Environmental exposures and multiple myeloma risk: A contemporary review of epidemiologic associations and mechanistic plausibility.

Despite major advances in the molecular characterization and treatment of multiple myeloma (MM), the factors driving disease onset remain poorly defined. Environmental influences represent a critical but underexplored component. Epidemiologic studies have associated a range of environmental and occupational exposures with increased MM risk, including pesticides, dioxins, and combustion byproducts, with experimental data supporting biologic plausibility through mechanisms such as oxidative stress, DNA damage, and aryl hydrocarbon receptor signaling. However, the available evidence is heterogeneous and largely associative, limiting causal inference. In this review, we synthesize current epidemiologic and mechanistic evidence linking environmental exposures to MM risk. We also highlight key methodological gaps and future directions, including the need for more precise exposure assessment, biospecimen-linked cohorts, and integrative studies that connect environmental data with disease biology.