Incidence Of non-Hodgkin Lymphoma Research Articles

Clinicopathological Spectrum of B-Cell Non-Hodgkin Lymphoma in Pakistan Population: A Single-Center Study.

Background B-cell non-Hodgkin lymphoma (NHL) is a common malignancy worldwide and in the Pakistani population. In our population, there was limited information regarding the clinicopathological characteristics of B-cell NHL. This study assessed the disease spectrum and most prevalent subtypes of B-cell NHL. Methodology An analysis of 548 cases was conducted in this cross-sectional study between January 2021 and September 2022, using a non-probability consecutive sampling approach. Patient age, gender, site of involvement, and diagnosis were documented according to the 5th edition of the World Health Organization (WHO)Classification of Tumors of Hematopoietic and Lymphoid Tissue, published in 2018. Data were entered and analyzed using Statistical Product and Service Solutions (SPSS) (IBM SPSS Statistics for Windows, Version 26.0, Armonk, NY). Results The mean age of the patients was 47.73±20.44 years. There were 369 males (67.34%) and 179 females (32.66%). The most prevalent type of B-cell NHL was diffuse large B-cell lymphoma (DLBCL) (58.94%), followed by chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) (13.14%), Burkitt lymphoma (9.85%), and precursor B-cell lymphoblastic lymphoma (5.11%). In contrast to low-grade B-cell NHL (22.99%), high-grade B-cell NHL was more common (77.01%). Nodal involvement was observed in 62.04% of cases. The cervical region was the most common nodal site of involvement (62.04%), and the gastrointestinal tract (GIT) was the most common extranodal site (48.29%). Conclusion The incidence of B-cell NHL is higher in older age groups. The most common nodal site was the cervical region, whereas the extranodal site was the GIT. The most reported subtype was DLBCL, followed by CLL/SLL, and Burkitt lymphoma. The prevalence of high-grade B-cell NHL is higher than that of low-grade B-cell NHL.

A new hope in the management of hematologic malignancy: immunotherapy

In recent years, Hodgkin's and Non-Hodgkin's lymphoma incidence is increasing all over the world. In the United States, lymphomas are the fourth most common malignancies among all. Lymphoid malignancies have a broad spectrum from mild indolent types, such as chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL), follicular lymphoma(FL), marginal zone lymphoma, and cutaneous T-cell lymphoma to aggressive types such as diffuse large B cell lymphoma (DLBCL), mantle cell lymphoma, Burkitt's lymphoma, peripheral T-cell lymphoma. With better response rates to chemotherapy, longer disease-free survival and overall survival rates, lymphomas have satisfactory treatment results rather than solid organ tumors for oncologists. Throughout history, conventional chemotherapy agents, radiotherapy and their combinations have been used for the treatment of lymphoma. Especially, in the early stages of Hodgkin's lymphoma, a rate of 85-90% complete remission and high rate long-term remission can be achieved. However, despite this high response rate, 15-30% of patients are resistant to treatment. With current therapiesresponse rate and persistent long-term remission rate in Non-Hodgkin's lymphomas are around 50%. Therefore, new therapeutic approaches such as immunotherapy and the using of cytotoxic properties of T cells against tumor has been developed and used in recent years for the treatment of refractory lymphoma.

Organic food consumption and the incidence of cancer in the Danish diet, cancer and health cohort

Expected beneficial health effects is a major reason why people purchase organically produced foods, although the existing evidence is limited. We investigated if organic food consumption, overall and by specific food groups, is associated with the incidence of cancer. We used data from the Danish Diet, Cancer and Health cohort. Organic food consumption was reported for vegetables, fruits, dairy products, eggs, meat, and bread and cereal products. Consumption was summarized into an overall organic food score, evaluated as a continuous variable and in categories specified as never, low, medium, and high consumption. We followed 41,928 participants for a median of 15 years, during which 9,675 first cancer cases were identified in the Danish Cancer Registry. We used cox proportional hazard models adjusted for sociodemographic and lifestyle variables to estimate associations between organic food consumption and cancer incidence. No association was observed between intakes of organic foods and incidence of overall cancer. When compared to never eating organic foods, overall organic food consumption was associated with a lower incidence of stomach cancer (low: HR = 0.50, 95% CI: 0.32-0.78, medium: HR = 0.50, 95% CI: 0.32-0.80, high: HR = 0.54, 95% CI: 0.27-1.07, p-trend = 0.09), and higher incidence of non-Hodgkin lymphoma (low: HR = 1.45, 95% CI: 1.01-2.10, medium: HR = 1.35, 95% CI: 0.93-1.96, high: HR = 1.97, 95% CI: 1.28-3.04, p-trend = 0.05). Similar patterns were observed for the specific food groups. Our study does not support an association between organic food consumption and incidence of overall cancer. The scarce existing literature shows conflicting results with risk of specific cancers.

Incidence trends and disparities in Helicobacter pylori related malignancy among US adults, 2000-2019.

Helicobacter pylori (H. pylori) is closely related to the carcinogenesis of gastric cancer (GC) and gastric non-Hodgkin lymphoma (NHL). However, the systemic trend analysis in H. pylori-related malignancy is limited. We aimed to determine the national incidence trend in non-cardia GC, cardia GC, and gastric NHL in the US during 2000-2019. In this population-based study, we included 186,769 patients with a newly diagnosed H. pylori-related malignancy, including non-cardia GC, cardia GC, and gastric NHL from the Surveillance, Epidemiology, and End Results (SEER) Registry from January 1, 2000 to December 31, 2019. We determined the age-adjusted incidence of three H. pylori-related malignancies respectively. Average annual percentage change (AAPC) in 2000-2019 was calculated to describe the incidence trends. Analyses were stratified by sex, age, race and ethnicity, geographic location and SEER registries. We also determined the 5-year incidence (during 2015-2019) by SEER registries to examine the geographic variance. The incidence in non-cardia GC and gastric NHL significantly decreased during 2000-2019, while the rate plateaued for cardia GC (AAPCs, -1.0% [95% CI, -1.1%-0.9%], -2.6% [95% CI, -2.9%-2.3%], and -0.2% [95% CI, -0.7%-0.3%], respectively). For non-cardia GC, the incidence significantly increased among individuals aged 20-64 years (AAPC, 0.8% [95% CI, 0.6-1.0%]). A relative slower decline in incidence was also observed for women (AAPC, -0.4% [95% CI, -0.6%-0.2%], P for interaction < 0.05). The incidence of cardia GC reduced dramatically among Hispanics (AAPC, -0.8% [95% CI, -1.4%-0.3%]), however it increased significantly among nonmetropolitan residents (AAPC, 0.8% [95% CI, 0.4-1.3%]). For gastric NHL, the decreasing incidence were significantly slower for those aged 20-64 years (AAPC, -1.5% [95% CI, -1.9-1.1%]) and Black individuals (AAPC, -1.3% [95% CI, -1.9-1.1%]). Additionally, the highest incidence was observed among Asian and the Black for non-cardia GC, while Whites had the highest incidence of cardia GC and Hispanics had the highest incidence of gastric NHL (incidence rate, 8.0, 8.0, 3.1, and 1.2, respectively) in 2019. Geographic variance in incidence rates and trends were observed for all three H. pylori-related malignancies. The geographic disparities were more pronounced for non-cardia GC, with the most rapid decline occurring in Hawaii (AAPC, -4.5% [95% CI, -5.5-3.6%]) and a constant trend in New York (AAPC 0.0% [95% CI, -0.4-0.4%]), the highest incidence in Alaska Natives, and the lowest incidence among Iowans (14.3 and 2.3, respectively). The incidence of H. pylori-related cancer declined dramatically in the US between 2000 and 2019, with the exception of cardia GC. For young people, a rising trend in non-cardia GC was noted. Existence of racial/ethnic difference and geographic diversity persists. More cost-effective strategies of detection and management for H. pylori are still in demand.

Global Burden, Risk Factors, and Trends of Non-Hodgkin Lymphoma in 2020 and Projections to 2040: A Population-Based Study

Background: Non-Hodgkin lymphoma (NHL) is one of the major health problems worldwide, but the global burden and trends of NHL have not been extensively assessed. We aimed to describe the disease burden, risk factors, trends in incidence and mortality of NHL globally. Methods: We collected up-to-date incidence and mortality data of NHL from the GLOBOCAN 2020, focusing on geographic disparities worldwide. The incidence trends of NHL in 42 countries over 15 years were examined, while mortality trends of 39 countries were calculated by data extracted from cancer registries. Prevalence data from the World Health Organization database was used to estimate the attributable risk factors in the development of NHL. Future burden estimates for incidence and mortality in 2040 were calculated by applying population projections in 2020. We reported incidence and mortality by sex and age alongside corresponding age-standardized rates and the average annual percentage change. Results: In 2020, there were an estimated 545,000 new cases and 260,000 deaths of NHL globally. The age-standardized incidence rates (ASIR) varied drastically across world areas, at least 10-fold in both sexes, with the highest rates observed in Australia and New Zealand. A great burden of NHL was recognized in high-income countries as the highest incidence rates were in Australia and New Zealand (ASIR, 12.5), Northern America (ASIR, 12.0), and Northern Europe (ASIR, 11.4) (Figure 1). Conversely, countries with a low human development index (HDI), such as those in North Africa, encountered a larger mortality burden in NHL than in highly-developed countries. In terms of different continents or regions, higher mortality rates were seen in Melanesia (ASR, 4.0), North Africa (ASR, 3.7), and Micronesia (ASR, 3.6). Considering the global trends of incidence, it was found that most developed countries had a trend of steady growth, while some low HDI countries have relatively large fluctuations in the incidence. In subgroups of different genders, close to 20 populations exhibited higher ASIRs for women than men. Observed trends also differed across age groups. The incidence of NHL increased in 34 populations (AAPCs, 4.9 to 0.1) among individuals aged 60 years or older. Taking into account differences in NHL burden across countries, we also reported estimated burden of NHL by HDI category. Considering all 185 countries, the ASIRs of NHL rose with HDI levels (= 0.41, P < 0.001), whereas the ASMRs of NHL were not associated with the levels of HDI (= 0, P = 0.754). HIV was generally believed to be a possible contributing factor to the development of some types of NHL, we presented the linear relation between the magnitude of the NHL incidence, HIV prevalence, and the level of HDI which seemly constricted to very high HDI countries. Regarding associated lifestyle risk factors, higher incidence of NHL was linked to a higher prevalence of obesity (β = 0.399, P < 0.001), a decreased prevalence of diabetes (β = -0.468, P <0.001) and hypertension (β = -0.386, P <0.001) based on the multivariate linear regression. As a result, countries with higher incidence were more likely to have a higher prevalence of obesity. In terms of demographic change, NHL incident cases are projected to rise to approximately 778,000 by 2040. Conclusions: In this pooled analysis, we provided evidence for the growing incidence trends in NHL, particularly among women and elderly populations. Despite the stable or downward mortality trends observed in most countries, the marked increase in the older population is still a public health issue that requires more attention. Future efforts should be directed to cultivating health awareness and formulating effective and locally tailored cancer prevention strategies, especially in most developing countries. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

High Grade B Cell NHL Outcomes: Real World Experience from the UK

Incidence of non-Hodgkin lymphoma (NHL) is increasing; it is already the sixth most common malignancy in UK (Cancer Research UK NHL incidence statistics 2022). It can present in aggressive or indolent form. Whilst for those with chemo-sensitive disease prognosis is good, with 5 year overall survival (OS) >50%, those with relapsing/refractory (R/R) forms have consistently poor outlook. Historically only 30-40% of these tolerate/respond to salvage therapy with <30% of those who respond able to proceed to consolidation with autologous stem cell transplant (ASCT). Despite this ~50% will relapse (Crump et al, Blood 2017 doi: 10.1182/blood-2017-03-769620). Recent treatment advances seek to address this area of unmet need. CAR-T cell therapy is presented as a highly effective solution for this cohort of patients. The pivotal studies leading to licensing and widespread adoption of these therapies drew comparison from SCHOLAR-1 which pooled data from 2 phase 3 clinical trials and 2 observational cohorts enabling data on 636 patients with refractory NHL to be analysed. There are challenges with this dataset and notably it does not include UK patients. We analysed patient level data for a UK NHL cohort and compare these to other, more historical data sets. 165 patients were identified. Diagnoses included primary DLBCL, DLBCL-transformed follicular lymphoma and PMBCL. Demographics: 92 male, 73 female; median age 64 (24-86yrs). Stage at diagnosis: I 10.3%, II 13.3%, III 21.2%, IV 54.5%, unknown <1%. IPI: 0- 2.4%, 1 - 13.3%, 2 - 27.3%, 3 - 26.7%, 4 - 18.8%, 5 - 3.6%, unknown 7.8%. C-MYC present in 20.7% of those where evaluated (24/116); of those 41.7% (10) double hit, 12.5% (3) triple hit. Cell of origin available for 54.5% (ACB 36.7%, GCB 63.3%). >90% considered suitable for intensive therapy; PS: 0 - 43%, 1 - 33.9%, 2 - 12.7%, 3 - 9.1%, 4 - <1%, unknown 4.2%. Nearly 2 thirds required >1 line treatment: 1 - 37%, 2 - 33.3%, 3 - 20.6%, 4 - 6.1%, 5 or greater - 3%. First line: 57.6% (95/165) 6-8 cycles R-CHOP (22% also received CNS prophylaxis - HD or intrathecal methotrexate, 16.8% additional radiotherapy (IFRT)); 10.3% abbreviated R-CHOP +/- IFRT; 9.7% dose attenuated R-CHOP, 16.4% R-CODOX-M/R-IVAC, 4.8% R-mini-CHOP, 1.8% non-intensive regimes and <1% IFRT alone. Best response was CR 52.7%, PR 11.5%, SD 13.3%, PD 11.5%, not available 10.9%. 63% (104/165) required second line treatment; time to treatment ranged from <6 months (27.9%), 6-12 months (32.7%), >12 months (37.5%), unknown in 2 cases. PS at first relapse: PS 0 - 36.6%, 1 - 45.5%, 2 - 7.1%, 3 - 7.1%, 4 - <1%. 35.6% with refractory disease had improvement in PS with treatment despite suboptimal response. 7.1% were considered too frail for further treatment. Second line therapy was primarily platinum based +/- IFRT +/- HD Mtx 71.2%; other intensive regimes included R-IVE, R-DHAP, R-ESHAP, R-CHOP and MATRIX (11.5%), less intensive regimes included R-lenalidomide, R-BP, R-miniCHOP, R-CVP, IFRT and R-CEPP (17.3%). Best response was CR 24.0%, PR 18.3%, SD 7.7%, PD 44.2%, not evaluated 5.8%. 31.7% proceeded to ASCT, 6 required >1 line of salvage therapy prior to ASCT. Exclusion basis: refractory disease 26.3%, declining PS and suboptimal response 7.5%, age only (>72years) 8.75%, frailty (PS > 2 - treatment induced/ comorbidities) 16.25%, age and frailty 13.75%, failed harvest 6.25%, patient choice 6.3%. 22 (66.6%) achieved CR after ASCT. 45 had suboptimal response to ≥2 lines intensive therapy but maintained fitness and would have been eligible for CAR-T. 47% (49/104) of those requiring salvage therapy proceeded to third line, 38.8% had refractory disease requiring treatment within 12months of first salvage treatment. 14.3% (7/49) had received ASCT. 57.1% (28/49) received intensive therapy, 18.4% (9/49) proceeded to ASCT. 42.9% were treated non-intensively. This UK dataset, analysing real world experience, highlights the challenge of high grade NHL. Whilst OS is: 2 year 63%, 5 year 29.1% with an additional 4.2% and 27.9% alive but <2 and <5 years from diagnosis respectively, for those with R/R disease OS is significantly reduced: 2 year 35.8%, 5 year 21.8%. CR rate after first line is 53.9%. However, 63% of patients required second line treatment; 4.8% relapsed >12months, 33.3% refractory; objective response rate (ORR) 42.3% (CR 24.0%), 35.8% alive at 2 years, 21.8% at 5 years. This is comparable to results from the referenced SCHOLAR-1 study supporting it as a reference point for new therapies.

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

ABCL-258 Incidence Patterns of Non-Hodgkin Lymphoma in the Republic of Armenia

It is known that one of the reasons for the increased incidence of hematological malignancies is, in particular, the growth of non-Hodgkin lymphoma (NHL). NHL is the most common hematological malignancy worldwide, accounting for nearly 3% of cancer diagnoses and deaths. NHL comprises various subtypes, each with different epidemiology, etiology, immunophenotypic, genetic, clinical features, and response to therapy. The main objective of this research was the investigation of incidence patterns of NHL within the Republic of Armenia and to portray disease distribution according to age and sex during the period of 2017-2021. The initial data for this retrospective cohort survey were derived from ambulance cards, hospitalization journals, and clinical data from the Registry of Blood Diseases at the Armenian Hematology Center After Prof. R. Yeolyan. Data analysis showed that during 2017-2021, the average annual incidence of NHL was 4.34 cases per 100,000 people. The comparison of this data with the results of our early studies (1998-2004 and 1966-1971) revealed an increase in the NHL incidence rate by 1.5 and 4 times, respectively. A significant increase was observed in 2019 compared to 2017, 5.9 versus 3.3 cases per 100,000 people. The age-standardized risk of NHL was 4.8 among male and 3.9 among female individuals. Our study showed that the incidence for both men and women is higher in the age group of 55 years and older. Currently, we can only provide data on the general statistics of the incidence of NHL; work is underway to analyze the statistics of specific subtypes of lymphomas, but the proportion of DLBCL is 30% and that of unclassified lymphomas is 20%-25%. The incidence rates for NHL increased several-fold during the analyzed period. The risk groups include the male contingent of the population and those aged over 55 years.

Cancer Incidence Among Adults With HIV in a Population-Based Cohort in Korea

In combination with a decreased risk of AIDS-defining cancers and improved survival of people infected with HIV, the burden of non-AIDS-defining cancer has increased markedly. Although a substantial number of studies have measured the cancer risk among people with HIV in developed countries, little research has been conducted on the risk of cancer in HIV-infected people in Asia. To examine the cancer incidence and the estimated risk of cancer among people in Korea infected with HIV compared with the general population. This retrospective cohort study evaluated patients without cancer newly diagnosed with HIV from January 1, 2006, to December 31, 2018, using a nationwide population-based claims database embedded in the National Health Insurance Service database. Data were analyzed between December 6, 2021, and February 28, 2022. Infection with HIV. Cancer incidence and standardized incidence rate (SIR) through indirect standardization. A total of 11 552 individuals without cancer (10 444 male [90.4%]; mean [SD] age, 39.9 [11.2] years) diagnosed with HIV were identified. The SIR for all cancers was 1.68 (95% CI, 1.50-1.87) in men and 1.26 (95% CI, 0.89-1.64) in women. In men, the highest SIRs were for Kaposi sarcoma (SIR, 349.10; 95% CI, 196.10-502.20) and anal cancer (SIR, 104.20; 95% CI, 55.56-149.90). The incidence of non-Hodgkin lymphoma (SIR, 15.62; 95% CI, 11.85-19.39), Hodgkin lymphoma (SIR, 16.67; 95% CI, 4.32-29.02), and oropharyngeal cancer (SIR, 2.97; 95% CI, 1.36-4.58) in men infected with HIV was higher than in the general population. In women infected with HIV, an increased incidence of cervical cancer (SIR, 4.98; 95% CI, 1.29-8.66) and non-Hodgkin lymphoma (SIR, 11.78; 95% CI, 2.35-21.21) compared with the general population was observed. The SIR of thyroid cancer in patients with HIV was lower than in the general population in both men (SIR, 0.63; 95% CI, 0.27-0.99) and women (SIR, 0.48; 95% CI, 0.06-0.90). In this cohort study, cancer risks, especially AIDS-defining cancer and virus-related cancer, were elevated in people with HIV. Efforts for cancer prevention, screening, and better accessibility to medical care in HIV-infected people are warranted.

Association between Meat, Fish, and Fatty Acid Intake and Non-Hodgkin Lymphoma Incidence: The Japan Public Health Center–Based Prospective Study

BackgroundMeat, fish, and fatty acid intakes have been reported to be associated with non-Hodgkin lymphoma (NHL), although results have been inconclusive. We hypothesized that red meat and SFA intakes increase NHL risk, and fish and PUFA intakes decrease NHL risk. ObjectivesWe investigated the association between NHL incidence and meat, fish, and various fatty acid type intakes using the Japan Public Health Center–based Prospective Study. MethodsThe current cohort study included 93,366 participants aged 45–74 y who were eligible for analysis; they were followed up until December 2012. Participants answered an FFQ between 1995 and 1999. We analyzed the effects of meat, fish, total fatty acid, SFA, and PUFA intakes on NHL incidence using the Cox proportional hazard model. ResultsThe median age was 57 y (IQR: 51–63 y), and 46.5% of the participants were men. Participants were followed up for 1,345,001 person-years, and 230 patients with NHL were identified. Total fatty acid and SFA intakes were associated with an increased incidence of NHL, with an adjusted HR of 1.56 (95% CI: 1.04, 2.34 highest compared with lowest quartile; P-trend = 0.062), and 1.63 (95% CI: 1.11, 2.41; P-trend = 0.074), respectively. In subtype analysis, total fatty acid and SFA intakes were also associated with increased incidence of follicular lymphoma but were not significantly associated with diffuse large B-cell lymphoma. Conversely, total meat, processed meat, unprocessed meat, red meat, poultry, fish, MUFA, PUFA, n–3 (ω-3) PUFA, and n–6 (ω-6) PUFA intakes were not significantly associated with the incidence of NHL or its subtypes. ConclusionsTotal fatty acid and SFA intakes were associated with increased incidence of NHL in the Japanese adult population. Further large-scale studies are warranted to test whether fatty acid intakes affect the development of NHL.

Risk of Cancer in Connective Tissue Diseases in Northeastern Italy over 15 Years.

Objective: To evaluate cancer risk among individuals with connective tissue disease (CTD) in Friuli Venezia Giulia, northern Italy. Methods: A population-based cohort study was conducted based on data from health records available in the regional healthcare database. Demographic characteristics, hospital discharges, exemption from medical charges, drug prescriptions, were individually matched with data from the population-based cancer registry. Cancer risk was assessed in people diagnosed with the following diseases: systemic lupus erythematosus (SLE), Sjögren’s syndrome (SS), systemic sclerosis (SSc), polymyositis (PM), and dermatomyositis (DM). Results: In all, 2504 patients were followed for a total of 18,006 person-years (median follow-up: 6.8 years). After 5 and 10 years of follow-up, the cumulative cancer incidence was 2.6% and 8.5%, respectively. The most common cancers were breast (n = 34), lung (n = 24), colon–rectum–anus (n = 20), and non-Hodgkin lymphomas (NHL) (n = 20). Overall, no excess cancer risk was noted (SIR = 0.87), whereas the number of observed NHL cases was more than two-fold significantly higher than expected (SIR = 2.52). The subgroup analysis showed a higher risk of NHL among SS patients (SIR = 3.84) and SLE patients (SIR = 2.69). Conversely, the study population showed a decreased risk for breast cancers (SIR = 0.61) and corpus uteri (SIR = 0.21). Conclusions: The incidence of NHL was higher among patients with SS and SLE. Careful surveillance for hematological malignancies in these patients is recommended.

Global patterns of non-Hodgkin lymphoma in 2020.

We evaluated the global patterns of non-Hodgkin lymphoma (NHL) in 2020 using the estimates of NHL incidence and mortality in 185 countries that are part of the GLOBOCAN 2020 database, developed by the International Agency for Research on Cancer (IARC). As well as new cases and deaths of NHL, corresponding age-standardized (world) rates (ASR) of incidence and mortality per 100 000 person-years were derived by country and world region. In 2020, an estimated 544 000 new cases of NHL were diagnosed worldwide, and approximately 260 000 people died from the disease. Eastern Asia accounted for a quarter (24.9%) of all cases, followed by Northern America (15.1%) and South-Central Asia (9.7%). Incidence rates were higher in men than in women, with similar geographical patterns. While the incidence rates were highest in Australia and New Zealand, Northern America, Northern Europe and Western Europe (>10/100 000 for both sexes combined), the highest mortality rates (>3/100 000) were found in regions in Africa, Western Asia and Oceania. The large variations and the disproportionately higher mortality in low- and middle-income countries can be related to the underlying prevalence and distribution of risk factors, and to the level of access to diagnostic and treatment facilities.

Benzene exposure increases the risk of non-Hodgkin's lymphoma: a systematic review and meta-analysis of observational studies.

BackgroundAlthough there is sufficient evidence that benzene exposure increases the risk of leukemia, whether benzene exposure increases the risk of non-Hodgkin’s lymphoma (NHL) remains controversial. The method of meta-analysis can reduce the uncertainty in evidence-based medicine (EBM) evidence decision-making caused by the bias between studies by systematically searching, evaluating, and combining all relevant literatures.MethodsPubMed, Embase, ScienceDirect and other databases were searched according to the population exposure comparison outcome principles: whether the general population exposed to benzene has a higher risk of developing NHL than the population without benzene exposure. Two independent researchers extracted the main endpoint indicators from the included literature, including the odds ratio (OR) or relative risk (RR) of benzene exposure to the risk of NHL. Risk of bias was assessed for each study using the Newcastle-Ottawa scale (NOS). Heterogeneity between studies was evaluated using the Cochrane Q test and I2 statistics, and combined risk estimates were calculated with the random-effects and fixed-effect models. Meanwhile, source of heterogeneity was evaluated by subgroup analysis. Publication bias was evaluated by funnel plot and Egger’s test, and the stability of results was evaluated by sensitivity analysis. All results with P<0.05 were considered statistically significant.ResultsA total of 14 articles were included in this study for meta-analysis, including 9 cohort studies and 5 case-control studies with NOS scores between 5 and 9. Four of the articles were at low risk of bias, and 10 were at moderate risk of bias. Of 492,719 people with benzene exposure, there were 1,994 cases of NHL. The OR of NHL in the benzene-exposed population compared with nonexposed population was 1.23 (P=0.03), with moderate heterogeneity (I2=63.47%). People with high exposure to benzene showed a higher risk of NHL (OR =1.81) and there was a low degree of heterogeneity (I2=27.56%). The risk of benzene exposure in China (OR =2.48) was higher than that in Europe (OR =1.19), the United Kingdom (OR =1.07), and the United States (OR =1.24).ConclusionsBenzene exposure was positively correlated with the incidence of NHL.

Selected Domains within a Comprehensive Geriatric Assessment in Older Patients with Non-Hodgkin Lymphoma are Highly Associated with Frailty

BackgroundThe incidence of Non-Hodgkin Lymphoma (NHL) is increasing, particularly among older patients who tend to have worse outcomes and can be predisposed to increased toxicities and less treatment tolerance. Therefore, a thorough pre-treatment assessment is essential. A comprehensive geriatric assessment (CGA) can be used to evaluate the older patient considering chemotherapy and is the preferred evaluation tool. However, a formal CGA is laborious, complex and time-consuming.ObjectivesTo characterize older adults with NHL and determine the CGA variables with the greatest association to frailty in order to propose a more simplified assessment.MethodsWe performed a cross-sectional study using data collected from CGAs in NHL patients > 65 years admitted to our oncology service, from September 2015 to August 2017. Our evaluation parameters included: polypharmacy, a screening tool of older people's prescriptions (STOPP), the Lawton scale, Barthel index, Katz index, gait speed, a Timed Up and Go (TUG) test, a Mini-Mental state examination (MMSE), the Yesavage and Gijon scales, a Mini-nutritional assessment (MNA), a Geriatric Syndromes assessment, and a Cumulative Illness Rating Scale-Geriatric (CIRS-G). The formal CGA was comprised of nine domains; frailty was defined as an impairment in > 2 domains. Each parameter was individually compared with frailty, and the results were used to build different multivariate models using logistic regression analyses to obtain the variables with the highest frailty association.ResultsA total of 253 patients were included. Their median age was 75.4 years (range 65–92), and 62.1% had > 1 impaired domain, with 39.9% considered frail. Bivariate analysis showed strong associations with age > 85 and all the geriatric parameters except for STOPP. Our final multivariate analysis resulted in 5 domains (the use of > 5 medications, a Lawton < 7, TUG > 20, Yesavage > 5, and the presence of at least one geriatric syndrome) being significantly associated with frailty and performing similarly to a CGA.ConclusionIn our population of older NHL patients, an abbreviated evaluation based of only five domains, polypharmacy, TUG, Lawton scale, Yesavage scale and the presence of at least one geriatric syndrome, had similar performance to a formal CGA in determining frailty.

No increased risk of mature B-cell non-Hodgkin lymphoma after Q fever detected: results from a 16-year ecological analysis of the Dutch population incorporating the 2007-2010 Q fever outbreak.

BackgroundA causative role of Coxiella burnetii (the causative agent of Q fever) in the pathogenesis of B-cell non-Hodgkin lymphoma (NHL) has been suggested, although supporting studies show conflicting evidence. We assessed whether this association is present by performing a detailed analysis on the risk of mature B-cell NHL after Q fever during and after the largest Q fever outbreak reported worldwide in the entire Dutch population over a 16-year period.MethodsWe performed an ecological analysis. The incidence of mature B-cell NHL in the entire Dutch population from 2002 until 2017 was studied and modelled with reported acute Q fever cases as the determinant. The adjusted relative risk of NHL after acute Q fever as the primary outcome measure was calculated using a Poisson regression.ResultsBetween January 2002 and December 2017, 266 050 745 person-years were observed, with 61 424 diagnosed with mature B-cell NHL. In total, 4310 persons were diagnosed with acute Q fever, with the highest incidence in 2009. The adjusted relative risk of NHL after acute Q fever was 1.02 (95% CI 0.97–1.06, P = 0.49) and 0.98 (95% CI 0.89–1.07, P = 0.60), 0.99 (95% CI 0.87–1.12, P = 0.85) and 0.98 (95% 0.88–1.08, P = 0.67) for subgroups of diffuse large B-cell lymphoma, follicular lymphoma or B-cell chronic lymphocytic leukaemia, respectively. Modelling with lag times (1–4 years) did not change interpretation.ConclusionWe found no evidence for an association between C. burnetii and NHL after studying the risk of mature B-cell NHL after a large Q fever outbreak in Netherlands.

Profiling the Cytopathological Diagnosis of Enlarged Lymph Nodes on Fine Needle Aspiration Cytology.

This study aimed to assess the distribution of fine-needle-aspiration-cytology or biopsy findings through cytopathological patterns of lymph nodes aspirations in different age groups of the population visiting a tertiary level hospital in Kathmandu. The retrospective study was conducted on the database of the 226 lymphadenopathy cases that underwent biopsy fine needle aspiration cytology from 1 January 2016 to 31 December 2019 at the Department of pathology of Helping Hand's Community Hospital, Kathmandu. A descriptive analysis was performed yielding proportions and counts for the quantitative variables. Chi-squared test was used to compare the proportions. Point estimates and confidence intervals for measures of association were assessed with 95% confidence interval andp-value ?0.05 was considered statistically significant. The 20-40 years were the most common age group undergoing biopsy fone needle aspiration cytology procedures. Males recorded majority of cases (68%, 153 of 226). The highest incidence of Reactive lymphadenitis was obtained (50%, 113 of 226) and it was the most common findings in the age group of <20 and 40-60 years. The Cervical lymph node (86%) was the most common anatomical location followed by axillary lymph nodes (8%). Squamous cell carcinoma and Adenocarcinoma accounted for more than half (53%, 20 of 38) of all the diagnosed malignancy. The incidence of Non-Hodgkin lymphoma and Hodgkin lymphoma were 8% (n = 3 of 38) and 5% (n = 2 of 38) respectively. Lymph node enlargement is associated with a wide range of etiologies with Reactive lymphadenitis as the most common cause and cervical lymph node as the common site.

Global, regional and national burden of non-Hodgkin lymphoma from 1990 to 2017: estimates from global burden of disease study in 2017

Backgroud Non-Hodgkin lymphoma (NHL) is a common B/NK/T cell lymphoma. We collected detailed data about the incidence and mortality of NHL from Global Burden of Disease (GBD) Study in 2017 and extensively assessed the disease burden of NHL at the global level and also analysed its current trends according to sex, age, socio-demographic index (SDI), country and region. Methods By obtaining relevant data from Global Burden of Disease Study in 2017, estimated annual percentage changes (EAPCs) of age-standardized rate (ASR) were calculated to assess the current trends of the rate of incidence and mortality. Results Globally, ASR of incidence in NHL was increased while ASR of mortality and its annual percentage change was relatively stable. EAPCs in the incidence of NHL decreased in the low SDI regions but increased in the high SDI regions. The ratio of male to female mortalities was the highest in the 50–69-year-old age group, especially in the middle and middle-high SDI regions. Conclusion The incidence of NHL was increased globally, whereas the deaths and its annual percentage change were relatively stable from 1990 to 2017. Key messages Age-standardized rate (ASR) of incidence in NHL was increased globally from 1990 to 2017. ASR of mortality and its annual percentage change in NHL were relatively stable globally from 1990 to 2017. Estimated annual percentage changes (EAPCs) in the incidence of NHL decreased in the low socio-demographic index (SDI) regions but increased in the high SDI regions.

Risk of Non-Hodgkin Lymphoma among Patients with Hepatitis B Virus and Hepatitis C Virus in Taiwan: A Nationwide Cohort Study.

Simple SummaryNon-Hodgkin lymphoma (NHL) is difficult to diagnose and has a high mortality rate. Large-scale database research is necessary to examine and strengthen the correlation between viral hepatitis and NHL. This retrospective cohort study analyzed differences in the risk of developing NHL for patients with hepatitis to elucidate these relationships by using nationwide data from Taiwan’s National Health Insurance Research Database. In this study, the incidence rate of NHL in patients with hepatitis B was 0.22%, and in patients with hepatitis C, the incidence rate of NHL was 0.35%. These comparisons indicate that patients with HBV or HCV have a higher incidence of NHL (OR, 2.37; 95% CI, 1.93–2.91).Hepatitis B virus (HBV) and hepatitis C virus (HCV) are associated with an increased risk of developing non-Hodgkin lymphoma (NHL); however, adequate data corroborating these associations are lacking. Therefore, a study based on the national database was performed to investigate the correlation between HBV and HCV with NHL in Taiwan. This research was a retrospective cohort study using a nationally representative database established by the Health and Welfare Data Science Center of the Ministry of Health and Welfare, Taiwan. The participants were patients with HBV and HCV, analyzed using the propensity score matching method. The study results indicated that the incidence rate of NHL (0.13%) was significantly higher than that in patients from the general population. After controlling related variables, the hazard ratio (HR) of the incidence of NHL in patients with hepatitis was 2.37 (95% CI, 1.93–2.91). Furthermore, the incidence of NHL in patients with HBV was significantly higher than in patients from the general population (HR, 2.49; 95% CI, 1.94–3.19). The incidence of NHL in patients with HCV was significantly higher than in patients from the general population (HR, 2.36; 95% CI, 1.73–3.22). This study indicated that HBV and HCV significantly increase the risk of NHL.

Progress against non-Hodgkin's lymphoma in children and young adolescents in the Netherlands since 1990: Stable incidence, improved survival and lower mortality

BackgroundWith epidemiologic analyses of population-based trends in incidence and outcomes, we ascertained progress against non-Hodgkin's lymphoma (NHL) in children and young adolescents in the Netherlands since 1990. MethodsTumour characteristics were extracted from the Netherlands Cancer Registry for patients aged <18 years at diagnosis, between 1990 and 2015. Mortality data for 1980–2016 were derived from Statistics Netherlands. NHL subtypes comprised lymphoblastic lymphoma (LBL), Burkitt lymphoma (BL), diffuse large B-cell lymphoma (DLBCL) and anaplastic large cell lymphoma (ALCL). Time trends in incidence and mortality rates and 5-year overall survival (OS) rates were evaluated by average annual percentage change (AAPC) analyses and parametric survival models, respectively. ResultsOverall incidence of NHL remained stable at 11 per million person-years (AAPC -0.2%, p = 0.68), with a marked decrease among children of 5–9 years (AAPC -2.6%, p < 0.01), especially among those with BL. Treatment regimens comprised less radiotherapy over time, especially for LBL and BL. Since 2004, most 15–17-year-old patients with NHL have been treated at a paediatric oncology centre. Five-year OS improved from 71% in 1990–94 to 87% in 2010–15 (p < 0.01), the most gain has been achieved in patients with DLBCL and ALCL from 60% and 73%, respectively, to both 90%. Population-based mortality from NHL decreased significantly towards 1.4 per million person-years (AAPC -4.2%, p < 0.01). ConclusionsThis population-based epidemiological study exhibited significant progress against childhood and young adolescent NHL in the Netherlands since 1990, before the advent of a national paediatric oncologic centre in 2018: incidence decreased among children of 5–9 years, survival improved, and mortality steadily decreased over time.

Radiation risks of lymphoma and multiple myeloma incidence in the updated NRRW-3 cohort in the UK: 1955–2011

The effect of external radiation on lymphoma, including non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL) and multiple myeloma (MM) incidence was evaluated in the National Registry for Radiation Workers based upon the third analysis cohort but with an additional 10 years of follow-up. The study includes 172 452 workers, of whom (90%) were men with 5.25 million person-years of follow-up from 1955 through to the end of 2011. A total of 711 cases of NHL, 113 cases of HL and 279 cases of MM were registered. Poisson regression was used to estimate the excess relative risk per unit of cumulative exposure to ionising radiation. A statistically significant association was found between radiation dose and the incidence of NHL and MM. There was no evidence of radiation associated excess risk for HL. The reported associations are based on a very small proportion of exposed workers, in particular among workers with cumulative doses above 0.5 Sv so should be treated with caution, further investigations are necessary to confirm our results.