Risk Factor For non-Hodgkin Lymphoma Research Articles

Occupational chlorophenol exposure and non-Hodgkin's lymphoma.

Occupational exposure to chlorophenols is suspected to increase non-Hodgkin's lymphoma (NHL) risk. This association was examined using data on 995 NHL cases and 1783 controls from the Selected Cancers Study, a population-based case-control study of men aged 32 to 60 years from eight population-based cancer registries conducted from 1984 to 1988. Potential chlorophenol exposure was characterized by an industrial hygienist using intensity estimates and confidence ratings, based upon review of verbatim job histories. Cases with substantial chlorophenol exposure had a significantly greater number of years of chlorophenol exposure (median years: cases, 4.0; controls, 2.0; P = 0.046); however, in conditional logistic regression models, the odds ratio for more than 8 years of substantial exposure was 1.51 (95% CI, 0.88 to 2.59). Overall, the findings do not provide strong support for an association with NHL risk. Chlorophenol exposure in this study is not based upon measured values and, therefore, may fail to characterize actual chlorophenol exposures accurately. Because of the large presence of machinists in the potentially chlorophenol-exposed group, these results may be underestimated by exposure misclassification if these subjects were not exposed to chlorophenolic biocides. However, these results are consistent with other findings, which suggest that chlorophenol exposure is not likely to be a strong risk factor for NHL.

Blood Transfusion at Delivery and Risk of Subsequent Malignant Lymphoma in the Mother

Blood transfusion has been shown to be a risk factor for non-Hodgkin's lymphoma (NHL). In a cohort of 77,928 women with bleeding complications at delivery in the period of 1973-1986, subsequent NHL cases were identified and the number was compared with the number expected from national incidence rates. In a case-control study the proportion of transfused NHL cases was compared with the proportion of transfused controls. The observed number of NHL in the cohort was 18 versus 22.0 expected. Information on transfusion was obtained for 15 of the NHL cases and none (0%) was transfused versus 32 out of 136 controls (23%). Blood transfusion at delivery is not a risk factor for NHL. The immune tolerance induced by pregnancy may reduce the risk of NHL associated with the transfusion of allogeneic blood cells.

Tobacco, alcohol, diet and risk of non-Hodgkin's lymphoma: a case-control study in Uruguay

To test whether high meat intake is associated with the development of non-Hodgkin lymphoma (NHL) in the Uruguayan population, a case-control study was performed at the Instituto Nacional de Oncologia, Montevideo, Uruguay. After controlling for age, sex, residence, education, urban/rural status and the habit of drinking the beverage `mate', red meat intake was associated with an increased risk of NHL of 2.5. This finding was similar in both sexes separately. Odds ratios (OR) for the highest tertile of barbecued meat was 1.7 among men, whereas salted meat was associated with an increased risk of NHL (OR 4.9, 95% CI 1.4–17.7). The effect of processed and salted meat among women was of much less magnitude and the OR's were non-significant. Also, cumulative exposure to `mate' drinking displayed an OR of 2.4 (95% CI 1.0–5.6). Smokers of black tobacco and hand-rolled cigarettes were associated with an increased risk of 3.5 (95% 1.1–10.9), whereas beer drinkers showed an increased OR of 5.5 (95% 1.1–26.7) in men. It could be concluded that red or salted meat intake, smoking of black tobacco, and beer and `mate' drinking are risk factors for NHL in the Uruguayan population.

RISK FACTORS FOR AIDS ASSOCIATED NON-HODGKIN'S LYMPHOMA: A CASE-CONTROL STUDY.

S6 Background: Although non-Hodgkin's lymphoma (NHL) occurs in more than 5% of people with AIDS, little is known of risk factors for this malignancy. The one clear risk factor is severity of immune deficiency. Our study was designed to identify other risk factors for NHL, including demographic, clinical and laboratory factors. Methods: 219 people with AIDS-NHL diagnosed in Sydney prior to 1995 were compared to 219 HIV positive controls matched for degree of immune deficiency as indicated by CD4 lymphocyte count. Data on risk factors were abstracted by medical record review. Results: AIDS and cancer register linkage confirmed that all registered cases of AIDS-NHL in the study area were included. The CD4 counts of cases and controls did not differ significantly (p = 0.66). NHL risk was associated with indices of prolonged immune deficiency including longer time since seroconversion (median of 6.5 and 5.0 years in cases and controls for whom this was known, p = 0.001), lower CD4 count one year prior to diagnosis (p trend 0.003) and a prior diagnosis of mycobacterium avium complex disease (OR 3.2, 95% CI 1.2-10). Markers of immune stimulation, including raised serum globulin (p trend 0.015), IgG (p trend 0.026), and HIV p24 antigen positivity (OR 2.0, 95% CI 1.3-3.3) were also associated with risk of NHL. Indices of lytic EBV infection, including a prior diagnosis of oral hairy leukoplakia and receipt of anti-herpesvirus therapy, were not associated with risk, although receipt of ganciclovir prior to diagnosis was non-significantly protective (OR 0.51, 95% CI 0.20-1.25). Total dose of AZT received was not related to risk of NHL, and the highest dose level of ddC was associated with a decreased risk of NHL (OR 0.38, 95% CI 0.17-0.82). Conclusion: These data indicate that prolonged immune deficiency and immune stimulation are risk factors for NHL in people with HIV. This study does not support a role of anti-EBV therapy in NHL prophylaxis. Our results suggest that effective anti-HIV therapy may decrease the risk of NHL by decreasing immune stimulation.

Non-Hodgkin's lymphoma risk derived from exposure to organic solvents: a review of epidemiologic studies.

The rate of non-Hodgkin's lymphomas (NHL) has increased around the world during the last decades. Apart from the role of the human immunodeficiency virus (HIV) infection in the development of NHL, exposure to chemical agents like phenoxyacetic pesticides, hair dyes, metal fumes and organic solvents are suspected to be involved. The present review evaluates the results of studies that directly or indirectly searched for an association between solvent exposure and NHL. The selected studies comprised those published from 1979 to 1997, designed to investigate risk factors for NHL, whether specifically looking for solvent exposure or for general risks in which solvent exposure could be included. In 25 of the 45 reviewed studies (55.5%), fifty-four statistically significant associations between NHL and solvent exposure related occupations or industries were reported. Statistical significance was more frequently shown in studies where solvent exposure was more accurately defined. In eighteen of such studies, 13 (72.2%) defined or suggested organic solvents as possible risk factors for NHL.

Occupational risk factors for subgroups of non-Hodgkin's lymphoma.

The non-Hodgkin's lymphomas (NHL) are a diverse group of neoplasms of the lymphatic system whose incidence has been increasing in recent years. The Centers for Disease Control Selected Cancers Study, a population-based case-control study of several cancers, included a large number of cases of NHL and a pathology review, providing a rare opportunity to study risk factors for groups of NHL subtypes. We examined the relation between occupational exposures and three subgroups of NHL: small cell diffuse lymphomas (N = 185), follicular lymphomas (N = 268), and large cell diffuse lymphomas (N = 526). There were 1,659 controls available for comparison. After controlling for demographic variables and previously identified risk factors for NHL, we observed two interesting associations, one between solvent exposure and small cell diffuse lymphomas [odds ratio (OR) = 1.60; 95% confidence interval (CI) = 1.10-2.20], and the other between meat packaging/processing and follicular lymphomas (OR = 1.60; 95% CI = 0.99-2.60). The results of this exploratory analysis are primarily negative. Our lack of positive findings may indicate that the subgroups of NHL used may not be etiologically distinct and that further work needs to be done to develop an NHL classification system that is etiologically informative and useful for epidemiologic studies.

New epidemiologic leads in the etiology of non-Hodgkin lymphoma in the elderly: the role of blood transfusion and diet

The incidence of non-Hodgkin lymphoma (NHL) in persons over the age of 65 years has increased dramatically since the 1950s in western countries. The strongest known risk factors for NHL are primary or acquired immunosuppression, but these severe deficiencies are relatively rare and cannot explain the rapid increase observed in the elderly. Recent work suggests that common exposures which influence immunocompetence, albeit at a much weaker level, may also be risk factors for NHL. Two such risk factors recently associated with NHL are prior history of blood transfusion and certain aspects of diet. In four out of four studies, prior history of blood transfusion was associated with approximately a doubling in NHL risk, even for a transfusion first received a decade or more before diagnosis. Other studies suggest that diets high in animal proteins and fats may increase the risk of NHL while fruit and vegetable consumption may decrease risk. Allogeneic blood transfusion is known to suppress the immune system, and diets high in protein and fat may also lead to altered immunocompetence, although other mechanisms such as viral transmission or the effects of heterocyclic amines and N-nitroso compounds may also play a role. Follow-up of these observations my lead to a better understanding of the NHL epidemic and new approaches to the prevention of NHL.

A meta-analysis of non-Hodgkin's lymphoma among farmers in the central United States.

A meta-analysis of studies examining the association between non-Hodgkin's lymphoma (NHL) and employment as a farmer in the central United States was performed to verify the observation by Blair et al. [1993] that this group is at excess risk of NHL. Six studies were selected for the meta-analysis, and the estimator of relative risk calculated was 1.34 (95% confidence interval (CI) = 1.17, 1.55). Exposures associated with NHL and associated with agricultural commodities frequently produced in the central United States are infectious microorganisms and pesticides. Examination of the production patterns of the farms in this region did not reveal a single specific risk factor consistently found on all farms; however, past production patterns suggest that exposure to either infectious microorganisms or pesticides might be a risk factor for NHL in this group of farmers.

Medical history risk factors for non-Hodgkin's lymphoma in older women.

It has been suggested that certain medical conditions and drug exposures might suppress the immune system and increase the risk of developing non-Hodgkin's lymphoma (NHL). We investigated whether specific medical conditions and drug exposures were associated with the risk of NHL in a cohort of older women who were enrolled in the Iowa Women's Health Study. A cohort of 41837 women, 55-69 years of age at baseline, was followed prospectively for the development of cancer from 1986 through 1992. These women had completed a baseline questionnaire in January 1986 that inquired about the occurrence and age at onset of specific medical conditions, about family history of cancer, and about the use of selected medications. Follow-up questionnaires were mailed to the women in 1987, 1989, and 1992. Incident cancers and deaths were ascertained through linkages to state and national databases. For most analyses, women with a self-reported history of cancer at baseline (n = 3903) were excluded. Relative risks (RRs) and 95% confidence intervals (CIs), adjusted for age or for age and other variables, were used as a measure of the association between NHL and medical history factors. Reported P values are two-sided. One hundred fourteen incident cases of NHL were identified in the cohort during follow-up. A history of adult-onset diabetes mellitus (i.e., first diagnosed after the age of 30 years) was associated with an increased risk of developing NHL (age-adjusted RR = 2.18; 95% CI = 1.22-3.90). In addition, there was an association between the duration of adult-onset diabetes and increasing risk of NHL (P for trend = .004), with an age-adjusted RR of 2.90 (95% CI = 1.07-7.90) for women with a diagnosis of diabetes for 15 or more years compared with women with no diagnosis of diabetes. Women with a history of blood transfusion were also at increased risk for the development of NHL (age-adjusted RR = 1.95; 95% CI = 1.33-2.85). The risk estimates for diabetes and transfusion history were independent of each other and were not changed substantially after adjustment for other risk factors. History of a previous cancer (excluding hematopoietic and lymphatic cancers) was associated with an increased risk of NHL (age-adjusted RR = 1.92; 95% CI = 1.21-3.06); this risk estimate was attenuated somewhat after adjustment for a history of diabetes, transfusion history, and other major risk factors (RR = 1.66; 95% CI = 1.02-2.69). No statistically significant associations were found between NHL and a history of chronic colitis, nonestrogen steroid use, use of exogenous estrogens, or use of thyroid medications. A history of adult-onset diabetes mellitus, blood transfusion, and a history of cancer (or its treatment) appear to be independent risk factors for NHL in older women.

Blood transfusion as a risk factor for non-Hodgkin lymphoma

In a case-control study of 280 out of 426 consecutive patients with a recent diagnosis of non-Hodgkin lymphoma (NHL) and 1827 control subjects, 53 (19%) and 230 (13%) respectively had received blood transfusions 1 year or more before the interview. Using an age- and sex-stratified analysis the odds ratio (OR) for transfusion was 1.74 (95% CI 1.24-2.44). ORs were also determined for transfusions received in the intervals 1-5, 6-15, 16-25 and > or = 26 years before diagnosis. In the interval 6-15 years, the OR for transfusion was 2.83 (95% CI 1.60-4.99) whereas ORs for transfusions received in other intervals were lower and not significantly elevated. Histological diagnoses (Kiel classification) and results of staging procedures were known for 185 patients. For low-grade NHL of nodal B-cell chronic lymphocytic leukaemia (B-CLL) or immunocytoma type, the OR for transfusions was 4.15 (95% CI 1.92-9.01). For low-grade nodal lymphomas of follicle centre cell type and high-grade nodal lymphomas, no relation to transfusions could be demonstrated. For high-grade extranodal lymphoma as sole manifestation, OR for transfusions was 3.27 (95% CI 1.30-8.24). It is concluded that blood transfusion may be a risk factor for NHLs especially those of B-CLL or immunocytoma type and for high-grade extranodal lymphoma.

Non-Hodgkin's Lymphoma and Sunlight

Incidence and mortality rates for nonHodgkin's lymphoma (NHL) continue to rise dramatically throughout the world (7,2). Changes in diagnostic practices and in levels of exposure to the established risk factors for NHL (including genetic predisposition, immunosuppression, infection with human immunodeficiency virus [HIV], and various occupational exposures) cannot account for the long-term, worldwide increases (3). On the basis of epidemiologic and experimental observations, some investigators (4,5) recently suggested that sunlight may contribute to the development of NHL and its upward trend. In particular, the rise in NHL incidence parallels the global rise in melanoma incidence (6), patients with NHL are at an elevated risk of developing melanoma (7-10), and experimental data show immunosuppressive effects of UV radiation that may predispose to melanoma or other cancers (//). The hypothesis that sunlight exposure may affect NHL risk (4Jj,10) prompted us to review the geographic patterns of mortality rates in the United States for the following three decades: 1950-1959, 1960-1969, and 1970-1980 (12). In white men and white women, NHL mortality was consistently lower in the southern half of the United States, particularly during the earliest period. In contrast, mortality from melanoma of the skin and nonmelanoma skin cancer A. White men

Rheumatic disorders and lymphoproliferative diseases

The incidence of non-Hodgkin lymphoma (NHL) in persons over the age of 65 years has increased dramatically since the 1950s in western countries. The strongest known risk factors for NHL are primary or acquired immunosuppression, but these severe deficiencies are relatively rare and cannot explain the rapid increase observed in the elderly. Recent work suggests that common exposures which influence immunocompetence, albeit at a much weaker level, may also be risk factors for NHL. Two such risk factors recently associated with NHL are prior history of blood transfusion and certain aspects of diet. In four out of four studies, prior history of blood transfusion was associated with approximately a doubling in NHL risk, even for a transfusion first received a decade or more before diagnosis. Other studies suggest that diets high in animal proteins and fats may increase the risk of NHL while fruit and vegetable consumption may decrease risk. Allogeneic blood transfusion is known to suppress the immune system, and diets high in protein and fat may also lead to altered immunocompetence, although other mechanisms such as viral transmission or the effects of heterocyclic amines and N-nitroso compounds may also play a role. Follow-up of these observations may lead to a better understanding of the NHL epidemic and new approaches to the prevention of NHL.

Radioiodine imaging in management of thyroid cancer; role of recombinant human tsh (rhtsh).

The incidence of non-Hodgkin lymphoma (NHL) in persons over the age of 65 years has increased dramatically since the 1950s in western countries. The strongest known risk factors for NHL are primary or acquired immunosuppression, but these severe deficiencies are relatively rare and cannot explain the rapid increase observed in the elderly. Recent work suggests that common exposures which influence immunocompetence, albeit at a much weaker level, may also be risk factors for NHL. Two such risk factors recently associated with NHL are prior history of blood transfusion and certain aspects of diet. In four out of four studies, prior history of blood transfusion was associated with approximately a doubling in NHL risk, even for a transfusion first received a decade or more before diagnosis. Other studies suggest that diets high in animal proteins and fats may increase the risk of NHL while fruit and vegetable consumption may decrease risk. Allogeneic blood transfusion is known to suppress the immune system, and diets high in protein and fat may also lead to altered immunocompetence, although other mechanisms such as viral transmission or the effects of heterocyclic amines and N-nitroso compounds may also play a role. Follow-up of these observations may lead to a better understanding of the NHL epidemic and new approaches to the prevention of NHL.

Purification of antithyroglobulin autoantibodies (ab-tg) for application in immunodetection- and immunotherapy of thyroid cancer.

The incidence of non-Hodgkin lymphoma (NHL) in persons over the age of 65 years has increased dramatically since the 1950s in western countries. The strongest known risk factors for NHL are primary or acquired immunosuppression, but these severe deficiencies are relatively rare and cannot explain the rapid increase observed in the elderly. Recent work suggests that common exposures which influence immunocompetence, albeit at a much weaker level, may also be risk factors for NHL. Two such risk factors recently associated with NHL are prior history of blood transfusion and certain aspects of diet. In four out of four studies, prior history of blood transfusion was associated with approximately a doubling in NHL risk, even for a transfusion first received a decade or more before diagnosis. Other studies suggest that diets high in animal proteins and fats may increase the risk of NHL while fruit and vegetable consumption may decrease risk. Allogeneic blood transfusion is known to suppress the immune system, and diets high in protein and fat may also lead to altered immunocompetence, although other mechanisms such as viral transmission or the effects of heterocyclic amines and N-nitroso compounds may also play a role. Follow-up of these observations may lead to a better understanding of the NHL epidemic and new approaches to the prevention of NHL.

Dietary factors and non-Hodgkin's lymphoma in Nebraska (United States).

Little is known about dietary factors and non-Hodgkin's lymphoma (NHL) risk, although high intakes of animal protein and milk have been associated with NHL in two previous studies. As part of a population-based case-control study of agricultural and other risk factors for NHL in eastern Nebraska (USA), we examined the self- and proxy-reported frequency of consumption of 30 food items by 385 White men and women with NHL and 1,432 controls. Animal protein intake was not associated significantly with the risk of NHL, however, there was a nonsignificantly elevated risk of NHL among men with high milk consumption. Vitamin C, carotene, citrus fruit, and dark green vegetable intakes were inversely significantly related to the risk of NHL for men, but not for women. Among men, the odds ratios for the highest quartiles of both vitamin C and carotene intake were 0.6 (95% confidence intervals = 0.3-1.0). There were no meaningful differences in the associations of nutrient intakes and NHL risk between B- and T-cell lymphomas and histologic types. Risks for low intakes of vitamin C and carotene were greater among men and women with a family history of cancer, particularly a history of lymphatic or hematopoietic cancer among first-degree relatives.

Second cancer risk following Hodgkin's disease: a 20-year follow-up study.

To determine risk factors for the development of second primary cancers during long-term follow-up of patients with Hodgkin's disease (HD). We assessed the risk of second cancers (SCs) in 1939 HD patients, who were admitted to the Netherlands Cancer Institute (NKI; Amsterdam) or the Dr Daniel den Hoed Cancer Center (DDHK; Rotterdam) between 1966 and 1986. For 97% of the cohort, we obtained a medical status up to at least January 1989. The median follow-up duration of the patients was 9.2 years; for 17% of the patients, follow-up was longer than 15 years. For more than 98% of all second tumors, the diagnosis was confirmed through a pathology report. In all, 146 patients developed a SC, compared with 41.9 cases expected on the basis of incidence rates in the general population (relative risk [RR], 3.5; 95% confidence interval [CI], 2.9 to 4.1). The mean 20-year actuarial risk of all SCs was 20% (95% CI, 17% to 24%). Significantly increased RRs were observed for leukemia (RR, 34.7; 95% CI, 23.6 to 49.3), non-Hodgkin's lymphoma (NHL) (RR, 20.6; 95% CI, 13.1 to 30.9), lung cancer (RR, 3.7; 95% CI, 2.5 to 5.3), all gastrointestinal cancers combined (RR, 2.0; 95% CI, 1.2 to 3.1), all urogenital cancers combined (RR, 2.4; 95% CI, 1.4 to 3.7), melanoma (RR, 4.9; 95% CI, 1.6 to 11.3), and soft tissue sarcoma (RR, 8.8; 95% CI, 1.8 to 25.8). As compared with the general population, the cohort experienced an excess of 63 cancer cases per 10,000 person-years. Cox-model analysis indicated the following as significant risk factors for developing leukemia: first-year treatment with chemotherapy (CT), follow-up treatment with CT, age at diagnosis of HD greater than 40 years, splenectomy, and advanced stage. Patients treated with CT in the 1980s had a substantially lower risk of leukemia than patients treated in the 1970s (10-year actuarial risks of 2.1% and 6.4%, respectively; P = .07). Significant risk factors for NHL were older age, male sex, and combined modality treatment as compared with either modality alone. Risk of lung cancer was strongly related to radiotherapy (RT), while an additional role of CT could not be demonstrated. After more than 15 years of follow-up, women treated with mantle-field irradiation before age 20 years had a greater than forty-fold increased risk of breast cancer (P < .001). While the long-term consequences of HD treatment as administered in the 1960s and 1970s are still evolving, it is promising that patients who received the new treatment regimens introduced in the 1980s have a much lower leukemia risk than patients treated in earlier years. Beginning 10 years after initial RT, the follow-up program of women who received mantle-field irradiation before age 30 years should routinely include breast palpation and yearly mammography.

Transfusion History and Cancer Risk in Older Women

To test the hypothesis that history of blood transfusion is associated with an increased incidence of cancer in older women. Prospective cohort study. General community in the state of Iowa. Random sample of 37,337 cancer-free Iowa women ages 55 to 69 years. Transfusion history was assessed with a mailed questionnaire completed in January 1986. Cancer incidence in 5 years was ascertained by a population-based cancer registry. Women who had ever received a blood transfusion were at an increased risk for non-Hodgkin lymphoma (relative risk (RR) = 2.20; 95% CI, 1.35 to 3.58) and kidney cancer (RR = 2.53; CI, 1.34 to 4.78). The relative risks for these cancers were greater with decreasing time from first transfusion. No increased risk occurred for cancers of the breast, lung, uterine corpus, ovary, pancreas, colon, rectum, skin (melanoma), or for all cancers considered together. These findings suggest that previous blood transfusion may be a risk factor for non-Hodgkin lymphoma and kidney cancer but is not associated with the most common neoplasms.