non-Hodgkin Lymphoma Mortality Research Articles

Global burden, risk factors, and trends of non-Hodgkin lymphoma: A worldwide analysis of cancer registries.

Non-Hodgkin lymphoma (NHL) accounts for 90% of all malignant lymphomas. This study aimed to evaluate the global incidence, mortality, associated risk factors, and temporal trends of NHL by sex, age, and country. Data from 185 countries globally were used for analysis. NHL incidence and mortality were collected via the GLOBOCAN (2020), CI5 series I-X, WHO mortality database, the Nordic Cancer Registries, and the SEER Program. The WHO Global Health Observatory provided country-level, age-standardized prevalence of lifestyle and metabolic risk factors. Trends were examined and reported based on average annual percentage change (AAPC) calculated using Joinpoint regression analysis. Incidence and AAPC are based on data for the last 10 years across countries. Globally, age-standardized incidence and mortality rates for NHL were recorded at 5.8 and 2.6 per 100,000 individuals, respectively. At country-level, NHL incidence was significantly associated with various factors, including HDI (Human Development Index), GDP per capita, prevalence of tobacco and alcohol consumption, sedentary lifestyle, obesity, hypertension, diabetes and hypercholesterolaemia. Rising trend in NHL incidence was observed, with the highest increase recorded in Estonia (AAPCmale = 4.15, AAPCfemale = 5.14), Belarus (AAPCfemale = 5.13), and Lithuania (AAPCfemale = 4.68). While overall NHL mortality has been decreasing, certain populations experienced increased mortality over the decade. In Thailand, AAPC for mortality was 31.28% for males and 30.26% for females. Estonia saw an AAPC of 6.46% for males, while Slovakia experienced an AAPC of 4.24% for females. Colombia's AAPC was 1.29% for males and 1.51% for females. This study indicates a rising trend of NHL incidence over the past decade- particularly in developed countries, older males, and younger populations. Further research should investigate deeper insights into specific etiology and prognosis of NHL across subtypes, and potential contributors towards these epidemiologic trends.

Trends in Diffuse Large B-Cell Lymphoma Mortality in the United States: A Comprehensive Review from 2000 to 2020

Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of Non-Hodgkin Lymphoma (NHL), accounting for approximately 30% of all cases. While NHL mortality rates have shown a downward trend over the last two decades, comprehensive investigations into DLBCL mortality trends and disparities across racial, ethnic, gender, and geographical categories in the United States are notably scarce. Methods: Utilizing the Centers for Disease Control and Prevention's (CDC) WONDER database we identified all patients who died from NHL and DLBCL from 2000 to 2020. Age-adjusted mortality rates per 100,000 persons (AAMR) were calculated and standardized to the 2000 US census data. The National Cancer Institute (NCI) Joinpoint Regression Program was used to analyze these data to calculate annual percent changes (APCs) and average annual percent changes (AAPCs). Statistically significant changes were confirmed when the confidence interval for the APC or AAPC did not encompass zero. Additionally, subgroup analyses were conducted based on race, ethnicity, gender, and geographic location. Results: The study identified 434,419 NHL and 46,252 DLBCL deaths. NHL mortality showed a statistically significant average annual decrease of 2.5% (95% CI: -2.7 to -2.4). DLBCL mortality trends varied, initially decreasing from 2000 to 2008, then notably increasing from 2008 to 2011, and subsequently rising moderately from 2011 to 2020. This pattern culminated in a statistically significant overall average annual increase of 3.5% (95% CI: 0.4 to 6.7) in DLBCL mortality. Subgroup analyses revealed that males, Blacks, and Asians or Pacific Islanders experienced the most marked upward trends in DLBCL mortality. Both metropolitan and non-metropolitan areas reported an increase in DLBCL mortality, with metropolitan areas showing a more pronounced rise. Conclusion: Representing the most comprehensive analysis of DLBCL mortality trends to date, our study revealed intriguing disparities among the subgroups we investigated, along with an upward trend in mortality rates that departs from previously reported data. The divergence could be attributed, in part, to the expansive population coverage of the database we utilized and the use of death certificates, which may present discrepant results from other cancer registries. These findings underscore the necessity for ongoing research, guiding the development of targeted intervention strategies for DLBCL and informing efforts to bridge the identified disparities.

Trends in non-Hodgkin lymphoma mortality rate in Japan and the United States: A population-based study.

Characterizing trends in mortality rates with consideration of trends in incidence rates at the population level could help identify unmet needs in public health and provide essential indicators of cancer control. In the late 20th century, the arrival of the first molecular targeted agent, rituximab, for non-Hodgkin lymphoma (NHL) led to a paradigm shift in NHL treatment. However, the public health impact of this arrival has not been fully clarified. Here, we evaluated trends in the mortality and incidence rates of NHL in Japan and the United States. Age-standardized rates of mortality reversed after the introduction of rituximab, around 2000, beginning to decline significantly with annual percent changes (95% confidence interval) of -2.6% (-3.6% to -1.6%) in Japan and - 3.9% (-4.2% to -3.5%) in the United States. Despite an increase in incidence, the mortality in all age groups weakened the upward trends or decreased in both countries. From a long-term perspective, the trends in mortality rates differed between the countries. In the United States, the mortality rate has declined continuously since the introduction of rituximab, with a declining incidence rate. In contrast, in Japan, the mortality rate stopped declining and the incidence rate increased remarkably. The introduction of rituximab has had a substantial impact at the population level across a wide range of individuals. To reduce the disease burden in terms of mortality, elucidating risk factors that lead to a decreasing incidence rate is warranted for NHL, as well as further development of novel treatments.

Abstract 6497: Availability of healthcare providers and its association with survival outcomes in non-Hodgkin lymphoma in the United States

Abstract Background: Survival outcome in Non-Hodgkin lymphoma (NHL) is significantly better in earlier stages, compared to advanced stages. Early identification of signs and symptoms, and prompt specialist availability and referral, are crucial for diagnosis and treatment at earlier stages. Mounting physician shortages are a growing concern, and we sought to analyze their effect on NHL mortality rates. Methods: We extracted data on the age-adjusted mortality rate (AAMR) and crude incidence rate (CIR) of NHL for all U.S. states and the District of Columbia from the Center for Disease Control (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database (2017-2019). Nevada was excluded due to missing information. Data on the state-wise number of primary care physicians (PCPs) was obtained from the Association of American Medical Colleges (AAMC) state physician workforce data report (2020), and of Hematology/Oncology specialists (HOs) was gathered from the National Provider Identifier (NPI) registry (2020). The number of PCPs and HOs per each NHL incidence (PCP/CIR, HO/CIR respectively) was then calculated. Correlations were analyzed using Pearson’s coefficient. Statistical analysis was performed using VassarStats. Results: Median AAMR for NHL in the US was 5.15 (IQR 4.35, 5.95) per 100, 000 population. The median number of PCP and HO per each case of NHL incidence was 4.32 (IQR 3.43, 5.21), and 0.28 (IQR 0.1, 0.37) respectively. States with fewer PCPs per each NHL incidence had higher AAMR (r=-0.37, p=0.007). States with a lower number of HOs per each NHL incidence had higher AAMR (r=-0.41, p=0.003) Conclusions: Based on the analysis, the availability of a lower number of PCPs and HOs per each NHL incidence is associated with increased AAMR of the disease. This data may strengthen the need for intensification of focus on decreasing the soaring physician shortages in the states, in order to help decrease the overall mortality associated with NHL. Citation Format: Shiva Jashwanth Gaddam, Udhayvir Singh Grewal, Zara Hassan, Poornima Ramadas. Availability of healthcare providers and its association with survival outcomes in non-Hodgkin lymphoma in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6497.

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

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.

Non-Hodgkin Lymphoma Mortality in the Elderly Population By Race, Gender, and Region in the United States

Background: Over the past decades, non-Hodgkin lymphoma (NHL) patients have significant improvement in the 5-year relative survival rate. In elderly NHL patients, comorbidities play a major role in mortality. Studies have shown that lower survival rates are multifactorial and strongly associated with certain races, gender, socioeconomic status, and availability of rituximab. Therefore, we aim to assess the differences in causes of mortality among races and genders. To better understand environmental contributions to one-year survival rate in NHL patients state-wise in the US, we examined the mortality-to-incidence rate (MIR) in senior NHL patients characterized by race, gender, and American health ranking (AHR) index.Methods: This is a retrospective study using the Centers for Disease Control and Prevention database from 2008 to 2017. Patients ≥65 years with non-Hodgkin lymphoma were included. AHR assesses the nation's health on a state-by-state basis to determine state health rankings with a composite index of health measures. AHR consists of five weighted core measures (four groups of health determinants and one health outcome): (1). Behaviors including excessive drinking, obesity, smoking, (2). Community and environment including air pollution, poverty, infectious disease, violent crime, (3). Policy including immunization, public health funding, uninsured rate, (4). Clinical care including primary care physicians, mental health providers, preventable hospitalizations, and (5). Outcomes including cancer deaths, cardiovascular deaths, diabetes, disparity in mental status. A ten-year (2008-2017) average of all-determinants value from AHR were reported and MIR, a parameter that can serve as a proxy for survival, was compared between US states. We analyzed the association between NHL mortality and state health disparities using linear regression. Multiple-cause-of-death data is based on death certificates for US residents. Each death certificate contains a single underlying cause of death, up to twenty additional multiple causes, and demographic data. We analyzed the multiple cause age-adjusted mortality rate in White males and females versus African American males and females. All data were analyzed using R version 4.0.5, with p-values <0.05 in two-sided t-tests to indicate statistical significance.Results: In this 10-year analysis, the mean age-adjusted mortality rate (AAMR) in Whites, African Americans, and all populations were 38.2, 21.4, and 36.7 per 1,000,000 population, respectively. Among all 50 states, Idaho had the highest AAMR for all populations (42.7/1,000,000) and Whites (43.1/1,000,000); Minnesota had the highest AAMR for African Americans (29/1,000,000). District of Columbia had the lowest AAMR for all populations (26.4/1,000,000); New Mexico had the lowest AAMR for Whites (30.6/1,000,000) and New York had the lowest AAMR for African Americans (Table 1). Our results demonstrated that elderly NHL patients in states with better health all-determinants index had significantly lower MIR in all populations (R 2=0.2654, p <0.001, Figure 1). The three lowest MIR states in the US were Florida (0.319), Connecticut (0.348), and New York (0.348) (Figure 2). Whites were more likely to have underlying comorbidities than African Americans, especially ischemic heart disease (Male: OR 87.16, 95% CI 74.23-102.34; Female: 26.10, 95% CI 22.01-30.94), congestive heart failure (Male: OR 53.31, 95% CI 45.35-62.66; Female: OR 25.98, 95% CI 22.25-30.34), and chronic obstructive pulmonary disease (Male: OR 54.55, 95% CI 45.27-65.73; Female: OR 45.98, 95% CI 36.48-57.95) (Table 2,3).Conclusions: States of better health index in terms of all determinants had lower MIR for elderly NHL patients in the US. Factors contributing to the difference in MIR possibly include variations in socioeconomic status, insurance coverage, and healthcare access. Our results highlight the need to focus on secondary prevention to decrease morbidities and health disparities in NHL patients. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

A Registry-Based Geodemographic Assessment of Non-Hodgkin Lymphoma Subtypes in North Carolina

Background: Non-Hodgkin lymphoma (NHL) is the most common hematologic malignancy in the United States. NHL comprises a heterogeneous group of over 40 histological subtypes, each of which has distinct genetic, morphologic and clinical features. While NHL epidemiology as a single entity has been well-characterized using population-based cancer registry data, the epidemiology of NHL subtypes is not well understood and even less data are available for rarer subtypes. We aimed to determine geodemographic correlates for NHL subtypes in North Carolina to provide rarely reported epidemiologic characterization of each distinct malignancy.Methods: Demographic data were obtained on all NHL subtypes reported in persons >18 years of age from 2009-2019 from the North Carolina Central Cancer Registry (NCCCR). NHL subtypes were determined based on World Health Organization International Classification of Diseases for Oncology,Third Edition (ICD-O-3) Morphology codes provided by NCCCR. Crude incidence and mortality rates were estimated per 100,000 persons for the 10-year period using 2019 population data from the U.S Census Bureau. Urban and rural residence designations were based on zip code using rural-urban commuting codes developed by the Rural Health Research Center. County tier designations were used as markers of economic prosperity, with 3 being most prosperous, and provided by the North Carolina Department of Commerce. Data are being mapped using ESRI ArcMap 10.8.1.Results: A total of 25,627 incident cases of NHL and 9,930 associated deaths were reported between 2009 and 2019 in North Carolina. Therefore, the standard NHL incidence and mortality rates are 24.1 and 9.3 per 100,000 persons. For incident NHL cases, median age at diagnosis was 68 years (range 19-103), 55% were male and 45% female. Most (83%) identified as white, 14% as black, and 3% as other. Median age at death was 70 years (range 19-106). Twenty-eight NHL subtypes were identified with the four most common NHL subtypes being Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL), Diffuse Large B Cell Lymphoma (DLBCL), Follicular Lymphoma (FL), and Marginal Zone Lymphoma with 6.54, 6.42, 3.55, and 2.0 cases (per 100,000 persons), respectively. Least common subtypes included Intravascular Large B Cell Lymphoma, Primary Effusion Lymphoma, Primary Cutaneous Gamma Delta T-cell Lymphoma (PCGD-TCL) and Subcutaneous Panniculitis-Like T-cell Lymphoma, all with 0.01 cases per 100,000 persons (or 15, 14, 9 and 6 cases respectively). The distribution of NHL subtypes varied according to demographics with several notable findings. DLBCL had the highest crude mortality rate of 2.98 deaths/100,000 persons, followed by CLL (2.12 deaths/100,000 persons), FL (0.98 deaths/100,000 persons) and Lymphoma NOS (0.51 deaths/100,00 persons). Mediastinal Large B-cell Lymphoma (MLBCL) was diagnosed in the youngest individuals with median age of 36 (range 20-74), whereas PCGD-TCL occurred in the oldest with median age of 74 (range 31-99). Primary Effusion Lymphoma had the highest male predominance (93%) and MLBCL had the highest female predominance (73%). Mantle Cell Lymphoma had the highest predominance of persons who identify as white (90%), Anaplastic Large Cell Lymphoma (ALK+/-) with those who identify as black (66%), and Primary Effusion Lymphoma with those who identify as other (14%). Predominance of rurality and county tier designations varied by NHL subtype.Conclusions: A registry-based assessment of NHL subtypes illustrates the heterogeneous nature of this group of malignancies and highlights significant variation in the geodemographic features of each subtype. Evaluating geodemographic correlates deepens our understanding of NHL subtypes and can inform populations at risk for each unique NHL subtype. [Display omitted] DisclosuresDittus: BeiGene: Other: Advisory Board; Seattle Genetics: Research Funding; AstraZeneca: Research Funding; Genentech: Research Funding.

Mortality in a cohort of US firefighters from San Francisco, Chicago and Philadelphia: an update

ObjectivesTo update the mortality experience of a previously studied cohort of 29 992 US urban career firefighters compared with the US general population and examine exposure-response relationships within the cohort.MethodsVital...

Long-term time trends in incidence, survival and mortality of lymphomas by subtype among adults in Manitoba, Canada: a population-based study using cancer registry data

ObjectiveTo examine 30-year time trends in incidence, survival and mortality of lymphomas by subtype in Manitoba, Canada.MethodsLymphoma cases diagnosed between 1984 and 2013 were classified according to the 2008 WHO...

The burden of non-Hodgkin lymphoma in Central and South America

Rationale and objectiveThe burden of non-Hodgkin lymphoma (NHL) has increased in some Central and South American countries. We describe the current patterns and trends in NHL incidence and mortality in Central and South America. MethodsWe obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries, and national-level cancer mortality data from the WHO mortality database for 18 countries. We estimated world population age-standardized incidence rates (ASRs) and mortality rates (ASMRs) per 100,000 person-years for 2003–2007, and presented distributions by histological subtype. ResultsNHL incidence and mortality rates varied between countries by 2–8- and 6-fold, respectively. ASRs per 100,000 ranged from 1.4 to 10.9 among males and 1.3–9.2 among females. Corresponding ASMRs were between 0.5 and 4.8 among males and between 0.5 and 3.0 among females. The highest incidence was observed in Uruguay (males), Ecuador, Peru and Colombia (males). The highest mortality was seen in Uruguay and Costa Rica. Trends in NHL incidence and mortality in Argentina, Brazil, Chile and Costa Rica did not show marked changes. B-cell neoplasms and NHL not otherwise specified (NOS) accounted for 44% and 34% of all NHL cases. Diffuse large B-cell lymphoma, NOS, was the most frequent histological subtype. ConclusionThe geographic variations in NHL rates may partially reflect differences in registration practices, disease classification, diagnostic practice, and death certification quality. There is a need for high-quality data and improvements in the accuracy of NHL histological diagnosis. Given the expected increase in NHL, careful monitoring of rates remains a priority to guide cancer control programs.

Contributions of HIV to Non-Hodgkin Lymphoma Mortality Trends in the United States.

The human immunodeficiency virus (HIV) epidemic has strongly influenced non-Hodgkin lymphoma (NHL) incidence in the U.S. general population, but its effects on NHL mortality trends are unknown. Using SEER cancer registry data, we assessed NHL mortality rates in the United States (2005-2012) and mapped NHL deaths to prior incident cases. Data included HIV status at NHL diagnosis. We describe the proportion of NHL deaths linked to an HIV-infected case, for 3 AIDS-defining subtypes [diffuse large B-cell lymphoma (DLBCL), Burkitt lymphoma, and central nervous system (CNS) lymphoma] and within demographic categories. We also present incidence-based mortality (IBM) rates showing the impact of HIV on mortality trends and describe survival after NHL diagnosis by calendar year. Of 11,071 NHL deaths, 517 (4.6%) were in HIV-infected persons. This proportion was higher in deaths mapped to DLBCL (7.3% with HIV), Burkitt lymphoma (33.3%), and CNS lymphoma (17.6%), and among deaths from these subtypes, for people aged 20-49 years (46.6%), males (15.2%), and blacks (39.3%). IBM rates declined steeply during 2005-2012 for HIV-infected NHL cases (-7.6% per year, P = 0.001). This trend reflects a steep decline in incident NHL among HIV-infected people after 1996, when highly active antiretroviral therapy was introduced. Five-year cancer-specific survival improved more markedly among HIV-infected cases (9%-54%) than HIV-uninfected cases (62%-76%) during 1990-2008. The HIV epidemic has strongly contributed to NHL deaths, especially for AIDS-defining NHL subtypes and groups with high HIV prevalence. Declining NHL mortality rates for HIV-infected cases reflect both declining incidence and improving survival. Cancer Epidemiol Biomarkers Prev; 25(9); 1289-96. ©2016 AACR.

Contributions of Subtypes of Non-Hodgkin Lymphoma to Mortality Trends.

Non-Hodgkin lymphoma (NHL) comprises distinct tumor subtypes. Although mortality from NHL overall has changed dramatically in the United States over time, little is known about trends for subtypes, because death certificates do not record this information. Using data from U.S. Surveillance, Epidemiology, and End Results (SEER) areas, we assessed NHL mortality rates and mapped NHL deaths to incident NHL cases in SEER cancer registries. This allowed us to evaluate population-level mortality trends attributed to specific NHL subtypes (incidence-based mortality; IBM). We also describe NHL incidence and survival after NHL diagnosis by calendar year. We used Joinpoint to identify years when IBM and incidence rate trends changed slope. Overall NHL mortality rates increased during 1975-1997, peaking at 10.9 per 100,000 person-years, then decreased subsequently in 1997-2011. Overall IBM rates mirror this trend during 1990-2011. For B-cell NHL subtypes, IBM rates decreased beginning in the mid-1990s, with yearly declines of -3.0% for diffuse large B-cell lymphoma (DLBCL), -2.7% for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), and -5.3% for follicular lymphoma. Incidence rates for these subtypes did not decrease until after 2003. Corresponding 5-year cancer-specific survival increased dramatically over time for DLBCL (from 37%-66%), CLL/SLL (69%-84%), and follicular lymphoma (69%-82%). IBM for peripheral T-cell lymphoma was flat during 2006-2011, although incidence increased. Mortality due to three common B-cell NHL subtypes has fallen over time in the United States. This decline reflects better survival after NHL diagnosis, likely from improved therapies, because the decline in NHL incidence occurred later.

Determinants Of Non-Hodgkin Lymphoma Mortality In 117 Countries: An Ecological Study

Introduction: Non Hodgkin's Lymphoma (NHL) mortality has been increasing worldwide, and it is one the most incident among hematologic cancers. HIV and pesticides exposure have been associated with NHL mortality, but it is also important to understand how, and if, social determinants are associated with mortality by this cancer. The aim of this study was to estimate an association between NHL Standardized Mortality Rates (NHL-SMR) and social determinants, having Human Development Index (HDI) and Country Income Level (CIL) as proxy of these determinants. Methods: secondary data from 117 Countries were collected from: NHL-SMR (as outcome) from GLOBOCAN/IARC-2012; CIL from World Bank (divided into: high; upper middle; lower middle; and low income Countries); pesticide per capita consumption (as a proxy of the population exposure to these chemicals and divided into tertiles of pesticide consumption) from FAO/WHO; HDI from UNDP/WHO; and HIV prevalence (HIVp) from UNAIDS/WHO. A GLM model (with gamma distribution) was used to establish association between NHL-SMR and HDI and CIL, having per capita pesticide consumption and HIVp as potential confounders. Results: The high level income Countries had lower NHL-SMR (beta=-0.562; p=0.041 - compared with the low income Countries), and the HDI is inversely associated with NHL-SMR (beta=-0.142; p=0.016), adjusting for per capita pesticide consumption (beta=0,462; p=0.02 – higher tertiles compared with the lower tertiles), and for HIVp (beta=0.024; p

Non-Hodgkin Lymphoma Mortality Time Trends In Brazil, 1980-2012

Objective: This paper aims to analyze the Non Hodgkin Lymphoma (NHL) mortality time trend in Brazil. Methodology: This was an epidemiological temporal trend study, with information on NHL deaths from 1980 to 2012 (ICD 9 and 10), standardized by age using the direct method. A Poisson (joinpoint) model was employed to estimate the Annual Percent Change (APC) of NHL mortality. Results: In Brazil and regions, there had a statistical significant increasing trend in the mortality ratio by NHL only from 1989 a 1998 (APC=3,4%; p

Parity, Age at First Birth, and Risk of Death from Non-Hodgkin's Lymphoma: A Population-Based Cohort Study in Taiwan.

We undertook this study to examine whether there exists an association between parity and age at first birth and risk of death from non-Hodgkin’s lymphoma (NHL). Our sample included a total of 1,292,462 women who had a first and singleton childbirth between 1 January 1978 and 31 December 1987. We followed each subject from their first childbirth to 31 December 2009, and determined their vital status by merging natality data with Taiwan’s national death certificate database. Hazard ratios (HR) of death from NHL associated with parity and age at first birth were estimated using Cox proportional hazard regression models. In all, 412 NHL deaths were recorded during 34,980,246 person-years of follow-up. NHL mortality rate was 1.18 cases per 100,000 person-years. Older age at first birth (>23 vs. ≤23 years) was linked to an increased risk of death from NHL (adjusted HR = 1.41; 95% CI = 1.13–1.75). Controlling for age at first birth, the adjusted HR were 0.74 (95% CI = 0.55–0.98) for women with 2 births, and 0.71 (95% CI = 0.53–0.95) for women with 3 births or more, respectively, when compared with women with only 1 birth. A statistically significant downward trend in the adjusted HR for NHL death was detected with increasing parity (p for trend = 0.05). The HR of death from NHL was decreased by 7% (HR = 0.93; 95% CI = 0.87–0.99) for each additional parity. Our findings are consistent with reproductive factors (parity and early age at first birth) conferring a protective effect against the risk of NHL death.

Tendência de mortalidade por linfomas não Hodgkin no Brasil, 1980 a 2012

ResumoObjetivoAnalisar a tendência de mortalidade por linfoma não Hodgkin (LNH) em adultos no Brasil.MetodologiaEstudo de série temporal, que utilizou informações sobre os óbitos por LNH obtidas do Sistema de Informação sobre Mortalidade entre 1980 e 2012. As taxas de mortalidade padronizadas pelo método direto foram agrupadas por Estados, regiões brasileiras e Brasil. Utilizou-se regressão Possion (Joinpoint), obtendo-se a variação percentual anual (APC) das taxas de mortalidade por LNH.ResultadosNo Brasil e na região Sudeste, a taxa de mortalidade por LNH apresentou tendência crescente somente no período de 1989 a 1998 (APC=3,4% e p&lt;0,05; APC=3,0%; p&lt;0,05, respectivamente), enquanto nas regiões Centro-Oeste (APC=2,3%; p&lt;0,05), Norte (APC=1,5%; p&lt;0,05) e Nordeste (APC=3,1%; p&lt;0,05) houve tendência estatisticamente significante de aumento em todo o período. A região Sul não apresentou tendência estatisticamente significativa no período.ConclusãoAs tendências das taxas de mortalidade por LNH não foram homogêneas no Brasil e regiões, o que pode sugerir diferentes fatores de risco, qualidade dos sistemas de informação e até mesmo mudanças no diagnóstico e no tratamento do LNH em cada Estado e regiões brasileiras.

Coronary artery disease and cancer mortality in a cohort of workers exposed to vinyl chloride, carbon disulfide, rotating shift work, and o-toluidine at a chemical manufacturing plant.

We updated through 2007 the mortality experience of 1,874 workers employed at a New York State chemical manufacturing plant between 1946 and 2006. Reassessed exposures to vinyl chloride, carbon disulfide, and shift work and categories of o-toluidine exposure were based on year, department and job title. Standardized mortality ratios (SMR) compared mortality to that of the US population. Internal comparisons used directly standardized rate ratios. Hepatobiliary cancer mortality was elevated among workers ever exposed to vinyl chloride (SMR = 3.80, 95% confidence interval 1.89-6.80); directly standardized rates increased with increasing vinyl chloride exposure duration. No increase in non-Hodgkin lymphoma mortality was observed with vinyl chloride and shift work exposures. Internal comparisons showed increased coronary artery disease mortality among long-term workers exposed to carbon disulfide and shift work for 4 years or more. Excess coronary artery disease mortality confirms earlier results; further investigation is needed to understand risk factors.

The Burden Of Illness and Prevalence In Diffuse Large B-Cell (DLBCL) and Follicular (FL) Lymphomas

IntroductionIn non-Hodgkin lymphoma (NHL), particularly diffuse large B-cell (DLBCL) and follicular (FL) lymphomas, the prevalence, burden of disease, including that of relapse/recurrence, and quality of life (QoL) play a role in how novel treatment strategies are evaluated. We conducted a literature review to identify whether the current understanding of the prevalence, burden of illness (BOI) including QoL in these two predominant NHL histologies is sufficient to support novel treatment and resource allocation decisions. MethodsUsing EMBASE, PubMed, Cochrane, conference abstracts, treatment guidelines, and government, business and industry literature such as data from the WHO, we identified estimates for prevalence and BOI, defined as disease-related costs and QoL, for DLBCL and FL, from 2005 to 2013 in the US and EU5 (France, Germany, Italy, Spain, UK). In addition to appropriate MeSH (Medical Subject Headings) terms, search terms included, but were not limited to, burden of illness, quality of life, QoL, HRQoL, cost, direct cost, resource use, resource utilization, economic, incidence, prevalence, epidemiology, and mortality. FindingsBOI-related information within DLBCL and FL are very limited and antiquated DLBCLOnly one health economic study was identified – a US study using data from 1999-2000 in patients with aggressive NHL, including DLBCL (Kutikova et al. Leuk Lymphoma. 2006). Among the patients receiving initial treatment, which did not include the current standard of care R-CHOP, 68% of patients experienced treatment failure. The incremental cost of treatment failure was $14,174 per month, driven by higher initial treatment costs ($13,866 vs $4,754) and the need for secondary and/or palliative care ($5,062). However, these data may not accurately depict relapse rates and costs associated with more current standards of care. For QoL, one study was identified in DLBCL, a US based study in the elderly. The NCI sponsored Surveillance, Epidemiology, and End Results-Medical Health Outcomes Survey database was used to evaluate QoL in elderly DLBCL patients using the Short Form (SF-36) Health Survey. Patients surveyed 0–1 year after the diagnosis of DLBCL had poor QoL scores (physical component [PCS] median=33.6, mental component [MCS] median=40.8, poor self-rated health: 51.6%) (Kelly et al. Blood. 2012). FLOnly one health economic study was identified – a US study using data from 2006-2009 which estimated the cost of disease progression. Results showed that mean overall per patient per month (PPPM) costs over the 6-month follow-up were significantly higher for patients with progressive disease (PD) vs non-PD ($3527 vs. $860; difference=$ 2667; p<0.001) (Beveridge et al. Leuk Lymphoma. 2011). One QoL study was identified, a UK study that reported statistically significant differences by disease state using multiple QoL instruments. The total scores derived from the Functional Assessment of Cancer Therapy – Lymphoma (FACT-Lym) questionnaire showed that relapsed patients have lower QoL scores (109.7) than newly diagnosed patients (136.4), those achieving partial (128.81) or complete response (133.28), or when disease free (135.26) (p = 0.001) (Pettengell et al. Ann of Oncol. 2008).Regarding prevalence data, in the EU5, prevalence of DLBCL ranges from 30 – 58% of NHL cases and in the US estimates range from 25 – 35%. Prevalence of FL is lower, ranging from 11 – 19% in the EU5 and 20 – 25% in the US. Regarding the prevalence of relapse/recurrent disease, one-third of DLBCL patients are either relapsed or refractory after standard therapy (Friedberg. Clin Cancer Res. 2011; Abramson et al. Blood. 2005). ConclusionsCurrently available data related to BOI and prevalence are limited and dated making it difficult to accurately assess the impact of DLBCL and FL on patients and healthcare systems. In the absence of renewed information it may be challenging to quantify the incremental impact that novel regimens may have on clinical outcomes, BOI, and QoL. While NHL mortality has steadily decreased over the past few decades as treatment options have improved, updated and accurate epidemiologic and BOI data are needed to better characterize the impact that novel treatments in development may have on the overall clinical, BOI and patient-reported outcomes in DBLCL and FL. Disclosures:Dulac: Celgene Corporation: Employment. Joy: IMS Health: Employment. Ndindjock: IMS Health: Employment. Coyle: IMS Health: Employment. Wade: IMS Health: Employment, Research Funding.

Pesticide use and non-Hodgkin's lymphoma mortality in Brazil

Brazil is one of the major pesticide consumers in the world. The continuous exposure to these substances may be etiologically associated with the development of Non-Hodgkin's Lymphoma (NHL). Estimate the correlation between the per capita sales of pesticides in 1985 (exposure) and NHL mortality rates between 1996 and 2005 (outcome), by Brazilian micro-regions. In this ecological descriptive study, the per capita consumption of pesticides in 1985 was used as a proxy of the population exposure to these chemicals in Brazil. All deaths by NHL occurred in the 446 non-urban micro-regions, between 1996 and 2005, among individuals with ages between 20 and 69, of both sexes, were retrieved from the Brazilian Mortality Information System. Micro-regions were then categorized into low, medium, high and very high pesticide consumption, according to the quartiles of per capita consumption of pesticides. NHL mortality rates and rate ratios for each quartile were obtained using the lowest quartile as reference. In addition, the Spearman's correlation coefficient between pesticide consumption and NHL mortality rates was estimated. A moderate correlation between per capita pesticides consumption and standardized mortality rate for NHL was observed (r=0.597). In addition, using the lowest quartile of pesticide consumption as a reference, the higher the quartile of pesticide consumption, the higher was NHL mortality risk: men - (second quartile - MRR=1.69, CI 95% 1.68-1.84; third quartile - MRR=2.41, CI 95% 2.27-2.57; fourth quartile - MRR=2.92, CI 95% 2.74-3.11) and females (second quartile - MRR=1.87, CI 95% 1.69-2.06; third quartile - MRR=2.28, IC 95% 2.10-2.47; fourth quartile - MRR=3.20; CI 95% 2.98-3.43). Our results suggest that pesticide exposure may play a role in the etiology of NHL.