Hamza Masoud
University of Miami
Co-Authors: Amrit Baral1, Ciné Brown1, Jasmine A Davis1, Denise C Vidot1
1University of Miami
Background: Multiple myeloma (MM) is a malignant blood cancer characterized by abnormal plasma cell proliferation, resulting in severe immunosuppression, bone degradation, and organ dysfunction. Cannabis and its cannabinoids [i.e., tetrahydrocannabinol (THC) and cannabidiol (CBD], have demonstrated potential anti-proliferative and pro-apoptotic effects in numerous trials. Given the increasing accessibility of cannabis alongside its growing use in medical care, further research is necessary to evaluate its impact on MM progression, symptom relief, and treatment outcomes.
Objective: To examine the past 10 years of published research on the impact of cannabis on Multiple Myeloma.
Methods: A comprehensive literature search was performed in February 2025 by two independent reviewers using a standardized rubric across PubMed, Scopus, and Embase. Keywords were “Multiple Myeloma,” “Marijuana”, “Cannabis,” and “Cannabinoids”. Covidence software facilitated the screening, review, and extraction process. Studies were included if they addressed the therapeutic potential, risks, or clinical outcomes of cannabinoid use in multiple myeloma cancer studies.
Results: The search resulted in 135 abstracts for review (N=114 after removing duplicates). Specifically, Embase identified 101 (11 duplicates); PubMed identified 13; Scopus identified 10 (10 duplicates). Of the 114 abstracts for review, reviewers discussed/settled the inclusion decision for 26 articles that had opposing inclusion results. The team agreed on 22 that fit the inclusion criteria for full manuscript review. After the review of full texts, 8 were included in the proposed study. The primary reason for exclusion was due to the articles describing the endocannabinoid system as a pathway, but not including data on specific relationship between cannabinoids/cannabis/marijuana and multiple myeloma. Of the 8 studies, cannabinoids have been shown to exhibit significant anti-myeloma properties through numerous different mechanisms including apoptosis induction, immune modulation, and telomere regulation. Four studies indicated that cannabinoids have the potential to selectively trigger apoptosis in myeloma cells via caspase activation, Bax/Bak upregulation, and ceramide synthesis. Studies reported that cannabinoids can downregulate levels of transcription factors (NF-κB and XBP1), subsequently moderating telomere length and TP53 expression. Together, these biomarkers influence the maintenance, division, and lifespan of myeloma cells in the body. In addition, 2 studies found cannabinoids to be more effective when used in unison with standard anti-myeloma therapies such as bortezomib and dexamethasone.
Conclusions: While findings suggest the anti-tumor potential of cannabinoids in multiple myeloma, variations in study design, cannabinoid administrations, and patient conditions indicate the need for further research to optimize dosing and treatment results.