, University of Bonn, Bonn, Germany; Division of Medical Genetics, Department of Biomedicine, University of Basel, Basel, Switzerland
16 Royal Victoria Infirmary, Newcastle upon Tyne, UK
17 Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
18 Department of Hematology, Landspitali, National University Hospital of Iceland, Reykjavik, Iceland
19 Section of Hematology, Sahlgrenska University Hospital, Gothenburg, Sweden
20 Center for Hematology and Regenerative Medicine, Stockholm, Sweden
21 Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK; Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
22 Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
23 Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
24 Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
25 Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK; Division of Breast Cancer Research, The Institute of Cancer Research, London, UK
26 Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK; Royal Marsden NHS Foundation Trust, London, UK
27 Institute of Population Health, University of Manchester, Manchester, UK; Warwick Medical School, University of Warwick, Coventry, UK
28 Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK; Department of Applied Health Research, University College London, London, UK
29 Institute of Human Genetics, University of Bonn, Bonn, Germany; Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
30 Wessex Regional Genetics Laboratory, University of Southampton, Salisbury, UK
31 Hematology Clinic, Skåne University Hospital, Lund, Sweden
32 Department of Haematology, University Hospital of Copenhagen at Rigshospitalet, Copenhagen, Denmark
33 Department of Haematology, Aarhus University Hospital, Aarhus C, Denmark
34 Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
35 deCODE Genetics, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
36 Department of Internal Medicine III, University of Ulm, Ulm, Germany
37 Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, Lund University, Lund, Sweden; Hematology Clinic, Skåne University Hospital, Lund, Sweden
38 Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; National Centre of Tumor Diseases, Heidelberg, Germany
39 Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, Lund University, Lund, Sweden; Broad Institute, Cambridge, MA, USA
40 Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK; Division of Molecular Pathology, The Institute of Cancer Research, London, UK
41 Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, USA
42 Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA; Seidman Cancer Center, University Hospitals, Cleveland, OH, USA
43 Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
44 Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA
45 Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
46 Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
47 Australian Prostate Cancer Research Centre-Qld, Institute of Health and Biomedical Innovation and School of Biomedical Science, Queensland University of Technology, Brisbane, QLD, Australia; Translational Research Institute, Brisbane, QLD, Australia
48 Department of Medical Biochemistry and Genetics, Institute of Biomedicine, University of Turku, Turku, Finland; Tyks Microbiology and Genetics, Department of Medical Genetics, Turku University Hospital, Turku, Finland; BioMediTech, University of Tampere, Tampere, Finland
49 Division of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
50 Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Radiotherapy Related Research, The Christie Hospital NHS Foundation Trust, Manchester, UK
51 Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
52 CeRePP, Pitie-Salpetriere Hospital, Paris, France; UPMC Univ Paris 06, GRC No. 5 ONCOTYPE-URO, CeRePP, Tenon Hospital, Paris, France
53 Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
54 Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
55 University of Cambridge, Department of Oncology, Addenbrooke’s Hospital, Cambridge, UK; Cancer Research UK Cambridge Research Institute, Li Ka Shing Centre, Cambridge, UK
56 Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Faculty of Medical Science, University of Oxford, John Radcliffe Hospital, Oxford, UK
57 School of Social and Community Medicine, University of Bristol, Bristol, UK
58 Cancer Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK
59 Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Canada
60 Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
61 Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
62 Cancer Epidemiology & Intelligence Division, The Cancer Council Victoria, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
63 Division of Urologic Surgery, Brigham and Womens Hospital, Boston, MA, USA
64 Fundación Pública Galega de Medicina Xenómica-SERGAS, Grupo de Medicina Xenómica, CIBERER, IDIS, Santiago de Compostela, Spain
65 Centre for Research in Environmental Epidemiology (CREAL), Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; IMIM (Hospital del Mar Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
66 Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA
67 Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
68 Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
69 International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
70 Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
71 Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
72 Institute for Human Genetics, University Hospital Ulm, Ulm, Germany
73 Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
74 Cancer Prevention Institute of California, Fremont, CA, USA; Department of Health Research & Policy (Epidemiology) and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
75 Department of Genetics, Portuguese Oncology Institute of Porto, Porto, Portugal; Biomedical Sciences Institute (ICBAS), University of Porto, Porto, Portugal
76 Department of Population Sciences, Beckman Research Institute of the City of Hope, Duarte, CA, USA
77 Ghent University, Faculty of Medicine and Health Sciences, Basic Medical Sciences, Ghent, Belgium
78 Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
79 Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Urology, University of Washington, Seattle, WA, USA
80 Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
81 Molecular Medicine Center, Department of Medical Chemistry and Biochemistry, Medical University, Sofia, Bulgaria
82 Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
83 Molecular Endocrinology Laboratory, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
84 Institute of Cancer Sciences, Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Science Centre, St. Mary’s Hospital, Manchester, UK
85 Genomic Medicine Group, Galician Foundation of Genomic Medicine, Instituto de Investigacion Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saúde, SERGAS, Santiago De Compostela, Spain; University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
86 Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
87 Cancer & Environment Group, Center for Research in Epidemiology and Population Health (CESP), INSERM, University Paris-Sud, University Paris-Saclay, Villejuif, France
88 Clinical Gerontology Unit, University of Cambridge, Cambridge, UK
89 Division of Genetic Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
90 The University of Surrey, Guildford, Surrey, UK