Haematopoietic cancer and medical history: a multicentre case control study

BACKGROUND: Viruses (such as Epstein-Barr virus) and pathological conditions (mainly involving immunosuppression) have been shown to increase the risk of haematolymphopoietic malignancies. Other associations (diabetes, tonsillectomy, autoimmune diseases) have been inconsistently reported. METHODS: The association between different haematolymphopoietic malignancies (lymphomas, myelomas and leukaemias) and the previous medical history has been studied in a population-based case-control investigation conducted in Italy, based on face to face interviews to 2669 cases and 1718 population controls (refusal rates 10% and 19%, respectively). Controls were a random sample of the general population. RESULTS: Previous findings were confirmed concerning the association between non-Hodgkin's lymphoma (NHL) and lupus erythematosus (odds ratio, OR=8.4; 95% CI 1. 6, 45), tuberculosis (OR=1.6; 1.05, 2.5) and hepatitis (1.8; 1.4, 2. 3). An association was found also between NHL and maternal (OR=2.8; 1.1, 6.9) or paternal tuberculosis (OR=1.7; 0.7, 3.9). Odds ratios of 4.0 (1.4, 11.8) and 4.4 (1.1, 6.6) were detected for the association between NHL and Hodgkin's disease, respectively, and previous infectious mononucleosis, but recall bias cannot be ruled out. No association was found with diabetes, tonsillectomy and adenoidectomy. An association with malaria at young age and "low grade" lymphatic malignancies is suggested. One interesting finding was the observation of four cases of poliomyelitis among NHL patients, one among Hodgkin's disease and one among myeloid leukaemia patients, compared with none among the controls (Fisher's exact test for NHL and Hodgkin's disease, p= 0.03, one tail). CONCLUSIONS: Some of these findings are confirmatory of previous evidence. Other observations, such as the putative role of the polio virus and of malaria are new. A unifying theory on the mechanisms by which previous medical history may increase the risk of haematolymphopoietic malignancies is still lacking.     

Risk factors for non-Hodgkin's lymphoma according to family history of haematolymphoproliferative malignancies

BACKGROUND: Aetiological profiles of non-Hodgkin's lymphoma (NHL) may differ depending upon whether the disease is inheritance-related or sporadic. Because familial risk (a probable surrogate of inheritance-relatedness) of NHL is influenced by haematolymphoproliferative malignancies (HLPM), we evaluated whether non-familial risk factors differ between NHL with and without a family history of HLPM, using the Selected Cancers Study data. METHODS: Cases were 1511 men aged 31-59 and diagnosed with NHL during 1984-1988. Controls were men without NHL, frequency-matched to cases by age range and cancer registry (n = 1910). These groups were compared: cases with a family history of HLPM and without, and controls without such a family history. RESULTS: Polytomous logistic regression analyses showed that the odds ratio (OR) estimates of homosexual behaviour were 18.2 (95% confidence interval (CI) : 4.8-69.4) and 5.6 (95% CI : 3.3-9.5) for NHL with and without a family history of HLPM, respectively. The corresponding estimates were 3.9 (95% CI : 1.7-8.9) and 2.2 (95% CI : 1.5-3.1) for history of enlarged lymph nodes. Variables only related to NHL with a family history were use of heroin (OR = 15.6, 95% CI : 3.4-70.4), exposure to a chlorinated hydrocarbon pesticide (OR = 2.3, 95% CI : 1.0-5.0), occupational exposure to plywood, fibreboard or particleboard (OR = 2.0, 95% CI : 1.2-3.4) and history of liver diseases (other than hepatitis or cirrhosis) (OR = 6.5, 95% CI : 1.2-36.2). The association between homosexual behaviour and NHL among men with a family history was stronger for those aged 31-44, especially for B-cell type of the disease. CONCLUSIONS: This study suggests differences in the risk factor profiles between NHL with and without a family history of HLPM. The higher risks of NHL for homosexual behaviour and heroin use, surrogates of HIV infection, in men with a family history of HLPM imply that genetic susceptibility may be influential on the occurrence of HIV-related NHL.     

The Association between Allergy and Rheumatoid Arthritis in the Canadian Population

Background: Antagonism between Th1 and Th2 lymphocyte mediated responses has been proposed to explain the observed 20th Century population increase in Th2 mediated allergic disease and reciprocal decrease in infectious disease, which stimulates a Th1 mediated response.Objective: To determine if Th1/Th2 antagonism would be consistent with associations between non-infectious diseases, we tested the hypothesis that the population prevalence of Th2 mediated allergies is inversely related to the prevalence of Th1 mediated rheumatoid arthritis.Methods: The analysis was based on data from the Canadian Community Health Survey conducted by Statistics Canada in 2000–2001 of those at least 12 years of age from 125,129 households. Each subject was asked if he or she had certain chronic health conditions that had been diagnosed by a health professional. Logistic regression models were used to evaluate the association between rheumatoid arthritis and allergies with consideration of other important variables.Results: Allergy history was positively related to the prevalence of rheumatoid arthritis both in women (adjusted odds ratio (OR): 1.57, 95% CI: 1.43, 1.73) and in men (adjusted OR: 1.55, 95% CI: 1.36, 1.77).Conclusions: The reported population prevalences of allergies and rheumatoid arthritis were positively associated and not explained by Th1/Th2 anatagonism suggesting that this mechanism may only be applicable to the association between an infectious and an immunologic disease. Mechanisms accounting for positive associations between immunologic diseases deserve further study.     

The spectrum of AIDS-defining diseases: temporal trends in Italy prior to the use of highly active anti-retroviral therapies, 1982-1996

OBJECTIVE: To evaluate time trends of the spectrum of AIDS-defining diseases in Italy, 1982-1996. METHODS: Surveillance data from the Italian National AIDS Registry were used to assess temporal patterns of all AIDS-defining diseases diagnosed among adults as of December 1996. Twenty-six initial clinical manifestations of AIDS were grouped into 12 categories. Relative frequencies were calculated by year of diagnosis and stratified by age, gender, HIV-exposure category, and CD4+ cell count. A multivariate polychotomous logistic model was used to estimate the proportions of each diagnostic category over time, adjusting simultaneously for the remaining diagnostic categories and for variables of interest. RESULTS: This analysis was based on 41772 diagnoses of AIDS-defining diseases among 36 638 reported cases. Mycoses represented the most frequent condition (27.3%), followed by Pneumocystis carinii pneumonia (PCP) (21.4%) and viral infections (8.9%). Cancers accounted for less than 10% of diseases. Downward trends were observed for mycoses, PCP (in the last part of the study period), Kaposi's sarcoma (KS), and non-Hodgkin's lymphomas (NHL). Upward trends were observed for mycobacterioses, and bacterial and protozoal infections. Brain toxoplasmosis increased up to 1994, and, thereafter, it appeared to decrease. These trends were less marked when the analysis was restricted to the diseases included in the pre- 1987 AIDS definition. Trends stratified by CD4+ cell count for the period 1990-1996 were substantially consistent with the above-reported results. CONCLUSIONS: The downward temporal trends in the most recent years of the study period for PCP and for brain toxoplasmosis are likely to be related to the use of prophylactic treatment. This analysis confirms a decline in KS but suggests that this was largely over by 1990.     

Self-reported hepatitis and non-Hodgkin lymphoma: an analysis according to the time since hepatitis diagnosis

PURPOSE: Using data from the Selected Cancers Study, the authors tested whether the association between hepatitis infection and non-Hodgkin lymphoma (NHL) varied according to the time since the diagnosis of hepatitis. METHODS: Cases were 1177 men ages 32-60 diagnosed with NHL between 1984 and 1988. Controls were men with no history of NHL who were frequency-matched to lymphoma cases by age and cancer registry (n = 1852). Interviews were conducted to collect data on risk factors including history of hepatitis. No information on types of hepatitis was obtained. RESULTS: Logistic regression analyses indicated that history of hepatitis diagnosed 3 or more years prior to the reference date was not a significant risk factor for NHL (OR [odds ratio] = 0.92, 95% CI: 0.63-1.35). In contrast, men with a history of hepatitis diagnosed within 3 years prior to the diagnosis date had more than a five-fold increased risk of NHL (OR = 5.77, 95% CI: 1.99-16.74). CONCLUSIONS: Although the study was limited by lack of information on different types of hepatitis, the increased OR for hepatitis diagnosed more closely to the NHL diagnosis suggests that the reported association between hepatitis and NHL might partly result from increased detection of NHL in patients with recently reported hepatitis virus infection.     

Farming and malignant lymphoma in Hancock County, Ohio.

Raised death rates have been reported for non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) among white male residents of Hancock County, Ohio, United States, for 1960-79. As a surveillance activity, to assess the possibility of workplace exposures contributing to these raised rates, a case-control study was conducted using death certificate records of white male Hancock County residents for 1958-83. There were 61 cases of NHL, 15 cases of HD, and 304 control subjects (chosen as a stratified random sample) in the study. Cases and controls were compared with respect to their usual occupation and industry statements on the death certificates, adjusting for age at death and year of death. Summary odds ratios (OR) and test-based 95% confidence intervals (CI) were calculated. NHL was associated with the occupation of farmer (OR = 1.6; CI = 0.8, 3.4; observed number of exposed cases (Obs) = 15). The association was restricted to 1958-73 (OR = 2.1; CI = 0.9, 4.8; Obs = 13). The three cases of HD among farmers occurred in a cluster in the 15-64 age range during 1958-63 (OR = 21.2). The results for occupations and industries other than farming were based on small numbers and were unremarkable. This small study adds to the growing body of reports linking farming and malignant lymphoma, particularly NHL.     

Farming and malignant lymphoma in Hancock County, Ohio

Raised death rates have been reported for non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) among white male residents of Hancock County, Ohio, United States, for 1960-79. As a surveillance activity, to assess the possibility of workplace exposures contributing to these raised rates, a case-control study was conducted using death certificate records of white male Hancock County residents for 1958-83. There were 61 cases of NHL, 15 cases of HD, and 304 control subjects (chosen as a stratified random sample) in the study. Cases and controls were compared with respect to their usual occupation and industry statements on the death certificates, adjusting for age at death and year of death. Summary odds ratios (OR) and test-based 95% confidence intervals (CI) were calculated. NHL was associated with the occupation of farmer (OR = 1.6; CI = 0.8, 3.4; observed number of exposed cases (Obs) = 15). The association was restricted to 1958-73 (OR = 2.1; CI = 0.9, 4.8; Obs = 13). The three cases of HD among farmers occurred in a cluster in the 15-64 age range during 1958-63 (OR = 21.2). The results for occupations and industries other than farming were based on small numbers and were unremarkable. This small study adds to the growing body of reports linking farming and malignant lymphoma, particularly NHL.     

Diet and risk of lymphoid neoplasms and soft tissue sarcomas

The relationship between frequency of intake of selected indicator foods, lymphoid neoplasms, and soft tissue sarcomas was investigated in an updated case‐control study conducted in Northern Italy between 1983 and 1992 on 158 incident, histologically confirmed cases of Hodgkin's disease (HD), 429 cases of non‐Hodgkin's lymphoma (NHL), 141 cases of multiple myelomas, 101 cases of soft tissue sarcomas, and 1,157 controls admitted to hospital for acute, nonneoplastic diseases unrelated to long‐term modifications of diet. Compared with the lowest fertile, the odds ratio (OR) for the highest fertile of milk intake was 1.8 for NHL and 1.9 for sarcomas. Liver intake was an indicator of the risk of HD (OR = 1.8), NHL (OR = 1.6), and myelomas (OR = 2.0), ham an indicator of HD (OR = 1.7), and butter an indicator of myelomas (OR = 2.8). A high consumption of green vegetables was inversely related to myelomas (OR = 0.4), and frequent use of whole‐grain foods was inversely related to NHL (OR = 0.4) and soft tissue sarcomas (OR = 0.2). No material association with meat was observed for any of the neoplasms considered. Likewise, coffee and alcohol intakes were not associated with lymphoid neoplasms and soft tissue sarcomas. The OR for the highest fertile of intake of β‐carotene ranged between 0.5 and 0.7, whereas the OR for retinal ranged between 15 and 23. Although available data do not point to any specific inference, this study suggests that certain aspects of diet are a correlate or an indicator of the risk of lymphoid neoplasms and soft tissue sarcomas.     

Blood transfusions as a risk factor for non-Hodgkin's lymphoma in the San Francisco Bay Area: a population-based study

The incidence of non-Hodgkin's lymphoma (NHL) has risen dramatically over the past 50 years. In the search for new risk factors, blood transfusions have been investigated and shown to be associated with subsequent lymphoma in some studies. The authors tested this association in a population-based, case-control study conducted between 1988 and 1995 in the San Francisco Bay Area of California. A total of 1,591 histologically confirmed adult cases of NHL were included in this study. Cases were frequency matched to 2,515 control participants by sex, county of residence, and 5-year age intervals. Multivariate logistic regression models were used to examine the impact of possible confounders. Persons who reported a history of allogeneic transfusion were not at increased risk of NHL in this population (odds ratio (OR) = 1.0, 95% confidence interval (CI): 0.84, 1.2). No significant associations were seen when lymphomas were stratified by histologic subtype, grade, or latency period. However, autologous transfusions were associated with a decreased risk (OR = 0.39, 95% CI: 0.16, 0.94). In summary, these findings are similar to those of prior negative studies and do not support some previous reports of an adverse association between blood transfusion and NHL.     

Comparison of interviewed and non-interviewed non-Hodgkin's lymphoma (NHL) patients in the San Francisco Bay Area

PURPOSE: To determine whether interviewed non-Hodgkin's lymphoma (NHL) patients differed from non-interviewed NHL patients and to revise the population-based risk estimate for NHL associated with HIV infection in homosexual men in the San Francisco Bay Area. Differences between study participants and non-participants are a concern in epidemiologic studies. Recruitment techniques can be modified when nonparticipation is a result of subject refusal. However, the solutions for nonparticipation due to death are less clear, especially when rapid case ascertainment (RCA) is used to identify newly diagnosed patients. METHODS: A large population-based case-control study was conducted in the San Francisco Bay Area between 1988 and 1995 to investigate risk factors for NHL. Nearly 1600 patients were interviewed and included in this study. A total of 1047 NHL patients were not interviewed because they had died prior to contact (602 patients) or we had received their RCA information after the study had ended (445 patients). We compared available demographic, clinical, and histologic profiles of the interviewed and non-interviewed NHL patients. RESULTS: Compared with the interviewed group, the non-interviewed group was younger, had more single HIV-infected homosexual men and a higher incidence of high-grade and "not-otherwise-specified" lymphoma. When categorized by sex and sexual preference, median age at diagnosis of NHL was the same for the interviewed and non-interviewed homosexual men. Combining interviewed and non-interviewed patients, the estimated risk for NHL associated with HIV infection in homosexual men [odds ratio (OR) = 50] is substantially higher than we had estimated in our earlier publications (OR = 20). CONCLUSIONS: High-grade lymphomas associated with poor survival in homosexual men are likely to be under-represented in case-control studies of NHL.     

Delayed diagnosis of HIV infection in the Spanish VACH cohort [1997-2002]

OBJECTIVE: To study the prevalence of delayed diagnosis of HIV infection and associated factors. METHODS: A cross sectional study of patients included in the Spanish VACH cohort who had been diagnosed with HIV infection between 1997 and 2002 was performed. Delayed diagnosis was defined as patients diagnosed with HIV infection and AIDS simultaneously or within the first month after the first positive serologic test, or those with a first CD4+ cell count below 200/ml. The epidemiological characteristics of these patients were compared with those of the remaining patients RESULTS: Of 2,820 new cases of HIV infection, delayed diagnosis was found in 506 (18%). These patients differed from the remaining patients in their lower mean age and higher HIV viral load, as well as in their distribution by sex (higher proportion of males), occupational status, history of incarceration in prison, and HIV-risk transmission group. The median survival during follow-up was significantly lower among AIDS patients with a delayed diagnosis. CONCLUSIONS: Delayed diagnosis remains a cause for concern in our environment, due to its magnitude and its association with mortality. Some epidemiological characteristics provide clues to guide future programs directed at increasing information and improving prevention.     

Non-Hodgkin's lymphomas and organic solvents

Organic solvents have been suggested as a possible risk factor for non-Hodgkin's lymphomas (NHL). We studied 109 NHL incident cases and 276 controls with other cancers (1990/1996) in the city of Salvador, Brazil. Occupational exposure to organic solvents was evaluated through standardized questionnaires and defined by industrial hygienists, taking into account individuals' lifetime history. An association between occupational exposure to organic solvents and NHL was observed, OR = 1.67 (95% CI, 0.97 to 2.87), especially among individuals less than 64 years, OR = 1.91 (95% CI, 0.99 to 3.67), and among those who used domestic insecticides, OR = 2.24 (95% CI, 1.01 to 3.97). Odds ratios were similar for nodal and diffuse NHL. These results suggest that organic solvents may contribute to the causation of NHL, especially among young individuals, and that synergism may play a role in the process of lymphomagenesis.     

The association between early life and adult body mass index and physical activity with risk of non-Hodgkin lymphoma: impact of gender

PurposeTo evaluate the association of body mass index (BMI) and physical activity (PA) during adulthood and at the age of 18 years with risk of non-Hodgkin lymphoma (NHL).MethodsWe enrolled 950 newly diagnosed NHL patients and 1146 frequency-matched clinic-based controls. Height, weight, and PA (recent adult and at the age of 18 years) were self-reported. Odds ratios (ORs), 95% confidence intervals, and tests for trend were estimated using unconditional logistic regression adjusted for age, gender, and residence.ResultsBMI at the age of 18 years was associated with an increased NHL risk (OR, 1.38 for highest vs. lowest quartile; p-trend = .0012), which on stratified analysis was specific to females (OR, 1.90; p-trend = .00025). There was no association of adult BMI with NHL risk. Higher PA in adulthood (OR, 1.03; p-trend = .85) or at the age of 18 years (OR, 0.88; 95% confidence interval, 0.72–1.07) was not associated with risk, but there was an inverse association for adult PA that was specific to females (OR, 0.71; p-trend = .039). Only BMI at the age of 18 years remained significantly associated with NHL risk when modeled together with PA in adulthood or at the age of 18 years. There was little evidence for heterogeneity in these results for the common NHL subtypes.ConclusionsEarly adult BMI may be of greatest relevance to NHL risk, particularly in females.     

The association between hepatitis C virus infection, genetic polymorphisms of oxidative stress genes and B-cell non-Hodgkin's lymphoma risk in Egypt

Hepatitis C virus (HCV) has been postulated to be an etiological agent for lymphoid malignancies. Polymorphisms in oxidative stress genes as; superoxide dismutase (SOD2), glutathione peroxidase (GPX1), catalase (CAT), myeloperoxidase (MPO) and nitric oxide synthase (NOS2) may influence non-Hodgkin's lymphoma (NHL) risk. HCV screening and polymorphisms in these five genes coding for antioxidant enzymes were studied in 100 Egyptian patients with B cell-NHL and 100 controls to clarify the association between HCV infection, oxidative stress genes polymorphisms and B cell-NHL risk. A significantly higher prevalence of HCV infection was detected among NHL patients relative to controls and this carried a 14-fold increased NHL risk (odds ratio (OR)=14.3, 95% confidence interval (CI)=5.4-38.3, p<0.0001). GPX1 and MPO genetic polymorphisms conveyed increase in B-NHL risk (OR=3.3, 95% CI=1.4-7.4, p=0.004 and OR=4.4, 95% CI=1.3-14.2, p=0.009 respectively). Further analyses stratified by HCV infection revealed that concomitant HCV infection and GPX1 gene polymorphism had a synergetic effect on NHL risk with an OR of 15 (95%CI=2.2-69.6, p<0.0001). In addition, combined HCV infection and MPO gene polymorphisms had a pronounced NHL risk (OR=9.2, 95%CI=2.5-33.9, p<0.0001). SOD2, CAT and NOS2 genetic polymorphisms were not found to confer increased NHL risk. This study revealed that HCV infection is a risk factor for NHL in Egypt. Polymorphisms in GPX1 and MPO genes may influence NHL risk in HCV infected Egyptian patients. Larger scale studies are warranted to establish this genetic susceptibility for NHL.     

Nutrients contributing to one-carbon metabolism and risk of non-Hodgkin lymphoma subtypes

Because little is known about the etiology of non-Hodgkin lymphoma (NHL), a heterogeneous disease, and because dietary factors are modifiable, the authors examined the associations between nutrients related to one-carbon metabolism and risk of NHL in a population-based case-control study of Connecticut women diagnosed between 1996 and 2000. A total of 594 cases and 710 controls completed a food frequency questionnaire for determination of intakes of folate, vitamins B(2), B(6), and B(12), and methionine. Through unconditional logistic regression, the authors estimated the risk of NHL associated with intake of each nutrient. Comparing the highest quartile of intake with the lowest, the authors found lower risks of all NHL associated with increasing intakes of folate and methionine. Analysis by NHL subtype indicated lower risks of diffuse large B-cell lymphoma (highest quartile vs. lowest: odds ratio (OR) = 0.54, 95% confidence interval (CI): 0.30, 0.98; p-trend = 0.02) and marginal zone lymphoma (highest quartile vs. lowest: OR = 0.08, 95% CI: 0.02, 0.26; p-trend < 0.0001) associated with folate. Vitamin B(6) intake was also associated with lower risk of NHL overall and of marginal zone lymphoma (highest quartile vs. lowest: OR = 0.23, 95% CI: 0.08, 0.65; p-trend = 0.002). These findings suggest that these nutrients may be important for susceptibility to NHL.     

淋巴细胞VCS参数在鉴别诊断病毒感染中的应用探讨

目的:探讨淋巴细胞VCS参数在鉴别诊断病毒感染中的应用。方法:分析81例病毒感染患者淋巴细胞VCS参数中平均淋巴细胞体积(MLV),高频传导参数(MLC)及体积分布宽度(LVD)的变化。用90名健康志愿者作为正常对照组,并与57例慢性淋巴细胞白血病组(CLL组)和34例非霍奇金淋巴瘤组(NHL)进行了比较分析。结果:病毒感染时MLV、LVD比健康对照组明显增高(q为3.505、.15 P<0.01),而MLC则比健康对照组降低(q为5.70 P<0.01)。病毒感染组与CLL组比较,MLC、LVD差别无统计学意义(q分别为1.34、1.36P均>0.05),但CLL组的MLV明显低于病毒感染组(q为8.91,P<0.01)。病毒感染组与NHL组比较,MLV、LVD差别无统计学意义(q分别为0.91、0.28,P均>0.05),但NHL组的MLC比病毒感染组高(q为3.55 P<0.01)。结论:淋巴细胞VCS参数能反映淋巴细胞的形态学变化,在诊断与鉴别病毒感染时是一个经济快速的观察指标。     

The estimation of age-related rates of infection from case notifications and serological data.

The paper describes a maximum-likelihood method for the estimation of age-related changes in the per capita rate of infection, from case notification records or serological data. The methods are applied to records of measles incidence in the UK and USA, for which the estimated rates of infection tend to rise to a maximum value at around 10 years of age and then to decline in the older age-classes. Longer-term and seasonal trends are analysed by reference to changes in the estimated average age at infection; a statistic derived from a knowledge of the age-specific rates of infection. Future data needs in the epidemiological study of directly transmitted viral and bacterial diseases are discussed with reference to the detection and interpretation of age-dependent rates of disease transmission.     

The estimation of age-related rates of infection from case notifications and serological data

The paper describes a maximum-likelihood method for the estimation of age-related changes in the per capita rate of infection, from case notification records or serological data. The methods are applied to records of measles incidence in the UK and USA, for which the estimated rates of infection tend to rise to a maximum value at around 10 years of age and then to decline in the older age-classes. Longer-term and seasonal trends are analysed by reference to changes in the estimated average age at infection; a statistic derived from a knowledge of the age-specific rates of infection. Future data needs in the epidemiological study of directly transmitted viral and bacterial diseases are discussed with reference to the detection and interpretation of age-dependent rates of disease transmission.