Epidemiology Of non-Hodgkin Lymphoma Research Articles

Epidemiology of Non-Hodgkin Lymphoma: Global Patterns of Incidence, Mortality, and Trends

INTRODUCTION The burden of cancer incidence and mortality including non-Hodgkin lymphoma (NHL) is expected to grow worldwide as populations grow, age, and adopt lifestyle behaviors that increase cancer risk, many of which are associated with socioeconomic development. Describing the current and future epidemiologic impact of NHL is crucial to evaluate the therapeutic demand and to inform adequate healthcare resource allocation. However, very few recent studies have described global estimates of non-Hodgkin lymphoma diagnoses, cancer burden, and future projection. In this study, we summarize the current burden, trends, risk factors, prevention, early detection, and survivorship of non-Hodgkin lymphoma that account for approximately 2.9% of the cancer burden among both men and women worldwide. METHODS Estimates of new cancer cases (incidence data) and cancer deaths (mortality data) in the year 2020 were extracted from Global Cancer Observatory (GLOBOCAN) database. GLOBOCAN provides country-specific estimates of cancer incidence, mortality, and prevalence for 185 countries or territories and 36 cancer types by age group and sex. Global geographic variability was assessed using 20 predefined world regions. For US rates, data from National Cancer Institute's (NCI's) Surveillance, Epidemiology, and End Results (SEER) 22 were assessed. All mortality data in the GLOBOCAN database was extracted from the World Health Organization (WHO) mortality database available through 2019. Rates are age-standardized (ASRs) (per 100,000 person-years) using the world Standard Population. We characterize the burden according to the 4-tier Human Development Index (HDI) by the United Nations Development Program. Finally, we provide a prediction of the future burden of NHL in 2040 based on demographic projections, assuming that national rates estimated in 2020 remain constant. RESULTS NHL ranked as the 5th to 9th most common cancer in most countries globally, with an estimated 544,000 new cancer cases and 260,000 cancer deaths in 2020. NHL incidence rates varied by approximately 5-fold in both men and women across WHO areas. The highest age-standardized incidence rates for both sexes (per 100,000) were observed in Australia and New Zealand (12.5) and North America (12), while the lowest rates were in South-Central Asia (2.7), a 4.6-fold difference. Regions with very high HDI had higher rates of NHL (9.3) than regions with medium HDI (3.1) and lower HDI (4.5). However, international variability in NHL mortality rates is smaller: 2.5-fold for both sexes. The lowest mortality rates were in South-Central Asia (1.6) and the highest rates were in Melanesia (4). In the United States, the age-standardized NHL incidence rate (per 100,000) doubled from 1975 (11) to 2007 (21.3) and then stabilized, while the 5-year relative survival rates improved from 47% in 1975 to 73.8% in 2018. These changes have significantly impacted age-adjusted NHL mortality rates (per 100,000), which were 5.6 in 1975, peaked at 8.9 in 1997, and have been decreasing since that time, most recently at 5 in 2019. Similar broad temporal trend patterns were observed in other western countries. In Asia, NHL incidence rates have not plateaued, and have shown rises in Japan during 1993-2010 and in Republic of Korea during 1999-2012. Worldwide, an estimated 779,000 new NHL cases are projected to occur in 2040, a 43% increase from the corresponding 544,000 cases in 2020, assuming national rates remain constant. CONCLUSION There is marked variation in NHL incidence rates among different populations of the world. NHL incidence and mortality rates have steadily increased in the United States and other populations over the past few decades, making NHL an increasingly important contributor to the global cancer burden. This epidemiologic assessment also reveals substantial growth in new NHL diagnoses over the next two decades. Keeping track of new cases, deaths, trends, and survival over time helps us understand where progress is made and where additional research is needed to address challenges. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Epidemiology of Non-Hodgkin Lymphomas in the 20th and at the beginning of the 21st century

Aim: to study the dynamics of incidence, mortality, survival of patients with non-Hodgkin lymphomas in the world, Ukraine and Zaporizhzhya region in the 20th and at the beginning of the 21st century. The modern understanding of the etiology and prognostic factors of the disease was considered.Methods and results. In order to study the dynamics of incidence, mortality, survival of patients with non-Hodgkin lymphomas in the world, Ukraine, Zaporizhzhya region in the 20th and early 21st century the review of the specialized literature was conducted. We also considered the current ideas about etiology and risk factors of the disease. Non-Hodgkin lymphomas are complicated and poorly treatable diseases, which are found everywhere, and affect all age groups of people. The peak incidence occurs in the elderly and senile age. Continuing the study of non-Hodgkin lymphomas contributes to a better understanding of this disease, which leads to the reduction in mortality and increased survival of patients with non-Hodgkin lymphomas.Conclusion. So, at the beginning of the 21st century, the non-Hodgkin lymphomas remain to be difficult to prevent, diagnose and treat malignant tumors, the incidence of which continues to increase.

Risk factors of follicular lymphoma

INTRODUCTION: Non-Hodgkin Lymphoma (NHL) is a heterogeneous group of malignancies with over thirty different subtypes. Follicular lymphoma (FL) is the most common form of indolent NHL and the second most common form of NHL overall. It has morphologic, immunophenotypic and clinical features significantly different from other subtypes. Considerable effort has been devoted to the identification of risk factors for etiology and prognosis of FL. These risk factors may advance our understanding of the biology of FL and have an impact on clinical practice. AREAS COVERED: The epidemiology of NHL and FL is briefly reviewed. For FL etiology and prognosis separately, we review clinical, environmental and molecular (including genetic, genomic, epigenetic and others) risk factors suggested in the literature. EXPERT OPINION: A large number of potential risk factors have been suggested in recent studies. However, there is a lack of consensus, and many of the suggested risk factors have not been rigorously validated in independent studies. There is a need for large-scale, prospective studies to consolidate existing findings and discover new risk factors. Some of the identified risk factors are successful at the population level. More effective individual-level risk factors and models remain to be identified.

Unanswered Questions in HIV Hematology

Hematological abnormalities are common manifestations of HIV infection that are regularly encountered in the clinical setting. Although initially recognized with the first descriptions of HIV infection over 30 years ago, our understanding of the epidemiology, natural history, and treatment of these blood disorders continues to evolve. Aggressive lymphomas such as diffuse large B-cell lymphoma and primary CNS lymphoma have decreased since the introduction of combination antiretroviral therapy (cART), though these and other HIV-associated malignancies continue to a have a major impact on the morbidity and mortality of persons with HIV. Other blood disorders frequently associated with HIV include cytopenias, particularly anemia and thrombocytopenia. In this special issue, studies investigating hematologic diseases associated with HIV infection are discussed. The diagnosis, treatment, and prognosis of Hodgkin lymphoma (HL) in the era of cART are reviewed by Jacobson and Abramson. Unlike non-Hodgkin lymphomas (NHL), the incidence of HL in HIV-infected patients has not decreased in the cART era. However, the introduction of cART has allowed the delivery of full doses of chemotherapy with significantly improved outcomes. Despite these advances, patients with HIV-associated HL remain at risk of treatment-related toxicity, and interactions between antiretroviral and chemotherapeutic agents necessitate careful attention to supportive care. Two papers focus on HIV-associated Burkitt lymphoma (BL). Though the outcome of HIV-NHL has improved substantially in the cART era, the outcome of HIV-BL with standard chemotherapy remains poor. J. A. Rodrigo et al. describe the combined experience in four Canadian centers treating patients with HIV-BL with the CODOX-M/IVAC regimen with or without rituximab in the modern era. In this study, intensive chemotherapy with CODOX-M/IVAC ± R yielded acceptable toxicity and favorable survival rates. A. M. Petrich et al. review the larger picture in the treatment of HIV-BL in the paper entitled “paradigms and controversies in the treatment of HIV-related Burkitt lymphoma.” In this paper, available data on the treatment of patients with HIV-BL with current BL-directed chemotherapy regimens are discussed in detail, including Hyper-CVAD, dose-adjusted EPOCH, the PETHEMA regimen, and CODOX-M/IVAC. Areas of uncertainty in the treatment of these patients include the addition of rituximab to chemotherapy regimens, the optimal approach to patients with relapsed or refractory BL and the role of stem cell transplantation, the appropriate approach to older patients and patients with central nervous system involvement, and the role of antiretroviral therapy and supportive care. An intriguing and pressing challenge in the management of patients with both malignant and nonmalignant hematologic disorders in HIV infection is the optimal approach to be taken in the developing world. This topic is addressed by M. Ulrickson et al. in the paper “Epidemiology, diagnosis, and treatment of HIV-associated NHL in resource-limited settings.” The epidemiology of NHL in Africa is compared to that of the US, and discrepancies in survival highlighted by cancer registries are discussed. Challenges in managing patients with NHL in resource-limited settings include diagnostic challenges due to limited access to a full battery of immunohistochemical tests and limited molecular testing. Treatment challenges include limited access to antiretroviral regimens, prophylactic agents, IV infusion centers, and a higher incidence of major infectious complications including tuberculosis and hepatitis B. Response assessments are further limited by a lack of ready access to cross-sectional imaging in some regions. Despite these challenges, progress has been made in developing tolerable and effective treatment regimens appropriate to these circumstances, and these important advances are reviewed. A common nonmalignant complication of HIV infection is immune thrombocytopenia (ITP). The characteristics of HIV-associated ITP were documented prior to the cART era, and the optimal treatment beyond cART is unknown. For this reason, K. L. S. Ambler et al. present a retrospective cohort study reviewing individuals with severe HIV-associated ITP diagnosed in the cART era. Their series is the largest such report of severe HIV-ITP in the post-cART era. The major finding from this study was that, although the various treatments were well tolerated and most patients achieved a safe platelet count, nearly all patients (87%) required retreatment for recurrence of severe ITP. This highlights that new approaches to the treatment of ITP in this population are needed. The intent of this special issue was to initiate interest in and further inquiry into the many hematologic complications faced by persons living with HIV. In addition to the topics discussed in this issue, areas for future exploration include the approach to management of patients with less common lymphoproliferative disorders such as indolent NHL, paraproteinemias, and Castleman disease, as well as non-malignant causes of cytopenias and their management. Heather A. Leitch Jeremy S. Abramson Matthew C. Cheung Lisa K. Hicks

Extranodal lymphoma: a comparative study

Background: The incidence of extranodal non-Hodgkin's lymphoma (NHL) is increasing worldwide. The epidemiology of NHL in the Middle East is largely unknown.Patients and methods: We evaluated all cases of NHL diagnosed at our institutions between 1998 and 2003 according to the site of presentation and their classification into primary nodal and primary extranodal NHL using strict criteria. Extranodal cases and early stage primary nodal cases were compared in terms of clinical characteristics and treatment outcomes.Results and discussion: There were 422 NHL cases diagnosed between January 1998 and December 2003, among which 97 cases (23%) were primary nodal, 132 (31%) were early nodal, and 193 (46%) were disseminated primary nodal. In general, there was a male preponderance of primary nodal cases (63% versus 44%; p=0·007). There was a higher prevalence of primary nodal cases in Arabs than in Asians: Kuwaiti Arabs, 50%; other Arabs, 46%; and Asians, 11%. There was a different distribution of histologic subtypes between primary nodal and extranodal NHL (p=0·001). The most common histologic subtype among extranodal cases was diffuse large B cell lymphoma, which accounted for 71% (69) of cases. The most common anatomic site involved was the gastrointestinal tract, which accounted for 45% of all cases. The difference in event-free survival between nodal and extranodal low-grade NHL was not statistically significant (p=0·17). Primary nodal high-grade lymphomas show an overall survival than the primary extranodal disease (p=0·003).Conclusion: We conclude that extranodal NHL is common among patients of Arabic descent. Diffuse large B cell lymphoma is the most common histologic subtype and often involves the gastrointestinal tract. Patients with aggressive primary extranodal NHL have lower overall survival than patients with early primary nodal disease.

Epidemiology of non-Hodgkin lymphomas in Tyrol/Austria from 1991 to 2000

Aims: To analyse the entity specific incidence and disease specific survival (DSS) of non-Hodgkin lymphomas (NHLs) in Tyrol/Austria, 1991–2000. Methods: Data from 1307 NHLs (excluding primary cutaneous lymphomas and monoclonal...

Study of prevalence of seropositivity from seven different virus associated to non Hodgkin's lymphoma (NHL)

6689 Objective.- NHL is the 5th leading cause of cancer mortality in Peru and it is well known that some virus are associated to NHL like EBV for Burkitt and posttransplantation lymphoma as well as HTLV-I for ATLL. There are emerging virus related to NHL like HCV, CMV, HIV, and HSV. The purpuse of this study is to know the prevalence of IgG and IgM viral seropositivity or by ELISA in some cases in new NHL patients. Patients and Methods.- We collect 60 new patients with confirmed NHL by pathology at Guillermo Almenara Hospital and HMC from 6/99 to 6/02, we took a blood sample for analizing the seropositivity measuring the level of IgG and IgM for HSV-I, HSV-II, EBV and CMV or by ELISA for HCV, HTLV-I and HIV. We do not accept NHL patients already in chemotherapy because many of them could have been infected by some of these virus during the neutropenic period. Results.- Tabla I.- Seropositivity by virus Tabla II.- Patient's Features Conclusions.- It is remarkable the high incidence of T cell and extranodal NHL, different from the epidemiology of NHL in occidental countries. On the other hand the HTLV-I infection (15%) is extremely high but we do not found any ATLL. Finally the memory of B cells of viral infections, expressed in high levels of IgG is important for EBV and HSV-I (75% and 78% respectevely); and for acute infection EBV 10% and CMV 7%. We need a case-control study to determine the significance of these results as well as molecular analisis in order to know if the insertion of viral genome is really in the lymphoma cells. No significant financial relationships to disclose.

Study of prevalence of seropositivity from seven different virus associated to non Hodgkin's lymphoma (NHL)

6689 Objective.- NHL is the 5th leading cause of cancer mortality in Peru and it is well known that some virus are associated to NHL like EBV for Burkitt and posttransplantation lymphoma as well as HTLV-I for ATLL. There are emerging virus related to NHL like HCV, CMV, HIV, and HSV. The purpuse of this study is to know the prevalence of IgG and IgM viral seropositivity or by ELISA in some cases in new NHL patients. Patients and Methods.- We collect 60 new patients with confirmed NHL by pathology at Guillermo Almenara Hospital and HMC from 6/99 to 6/02, we took a blood sample for analizing the seropositivity measuring the level of IgG and IgM for HSV-I, HSV-II, EBV and CMV or by ELISA for HCV, HTLV-I and HIV. We do not accept NHL patients already in chemotherapy because many of them could have been infected by some of these virus during the neutropenic period. Results.- Tabla I.- Seropositivity by virus Tabla II.- Patient's Features Conclusions.- It is remarkable the high incidence of T cell and extranodal NHL, different from the epidemiology of NHL in occidental countries. On the other hand the HTLV-I infection (15%) is extremely high but we do not found any ATLL. Finally the memory of B cells of viral infections, expressed in high levels of IgG is important for EBV and HSV-I (75% and 78% respectevely); and for acute infection EBV 10% and CMV 7%. We need a case-control study to determine the significance of these results as well as molecular analisis in order to know if the insertion of viral genome is really in the lymphoma cells. No significant financial relationships to disclose.

Rising incidence of post-transplant lymphoproliferative disease in kidney transplant recipients.

The purpose of this study was to determine whether the incidence of post-transplant lymphoproliferative disease (PTLD) has been increasing in renal transplant recipients in this centre. Prospectively gathered data were analysed to establish trends in the epidemiology of PTLD in 1537 patients. Overall, PTLD occurred in 2.3 per cent of renal transplant recipients. An increase in its incidence coincided with the introduction of cyclosporin in the 1980s. However, there was a further increase in the incidence of PTLD in the 1990s when the only change in immunosuppressive policy was the abandonment of pretransplantation blood transfusion. The latter increase was particularly pronounced in patients with early-onset PTLD in whom it presented within 600 days after transplantation. The incidence of PTLD has been increasing in renal transplant recipients. The recent increase appears to be independent of cyclosporin and may reflect the reduction in pretransplant blood transfusion. Changes in the incidence of PTLD may also mirror changes in the epidemiology of non-Hodgkin lymphoma in the general population.

Epidemiology of non-Hodgkin's lymphoma: Recent findings regarding an emerging epidemic

Between 1973 and 1989, the incidence of non-Hodgkin's lymphoma (NHL) increased by nearly 60% in the United States, one of the largest increases of any cancer. In 1993, approximately 43,000 new cases of NHL will be diagnosed and over 20,000 deaths due to NHL will occur. The annual incidence rate of NHL per 100,000 persons in the US has risen from 5.9 in 1950 to 13.7 in 1989. This increase has occurred in both males and females, blacks and whites, and in all age groups except the very young. The largest increase has occurred in the elderly, and rates have increased more rapidly in rural areas. Most of the increase cannot be attributed to acquired immunodeficiency syndrome. Similar findings have been reported from other developed countries. Epidemiologic studies indicate that environmental factors may play an important role in the etiology of NHL. In this paper, current knowledge concerning the epidemiology of NHL is summarized, with special emphasis on environmental factors of possible etiologic importance, such as drugs, pesticides, solvents and other chemicals, dusts and particles, hair dyes, smoking, Helicobacter pylori infection, and diet. Many different environmental factors of low risk acting on large segments of the population could account for much of the increase in NHL.