IBCL-077: Clinical Characteristics and Outcomes of Indolent B-Cell Lymphoid Malignancies in Carcinogen-Exposed vs Unexposed US Veterans: A Matched Case–Control Study

Abstract

Context Military personnel and civilians living in theaters of conflict were exposed to environmental carcinogens, such as Agent Orange and Burn Pits, which are associated with increased risk of lymphoid malignancies. There is a need to understand how exposures have impacted disease presentation and outcomes. Objective To determine whether clinical presentations and outcomes of indolent B-cell lymphoid malignancies differ in persons exposed to carcinogens compared to matched unexposed persons. Design Matched case–control study (January 1, 1994 – August 15, 2020). Data abstraction through January 31, 2021. Setting Veteran Affairs Medical Center. Results We studied 217 veterans. Median age at diagnosis was 66 years (range, 32–91), 208 (96%) were male, median duration of time in military service was 3 years (range, 0–23), and median time from enlistment until diagnosis of lymphoid malignancy was 47 years (range, 10–69). First-line management consisted of chemotherapy (n=109), targeted therapy (n=27), other treatments (n=15), untreated (n=60), or unknown (n=6). Fifty-six patients reported carcinogen exposures, and 161 patients did not have documented exposures; both groups were mostly male, 54 (96%) and 152 (95%), respectively. Median age at diagnosis was lower (63 years; range, 33–76) in exposed vs 67 years (range, 32–91) in unexposed patients (p=0.005), and median time from enlistment until diagnosis of lymphoid malignancy was shorter (42 years; range, 13–55) in exposed vs 47 years (range, 10–71) in unexposed patients (p=0.004). Median duration of time in service (3 years; range, 0–28; p=0.11) and median number of therapies (1; range, 0–8) were similar for both groups. Median overall survival in exposed patients was significantly shorter in exposed vs unexposed patients (12 years vs not reached, Log-Rank Test, p Conclusions Veterans who developed indolent B-cell lymphoid malignancies after prior exposure to chemical carcinogens had a younger age at diagnosis, shorter time from enlistment in military service to diagnosis, and shorter survival. Our findings provide the rationale for larger clinical, epidemiological, and mechanistic investigations. Acknowledgments HM is supported by the SOHO Young Investigator Program Award.