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Alkhayat N, Alshahrani M, Elyamany G, Sedick Q, Ibrahim W, Hamzi H, Binhassan A, Othman M, Alshieban S, Aljabry MS, Asiri S, Alzouman M, Alsuhaibani O, Alabbas F, Alsharif O, Elborai Y. Clinicopathologic features and therapy outcome in childhood Hodgkin's lymphoma: a report from tertiary care center in Saudi Arabia. J Egypt Natl Canc Inst 2021; 33:21. [PMID: 34396456 DOI: 10.1186/s43046-021-00078-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 07/18/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Hodgkin lymphoma (HL) is lymphoid neoplasm usually affecting lymphatic system; it accounts 3.6% of cancers in Saudi Arabia. Modern treatment protocols had shown particular success rates in overall-survival (OS) and event-free-survival (EFS). In our study, we reviewed the medical records of 80 pediatric and young adolescent patients diagnosed HL from January 2006 to July 2020, treated at tertiary care hospital in Riyadh, Saudi Arabia. Demographic, clinical, and pathological data were explored. First line therapy was ABVD, COG, COPP, R-CHOP, or radiotherapy alone in 53/80 (66.4%), 24/80 (30%), 1/80 (1.2%), 1/80 (1.2%), or 1/80 (1.2%) patients; respectively. Response assessment was done by CT + / - PET scan after first 2 cycles then every 2 cycle and end of therapy. Another assessment was done if any clinical suspicion of recurrence. RESULTS Median age 11 (range 3-16) years. Males to females 1.3:1. Seventy-two out of eighty (90%) patients showed first complete remission (CR1) and maintained remission for median 40 (range 7-136) months. Eight out of eighty (10%) patients showed refractory disease. Nineteen patients received salvage therapy (ICE or ESHAP/brentuximab vedotin or gemcitabine/brentuximab vedotin), 14/19 (73.7%) had 2nd complete remission (CR2) for median time 24 (ranged 9-78) months, while 5/19 (26.3%) did not show any response. Five-year OS and EFS were 95% and 75%. Two patients had 2ry malignant neoplasms, one had AML and died, the other had malignant fibrous histocytoma and still alive. None of our patients had fertility problem. Also, they did not experience chronic pulmonary or cardiotoxicity. Classic Hodgkin's lymphoma: nodular sclerosis subtype was more prominent (55%) than mixed cellularity subtype (22.5%), which is similar to several European and US studies, lymphocyte rich (11.25%) and lymphocyte depleted (0%), while nodular lymphocyte predominant Hodgkin's lymphoma (11.25%). CONCLUSIONS Our study provided unique descriptive study of childhood HL, in Saudi Arabia, with valuable insight into the long-term outcome and late toxicity. Our results are comparable to other studies in the Middle East and European countries.
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Affiliation(s)
- Nawaf Alkhayat
- Department of Pediatric Hematology/Oncology, Prince Sultan Military Medical City, Riyadh, Riyadh, 11159, Saudi Arabia
| | - Mohammad Alshahrani
- Department of Pediatric Hematology/Oncology, Prince Sultan Military Medical City, Riyadh, Riyadh, 11159, Saudi Arabia.
| | - Ghaleb Elyamany
- Department of Central Military Laboratory and Blood Bank, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Qanita Sedick
- Department of Central Military Laboratory and Blood Bank, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Walid Ibrahim
- Department of Pediatric Hematology/Oncology, Prince Sultan Military Medical City, Riyadh, Riyadh, 11159, Saudi Arabia
| | - Hasna Hamzi
- Department of Pediatric Hematology/Oncology, Prince Sultan Military Medical City, Riyadh, Riyadh, 11159, Saudi Arabia
| | - Amal Binhassan
- Department of Pediatric Hematology/Oncology, Prince Sultan Military Medical City, Riyadh, Riyadh, 11159, Saudi Arabia
| | - Mohamed Othman
- Department of Pediatric Hematology/Oncology, Prince Sultan Military Medical City, Riyadh, Riyadh, 11159, Saudi Arabia
| | - Saeed Alshieban
- Department of Pathology and Laboratory Medicine, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mansour S Aljabry
- Pathology Department, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Shuaa Asiri
- Department of Central Military Laboratory and Blood Bank, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Muneerah Alzouman
- Department of Central Military Laboratory and Blood Bank, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Omar Alsuhaibani
- Department of Central Military Laboratory and Blood Bank, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Fahad Alabbas
- Department of Pediatric Hematology/Oncology, Prince Sultan Military Medical City, Riyadh, Riyadh, 11159, Saudi Arabia
| | - Omar Alsharif
- Department of Pediatric Hematology/Oncology, Prince Sultan Military Medical City, Riyadh, Riyadh, 11159, Saudi Arabia
| | - Yasser Elborai
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
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Rafiq M, Hayward A, Warren-Gash C, Denaxas S, Gonzalez-Izquierdo A, Lyratzopoulos G, Thomas S. Socioeconomic deprivation and regional variation in Hodgkin's lymphoma incidence in the UK: a population-based cohort study of 10 million individuals. BMJ Open 2019; 9:e029228. [PMID: 31542744 PMCID: PMC6756616 DOI: 10.1136/bmjopen-2019-029228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/18/2019] [Accepted: 07/12/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Hodgkin's lymphoma (HL) is the the most common cancer in teenagers and young adults. This nationwide study conducted over a 25-year period in the UK investigates variation in HL incidence by age, sex, region and deprivation to identify trends and high-risk populations for HL development. DESIGN Population-based cohort study. SETTING Clinical Practice Research Datalink (CPRD) electronic primary care records linked to Hospital Episode Statistics and Index of Multiple Deprivation data were used. PARTICIPANTS Data on 10 million individuals in the UK from 1992 to 2016 were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES Poisson models were used to explore differences in HL incidence by age, sex, region and deprivation. Age-specific HL incidence rates by sex and directly age-standardised incidence rates by region and deprivation group were calculated. RESULTS A total of 2402 new cases of HL were identified over 78 569 436 person-years. There was significant variation in HL incidence by deprivation group. Individuals living in the most affluent areas had HL incidence 60% higher than those living in the most deprived (incidence rate ratios (IRR) 1.60, 95% CI 1.40 to 1.83), with strong evidence of a marked linear trend towards increasing HL incidence with decreasing deprivation (p=<0.001). There was significant regional variation in HL incidence across the UK, which persisted after adjusting for age, sex and deprivation (IRR 0.80-1.42, p=<0.001). CONCLUSIONS This study identified high-risk regions for HL development in the UK and observed a trend towards higher incidence of HL in individuals living in less deprived areas. Consistent with findings from other immune-mediated diseases, this study supports the hypothesis that an affluent childhood environment may predispose to development of immune-related neoplasms, potentially through fewer immune challenges interfering with immune maturation in early life. Understanding the mechanisms behind this immune dysfunction could inform prevention, detection and treatment of HL and other immune diseases.
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Affiliation(s)
- Meena Rafiq
- Institute of Health Informatics, University College London, London, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Charlotte Warren-Gash
- Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - S Denaxas
- Institute of Health Informatics, University College London, London, UK
| | | | - Georgios Lyratzopoulos
- Department of Behavioural Science and Health, ECHO (Epidemiology of Cancer Healthcare & Outcomes) Research Group, University College London, London, UK
| | - Sara Thomas
- Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Bleyer A, Keegan T. Incidence of malignant lymphoma in adolescents and young adults in the 58 counties of California with varying synthetic turf field density. Cancer Epidemiol 2018; 53:129-136. [PMID: 29427968 DOI: 10.1016/j.canep.2018.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 01/11/2023]
Affiliation(s)
- Archie Bleyer
- Oregon Health and Science University and University of Texas Medical School at Houston, United States.
| | - Theresa Keegan
- University of California Davis Comprehensive Cancer Center, United States.
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Relevance of the Measles Virus Expression in Cancer - an Update. Pathol Oncol Res 2016; 22:661-6. [PMID: 27287391 DOI: 10.1007/s12253-016-0080-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Abstract
Evidence of an association between classical Hodgkin lymphoma and the measles virus has previously been presented by our group. Arguments held against our thesis were reevaluated. Substantiation of a relationship between the measles virus and additional solid tumors was submitted. Moreover, a pathogenic pathway was suggested to support a possible contribution of the measles virus to the development of classical Hodgkin lymphoma. We have chosen to exclude a discussion of measles virotherapy, since this carries distinct implications. We now add new evidence regarding the expression of the measles virus phosphoprotein in a few cancers. We also suggest a role in this context for atypical measles syndrome in malignant tumors. Last, we propose a collaboration which may make the best, on the one hand of our cohort of classical Hodgkin lymphoma, half of which carry the measles virus expression in their tumor cells. The planned study will also look into the patients vaccination records and into a previous history of the measles disease. On the other hand, cohorts of patients diagnosed with late onset measles will be assessed for the eventual diagnosis of atypical measles syndrome and will be followed up for the subsequent development of a malignant tumor.
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Glaser SL, Clarke CA, Keegan THM, Chang ET, Weisenburger DD. Time Trends in Rates of Hodgkin Lymphoma Histologic Subtypes: True Incidence Changes or Evolving Diagnostic Practice? Cancer Epidemiol Biomarkers Prev 2015; 24:1474-88. [PMID: 26215294 PMCID: PMC4592457 DOI: 10.1158/1055-9965.epi-15-0281] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/20/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Histologic subtypes of classical Hodgkin lymphoma [cHL; e.g., nodular sclerosis, mixed cellularity, not otherwise specified (NOS)] are epidemiologically and prognostically distinctive. Therefore, unexplained, ongoing incidence rate declines for mixed cellularity and increases for NOS require examination. METHODS We analyzed detailed histology-specific Hodgkin lymphoma incidence rates in 1992 through 2011 U.S. SEER data (n = 21,372) and reviewed a regional subset of 2007 through 2011 NOS pathology reports for insight into diagnostic practices. RESULTS cHL rates were stable until 2007, then decreased for whites [annual percent change (APC) and 95% confidence interval (CI), -3.6% (-5.6% to -1.5%)]. Nodular sclerosis rates declined after 2007 by 5.9% annually, with variation by gender, age, and race/ethnicity. In 1992 through 2011, mixed cellularity rates declined [APC -4.0% (-4.7% to -3.3%)], whereas NOS rates rose [5.3% (4.5%-6.2%)] overall and in most patient groups. The 2007-2011 NOS age-specific rates were more similar to mixed cellularity rates for 1992-1996 than 2007-2011. Trends in combined rates were minimal, supporting increasing misclassification of mixed cellularity, lymphocyte depletion, and specific nodular sclerosis subtypes as NOS. Eighty-eight of 165 reviewed NOS pathology reports addressed classification choice. Twenty (12.1%) justified the classification, 21 (12.7%) described insufficient biopsy material, and coders missed specific subtype information for 27 (16.4%). CONCLUSION Recent nodular sclerosis rate declines largely represent true incidence changes. Long-term rate decreases for mixed cellularity and other less common subtypes, and increases for NOS (comprising ∼30% of cHL cases in 2011), likely reflect changes in diagnostic and/or classification practice. IMPACT Diminishing histologic subtyping undermines future surveillance and epidemiologic study of Hodgkin lymphoma. Guideline-based use of excisional biopsies and more coding quality control are warranted.
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Affiliation(s)
- Sally L Glaser
- Cancer Prevention Institute of California, Fremont, California. Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California.
| | - Christina A Clarke
- Cancer Prevention Institute of California, Fremont, California. Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California
| | - Theresa H M Keegan
- Cancer Prevention Institute of California, Fremont, California. Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California
| | - Ellen T Chang
- Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California. Health Sciences Practice, Exponent, Inc., Menlo Park, California
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Glaser SL, Chang ET, Clarke CA, Keegan TH, Yang J, Gomez SL. Hodgkin lymphoma incidence in ethnic enclaves in California. Leuk Lymphoma 2015; 56:3270-80. [PMID: 25899402 PMCID: PMC4801145 DOI: 10.3109/10428194.2015.1026815] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Hodgkin lymphoma (HL) incidence varies with migration and nativity, suggesting an influence of acculturation on risk. In population-based California data including 1483 Hispanic and 348 Asian/Pacific Islander (API) HL cases, we examined HL rates in residential neighborhoods classified by ethnic enclave status (measuring degree of acculturation) and socioeconomic status (SES). Rates were inversely associated with enclave intensity, although associations varied by gender and race. In females, the enclave effect was stronger in low-SES settings, but rates were higher in less-ethnic/high-SES than more-ethnic/low-SES neighborhoods--diminishing enclave intensity affected rates more than higher SES. In Hispanics, associations were modest, and only females experienced SES modification of rates; in APIs, the enclave effect was much stronger. Thus, acculturation measured by residence in ethnic enclaves affects HL rates independently of neighborhood SES but in complex patterns. Living in less-ethnic neighborhoods may increase HL rates by facilitating social isolation and other gender-specific exposures implicated in risk.
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Affiliation(s)
- Sally L. Glaser
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538
- Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA 94306
| | - Ellen T. Chang
- Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA 94306
- Health Sciences Practice, Exponent, Inc., 149 Commonwealth Drive, Menlo Park, CA 94025
| | - Christina A. Clarke
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538
- Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA 94306
| | - Theresa H.M. Keegan
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538
- Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA 94306
| | - Juan Yang
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538
- Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA 94306
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Sherief LM, Elsafy UR, Abdelkhalek ER, Kamal NM, Elbehedy R, Hassan TH, Sherbiny HS, Beshir MR, Saleh SH. Hodgkin lymphoma in childhood: clinicopathological features and therapy outcome at 2 centers from a developing country. Medicine (Baltimore) 2015; 94:e670. [PMID: 25881843 PMCID: PMC4602501 DOI: 10.1097/md.0000000000000670] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Hodgkin lymphoma (HL) accounts for 5% to 6% of all childhood cancer. It displays characteristic epidemiological, clinical, and pathological features according to various geographic areas. We aimed to assess the epidemiological aspects, clinicopathological features, and treatment outcome of pediatric HL treated at 2 Egyptian centers: Zagazig University Pediatric Oncology Unit and Benha Special Hospital Pediatric Oncology Unit. We carried a cross-sectional retrospective study by reviewing medical records for all patients admitted with the diagnosis of HL over 8 years in 2 oncology units during the period from January 2004 to January 2012. Age of the patients at presentation ranged from 3 to 14 years (median 6 years) and male: female ratio 1.7:1. Lymphadenopathy was the most common presentation (96.6%). Mixed cellularity subtype was dominant (50.8%), followed by nodular sclerosis (28.9%), lymphocyte-rich (18.6%) with lymphocyte depletion being the least dominant (1.7%). More than half of patients (55.9 %) had advanced disease (Ann Arbor stage III/IV disease). The duration of follow-up ranged from 5 to 87 months (mean 39.8 ± 24.1 months). The 5-year overall survival and event-free survival for patients were 96.6% and 84.7% respectively. In Egypt, HL occurs in young age group, with a higher incidence of mixed cellularity subtype and advanced disease. None of the clinical, epidemiological, or pathological characteristics had a significant association with the overall survival. The outcomes of HL in our 2 centers were satisfactory approaching the international percentage.
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Affiliation(s)
- Laila M Sherief
- From the Departments of Pediatrics, Faculty of Medicine, Zagazig (LMS, URE, ERA, RE, THH, HSS, MRB, SHS); Cairo Universities (NMK); and Benha Specialized Pediatric Hospital, Benha, Egypt (LMS, ERA)
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Benharroch D, Gopas J, Ariad S. Does the measles virus contribute to carcinogenesis? - a review. J Cancer 2014; 5:98-102. [PMID: 24494027 PMCID: PMC3909764 DOI: 10.7150/jca.7430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 12/06/2013] [Indexed: 11/05/2022] Open
Abstract
An association between the measles virus and classical Hodgkin lymphoma has previously been suggested by us. This has been refuted by two European groups. A reevaluation of the arguments held against our thesis was carried out and further evidence for a relationship between the measles virus and additional solid tumors has been presented. We have suggested a molecular mechanism to support a possible contribution of the virus to carcinogenesis in classical Hodgkin lymphoma.
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Affiliation(s)
| | - Jacob Gopas
- 2. Department of Oncology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Samuel Ariad
- 2. Department of Oncology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Gao Y, Li Q, Bassig BA, Chang ET, Dai M, Qin Q, Zhang Y, Zheng T. Subtype of dietary fat in relation to risk of Hodgkin lymphoma: a population-based case-control study in Connecticut and Massachusetts. Cancer Causes Control 2013; 24:485-94. [PMID: 23314676 DOI: 10.1007/s10552-012-0136-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 12/17/2012] [Indexed: 12/19/2022]
Abstract
Few epidemiological studies have examined the relationship between dietary fat, which may affect immune function and risk of Hodgkin lymphoma (HL). The aim of this study was to test the hypothesis that high dietary intake of fat and specific subtypes of fat is associated with the risk of HL among 486 HL cases and 630 population-based controls recruited between 1997 and 2000 in Connecticut and Massachusetts. Unconditional logistic regression was used to calculate odds ratios (ORs) and 95 % confidence intervals (CIs) stratified by age and gender. Among younger adults, HL risk was significantly and positively associated with higher intake of saturated fat [ORs for increasing quartiles = 1.3, 1.8, and 2.1; p trend = 0.04] and negatively associated with higher intake of monounsaturated fat [ORs for increasing quartiles = 0.5, 0.5, and 0.4; p trend = 0.03), after adjustment for potential confounders including lifestyle and other dietary factors. The associations with saturated fat (ORs for increasing quartile = 2.4, 3.2, and 4.4; p trend < 0.01] and monounsaturated fat (ORs for increasing quartile = 0.3, 0.6, and 0.3; p trend = 0.04) were most apparent in younger women, whereas there was no significant association between intake of total fat or any type of fat and risk of HL in older females or younger or older males. These findings show that the associations between dietary fat and risk of HL may vary by gender and age and require confirmation in other populations.
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Affiliation(s)
- Yongshun Gao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Crump C, Sundquist K, Sieh W, Winkleby MA, Sundquist J. Perinatal and family risk factors for Hodgkin lymphoma in childhood through young adulthood. Am J Epidemiol 2012; 176:1147-58. [PMID: 23171883 PMCID: PMC3571233 DOI: 10.1093/aje/kws212] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 04/11/2012] [Indexed: 11/12/2022] Open
Abstract
The incidence of Hodgkin lymphoma has increased among adolescents and young adults in recent decades, but the relevant risk factors in early life are still unknown. A national cohort study was conducted of 3,571,574 individuals born in Sweden in 1973-2008 and followed up for Hodgkin lymphoma incidence through 2009, to examine perinatal and family risk factors for Hodgkin lymphoma in childhood through young adulthood (ages 0-37 years). There were 943 Hodgkin lymphoma cases identified in 66.3 million person-years of follow-up. High fetal growth was associated with an increased risk of Hodgkin lymphoma after adjustment for gestational age at birth and other potential confounders (P(trend) = 0.005). Family history of Hodgkin lymphoma in a sibling or parent also was strongly associated with an increased risk, with adjusted hazard ratios = 8.83 (95% confidence interval: 3.67, 21.30) and 7.19 (95% confidence interval: 3.58, 14.44), respectively. No association was found between gestational age at birth, birth order, twinning, parental age, or parental education and Hodgkin lymphoma. These findings did not vary by age at Hodgkin lymphoma diagnosis. Similar associations were found for nodular sclerosis and mixed cellularity subtypes. These findings suggest that perinatal factors including possible growth factor pathways may contribute to the risk of Hodgkin lymphoma in childhood through young adulthood.
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Affiliation(s)
- Casey Crump
- Department of Medicine, Stanford University, Stanford, CA, USA.
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Ferreira JMDO, Klumb CE, Reis RDS, Santos MDO, Oliveira JFP, de Camargo B, Pombo-de-Oliveira MS. Lymphoma subtype incidence rates in children and adolescents: First report from Brazil. Cancer Epidemiol 2012; 36:e221-6. [DOI: 10.1016/j.canep.2012.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 03/01/2012] [Accepted: 03/04/2012] [Indexed: 10/28/2022]
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Clarke CA, Glaser SL, Gomez SL, Wang SS, Keegan TH, Yang J, Chang ET. Lymphoid malignancies in U.S. Asians: incidence rate differences by birthplace and acculturation. Cancer Epidemiol Biomarkers Prev 2011; 20:1064-77. [PMID: 21493873 PMCID: PMC3111874 DOI: 10.1158/1055-9965.epi-11-0038] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Malignancies of the lymphoid cells, including non-Hodgkin lymphomas (NHL), HL, and multiple myeloma, occur at much lower rates in Asians than other racial/ethnic groups in the United States. It remains unclear whether these deficits are explained by genetic or environmental factors. To better understand environmental contributions, we examined incidence patterns of lymphoid malignancies among populations characterized by ethnicity, birthplace, and residential neighborhood socioeconomic status (SES) and ethnic enclave status. METHODS We obtained data about all Asian patients diagnosed with lymphoid malignancies between 1988 and 2004 from the California Cancer Registry and neighborhood characteristics from U.S. Census data. RESULTS Although incidence rates of most lymphoid malignancies were lower among Asian than white populations, only follicular lymphoma (FL), chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), and nodular sclerosis (NS) HL rates were statistically significantly lower among foreign-born than U.S.-born Asians with incidence rate ratios ranging from 0.34 to 0.87. Rates of CLL/SLL and NS HL were also lower among Asian women living in ethnic enclaves or lower SES neighborhoods than those living elsewhere. CONCLUSIONS These observations support strong roles of environmental factors in the causation of FL, CLL/SLL, and NS HL. IMPACT Studying specific lymphoid malignancies in U.S. Asians may provide valuable insight toward understanding their environmental causes.
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Affiliation(s)
- Christina A Clarke
- Cancer Prevention Institute of California, Fremont, California 94538, USA.
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Grulich AE, Vajdic CM, Falster MO, Kane E, Smedby KE, Bracci PM, de Sanjose S, Becker N, Turner J, Martinez-Maza O, Melbye M, Engels EA, Vineis P, Costantini AS, Holly EA, Spinelli JJ, La Vecchia C, Zheng T, Chiu BCH, Franceschi S, Cocco P, Maynadié M, Foretova L, Staines A, Brennan P, Davis S, Severson RK, Cerhan JR, Breen EC, Birmann B, Cozen W. Birth order and risk of non-hodgkin lymphoma--true association or bias? Am J Epidemiol 2010; 172:621-30. [PMID: 20720098 PMCID: PMC2950815 DOI: 10.1093/aje/kwq167] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 05/10/2010] [Indexed: 12/22/2022] Open
Abstract
There is inconsistent evidence that increasing birth order may be associated with risk of non-Hodgkin lymphoma (NHL). The authors examined the association between birth order and related variables and NHL risk in a pooled analysis (1983-2005) of 13,535 cases and 16,427 controls from 18 case-control studies within the International Lymphoma Epidemiology Consortium (InterLymph). Overall, the authors found no significant association between increasing birth order and risk of NHL (P-trend = 0.082) and significant heterogeneity. However, a significant association was present for a number of B- and T-cell NHL subtypes. There was considerable variation in the study-specific risks which was partly explained by study design and participant characteristics. In particular, a significant positive association was present in population-based studies, which had lower response rates in cases and controls, but not in hospital-based studies. A significant positive association was present in higher-socioeconomic-status (SES) participants only. Results were very similar for the related variable of sibship size. The known correlation of high birth order with low SES suggests that selection bias related to SES may be responsible for the association between birth order and NHL.
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Affiliation(s)
- Andrew E Grulich
- HIV Epidemiology and Prevention Program, National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, New South Wales 2052, Australia.
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McClure LA, Glaser SL, Shema SJ, Allen L, Quesenberry C, John EM, Gomez SL. Availability and accuracy of medical record information on language usage of cancer patients from a multi-ethnic population. J Immigr Minor Health 2009; 12:480-8. [PMID: 19685187 DOI: 10.1007/s10903-009-9282-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Documentation of language usage in medical settings could be effective in identifying and addressing language barriers and would improve understanding of health disparities. This study evaluated the availability and accuracy of medical records information on language for 1,664 cancer patients likely to have poor English proficiency. Accuracy was assessed by comparison to language obtained from interview-based research studies. For patients diagnosed at facilities where information on language was not abstracted electronically, 81.6% had language information in their medical records, most often in admissions documents. For all 37 hospitals, agreement between medical records and interview language was 79.3% overall and was greater for those speaking English than another language. Language information is widely available in hospital medical records of cancer patients. However, for the data to be useful for research and reducing language barriers in medical care, the information must be collected in a consistent and accurate manner.
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Affiliation(s)
- Laura A McClure
- Northern California Cancer Center, 2201 Walnut Avenue, Fremont, CA 94538, USA
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16
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Glaser SL, Chang ET, Horning SJ, Clarke CA. Understanding the validity of self-reported positive family history of lymphoma in extended families to facilitate genetic epidemiology and clinical practice. Leuk Lymphoma 2009; 48:1110-8. [PMID: 17577774 DOI: 10.1080/10428190701302434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The validity of self-reported information about familial Hodgkin lymphoma (HL), important for epidemiologic research and clinical practice, is undetermined. We attempted to validate 55 familial lymphomas previously reported by 48 subjects in a population-based case-control study of HL in women. Of 44 diagnoses (80%) reported by 40 (83%) recontacted subjects, we obtained medical documentation for 36 (82%). Twenty-nine (81%) were validated as lymphoma, with accuracy better for first-degree relatives and subjects with larger nuclear families and other family illness. Fourteen reports of familial HL were validated as lymphoma for 13 (93%) and as HL for nine (64%). Fifteen reports of familial NHL were validated as lymphoma for 10 (67%) and as NHL for 10 (67%). Thus, familial HL reported by HL patients and controls is highly likely to be lymphoma even in extended family members but less likely to be HL per se. Validity may vary with the subject's family size and medical history.
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Affiliation(s)
- Sally L Glaser
- Northern California Cancer Center, Fremont, CA 94538, USA.
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17
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Hjalgrim H, Engels EA. Infectious aetiology of Hodgkin and non-Hodgkin lymphomas: a review of the epidemiological evidence. J Intern Med 2008; 264:537-48. [PMID: 19017178 DOI: 10.1111/j.1365-2796.2008.02031.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Lymphomas constitute a heterogeneous group of malignant disorders with different clinical behaviours, pathological features and epidemiological characteristics. For some lymphoma subtypes, epidemiological evidence has long pointed to infectious aetiologies. A subset of Hodgkin lymphoma is strongly linked to Epstein-Barr virus (EBV) infection. In addition, infectious agents can directly infect and transform lymphocytes (e.g. EBV, human herpesvirus 8), induce immunosuppression (human immunodeficiency virus), or cause chronic immune stimulation (hepatitis C virus, Helicobacter pylori), all of which may play a role in the development of various non-Hodgkin lymphoma subtypes. Here, we review the epidemiological evidence linking infections with malignant lymphoma.
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Affiliation(s)
- H Hjalgrim
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
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18
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Roswall N, Olsen A, Christensen J, Rugbjerg K, Mellemkjær L. Social inequality and incidence of and survival from Hodgkin lymphoma, non-Hodgkin lymphoma and leukaemia in a population-based study in Denmark, 1994–2003. Eur J Cancer 2008; 44:2058-73. [DOI: 10.1016/j.ejca.2008.06.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 06/06/2008] [Accepted: 06/16/2008] [Indexed: 10/21/2022]
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19
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Gomez SL, Glaser SL. Misclassification of race/ethnicity in a population-based cancer registry (United States). Cancer Causes Control 2006; 17:771-81. [PMID: 16783605 DOI: 10.1007/s10552-006-0013-y] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Revised: 01/18/2006] [Indexed: 10/24/2022]
Abstract
Cancer registry data on race/ethnicity are vital for understanding cancer patterns in population subgroups, as they inform public health policies for allocating resources and form the bases of etiologic hypotheses. However, accuracy of cancer registry data on race/ethnicity has not been systematically evaluated. By comparing race/ethnicity in the Greater Bay Area Cancer Registry to self-reported race/ethnicity for patients from 14 racial/ethnic groups, we determined the accuracy of this variable and the patient and hospital characteristics associated with disagreement. The extent of misclassification (measured by sensitivity and predictive value positive (PV+)) varied across racial/ethnic groups (total n=11,676). Sensitivities and PV+'s were high (exceeding 90%) for non-Hispanic Whites and Blacks, moderate for Hispanics and some Asian subgroups (70-90%), and very low for American Indians (<20%). Overall, registry and interview race/ethnicity disagreed for 11% of the sample. In a multivariate model, disagreement was associated with non-White race/ethnicity, younger age, being married, being foreign-born but preferring to speak English, and diagnosis in a large hospital. Improving data quality for race/ethnicity will be most effectively attempted at the reporting source. We advocate a concerted effort to systematize collection of these patient data across all facilities, which may be more feasible given electronic medical admissions forms.
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Affiliation(s)
- Scarlett L Gomez
- Northern California Cancer Center, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538, USA.
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20
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Tzankov A, Dirnhofer S. Pathobiology of Classical Hodgkin Lymphoma. Pathobiology 2006; 73:107-25. [PMID: 17085956 DOI: 10.1159/000095558] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Accepted: 07/13/2006] [Indexed: 12/28/2022] Open
Abstract
The World Health Organization has acknowledged the malignant nature of classical Hodgkin lymphoma (cHL), which encompasses four histological subtypes. The diagnosis of cHL is based on the detection of malignant Hodgkin and Reed-Sternberg cells (HRSC) confirmed by immunophenotyping and the detection of growth patterns specific to each histological subtype. The pathologic HRSC arise from germinal center or immediate postgerminal cells that lack detectable immunoglobulin/B-cell antigen receptor expression, with a consequent loss of B-cell identity; very few cHL cases are of T-cell origin. To escape apoptosis, which normally occurs in B cells with nonfunctioning antigen receptor machinery, HRSC develop concurrent antiapoptotic mechanisms by activation of nuclear factor-kappaB or are rescued by Epstein-Barr virus infection. HRSC are characterized by a variable and inconstant immunophenotype, with a remarkable loss of lineage-specific cell antigens and expression of antigens of other cell lineages. The master plan of B-cell identity in HRSC is disturbed not only at the immunoglobulin expression level, but also at the transcriptional factor level. HRSC are further characterized by profound cell cycle deregulation with futile replication, multinucleation and poly- and aneuploidy. Here, we review pathobiological aspects of cHL with respect to lymphomagenesis and routine diagnostics.
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Affiliation(s)
- Alexandar Tzankov
- Institute of Pathology, Medical University of Innsbruck, Innsbruck, Austria
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21
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Keegan THM, Glaser SL, Clarke CA, Dorfman RF, Mann RB, DiGiuseppe JA, Chang ET, Ambinder RF. Body size, physical activity, and risk of Hodgkin's lymphoma in women. Cancer Epidemiol Biomarkers Prev 2006; 15:1095-101. [PMID: 16775165 DOI: 10.1158/1055-9965.epi-06-0020] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Few studies have examined the associations of body size and physical activity with the development of Hodgkin's lymphoma (HL) in women. In data from a population-based case-control study in women ages 19 to 79 years, we assessed the relation of self-report height, weight, body mass index (BMI), and strenuous physical activity to HL risk in 312 cases with diagnostic re-review and 325 random-digit dialed controls using logistic regression. Analyses were stratified by age group and tumor cell presence of EBV. After adjustment for social class measures, taller childhood and adult height were associated with higher HL risk. In women ages 19 to 44 years, HL risk was elevated for higher, but healthy, BMI values, whereas in women ages 45 to 79 years, associations with BMI were inverse. The odds of developing HL were lower with participation (versus nonparticipation) in strenuous physical activity in the past year [odds ratio (OR), 0.58; 95% confidence interval (95% CI), 0.39-0.87 in women 19-44 years; OR, 0.45; 95% CI, 0.19-1.06 in women 45-79 years] and throughout adult life, and with sports team membership (versus nonmembership) in high school and/or at ages 18 to 22 years. Results were similar in cases (n = 269) with and without tumor-cell EBV compared with controls, although the inverse association with physical activity was somewhat stronger for women with EBV-positive disease. These findings show that in women, body size and strenuous physical activity, both modifiable characteristics, are associated with HL risk in adult life possibly through immunologic, infectious, or genetic mechanisms.
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Affiliation(s)
- Theresa H M Keegan
- Northern California Cancer Center, Suite 300, 2201 Walnut Avenue, Fremont, CA 94538-2334, USA.
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22
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Gomez SL, Glaser SL. Quality of cancer registry birthplace data for Hispanics living in the United States. Cancer Causes Control 2005; 16:713-23. [PMID: 16049810 DOI: 10.1007/s10552-005-0694-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2004] [Accepted: 01/17/2005] [Indexed: 10/25/2022]
Abstract
Patient birthplace from the SEER population-based cancer registries is potentially useful for identifying disparities in cancer occurrence and for studying cancer etiology. However, for Hispanics, completeness and accuracy of registry birthplace is unknown. By comparing registry birthplace to self-reported birthplace from 13 interview studies, we determined the completeness and accuracy of this variable and the associations of these measures with patient and hospital characteristics in the Greater Bay Area. Registry birthplace was unrecorded for 46% of 1277 Hispanic cancer cases, and unrecorded birthplace (i.e., incompleteness) was associated with younger age, higher education, English language preference, US birthplace, and admission at certain hospitals. For 691 Hispanics with available registry birthplace, sensitivity and positive predictive value compared to self-report (i.e., accuracy) were 96.3 and 97.3 among foreign-born, and 96.8 and 95.6 among US-born. US-born Hispanics misclassified in the registry as foreign-born were more likely to have unavailable education information, be deceased, prefer a language besides English, and be diagnosed at a smaller hospital or before 1996. Among self-reported foreign-born Hispanics, those misclassified as US-born were less likely to have been diagnosed at an HMO. Although the completeness and accuracy of birthplace information may vary across registries, this variable appears to be limited for analyses involving Hispanics.
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Affiliation(s)
- Scarlett L Gomez
- Northern California Cancer Center, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538, USA.
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23
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Glaser SL, Keegan THM, Clarke CA, Trinh M, Dorfman RF, Mann RB, DiGiuseppe JA, Ambinder RF. Exposure to childhood infections and risk of Epstein-Barr virus--defined Hodgkin's lymphoma in women. Int J Cancer 2005; 115:599-605. [PMID: 15700307 DOI: 10.1002/ijc.20787] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The role of Epstein-Barr virus (EBV) in Hodgkin's lymphoma (HL) etiology remains unresolved as EBV is detected in only some HL tumors and few studies have tried to reconcile its presence with factors suggesting viral etiology (e.g., childhood social class, infection history). In a population-based case-control study of San Francisco Bay area women, we analyzed interview data by tumor EBV status. Among 211 young adult cases, EBV-positive HL (11%) was associated with a single vs. shared bedroom at age 11 (OR = 4.0, 95% CI 1.1-14.4); risk was decreased for common childhood infections (OR = 0.3, 95% CI 0.1-1.0), including measles before age 10, but not with prior infectious mononucleosis (IM), which is delayed EBV infection. No study factors affected risk of young adult EBV-negative HL. Among 57 older adult cases, EBV-positive HL (23%) was unrelated to study factors; EBV-negative HL was associated with a single bedroom at age 11 (OR = 3.6, 95% CI 1.5-9.1) and IM in family members (OR = 3.1, 95% CI 1.1-9.0). Thus, delayed exposure to infection may increase risk of EBV-positive HL in young adults, but risk patterns differ in younger and older women for both EBV-positive and -negative HL. Late EBV infection does not appear relevant to risk, suggesting that other pathogens impact HL etiology in affluent female populations. Inconsistency of findings with prior studies may reflect failure of study risk factors to proxy meaningful exposures, risk differences by gender, or selection or misclassification bias. Null findings for EBV-negative HL indicate that etiologic models should be reconsidered for this common form.
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Affiliation(s)
- Sally L Glaser
- Northern California Cancer Center, Fremont, CA 94538, USA.
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24
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Abstract
Childhood Hodgkin's disease (HD) is not a biologically unique disease; it differs from adult HD primarily in the relative incidence of disease histology. Preadolescent children are more likely to have Mixed Cellularity and nodular lymphocyte predominant HD. Adolescent and young adult HD is indistinguishable, with a predominance of nodular sclerosing (NS) HD. Nonetheless, treatment paradigms have diverged over the years as pediatric oncologists responded first to developmental issues in the young child, and later to the long-term treatment consequences in all young survivors. The latter concerns are of equal relevance to the young adult with HD. The increasing convergence of treatment approaches in the past decade is therefore most appropriate. Reproductive potential, risk of secondary malignancy and cardiopulmonary consequences of therapy have driven the pediatric treatment paradigm of care. Chemotherapy with low dose, limited field radiation is standard, with low-stage patients often treated by chemotherapy alone. Algorithms tailor therapy to response. The prognostic importance of very early chemotherapy response rather than end-of-chemotherapy response has led the Children's Oncology Group to use early response (after 6 wk) to titrate individual therapy and dense regimens to maximize the early response rates. Although the dose dense regimens of adult groups are similar, the pediatric algorithms emphasize using the enhanced efficacy to limit cumulative therapy. This review intends to address the special issues of childhood HD, with the intent of further encouraging understanding that will foster convergence of pediatric and adult treatment paradigms.
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Affiliation(s)
- Cindy L Schwartz
- Department of Oncology and Pediatrics, Sidney Kimmel Oncology Center at Johns Hopkins University, Baltimore, MD, USA.
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25
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Clarke CA, Glaser SL, Keegan THM, Stroup A. Neighborhood Socioeconomic Status and Hodgkin's Lymphoma Incidence in California. Cancer Epidemiol Biomarkers Prev 2005; 14:1441-7. [PMID: 15941953 DOI: 10.1158/1055-9965.epi-04-0567] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hodgkin's lymphoma occurrence has long been noted to associate with higher socioeconomic status (SES). However, the Hodgkin's lymphoma-SES association has not been examined recently or across important, possibly etiologically distinct, patient subgroups. In approximately 150 million person-years of observation in the multiethnic population of California, we examined the association of Hodgkin's lymphoma incidence with a composite measure of neighborhood-level SES in patient subgroups defined by age, sex, race/ethnicity, and Hodgkin's lymphoma histologic subtype. Using population-based cancer registry data on 3,794 Hodgkin's lymphoma patients diagnosed 1988 to 1992 and 1990 census data, we assigned a previously validated, multidimensional SES index to census block groups of patient residence. We then calculated neighborhood SES-specific incidence rates and estimated rate ratios using Poisson regression. Positive neighborhood SES gradients in Hodgkin's lymphoma incidence were observed only in young adults (ages 15-44 years at diagnosis) with nodular sclerosis Hodgkin's lymphoma and older adult (ages > or =45 years) White and Hispanic males with mixed cellularity Hodgkin's lymphoma. For young adults, associations were marked in Hispanic and Asian women, weaker in Hispanic and White men and White women, and subtle to nonexistent in Blacks and Asian men. Neighborhood SES gradients in Hodgkin's lymphoma incidence varied by age, sex, race/ethnicity, and histologic subtype, underscoring etiologic complexity in Hodgkin's lymphoma. Racial/ethnic gradients were not entirely explained by neighborhood SES. In California, etiologically relevant exposures for young adult Hodgkin's lymphoma, the most common form, could associate more with race/ethnicity or foreign birthplace than neighborhood SES and may be modified by reproductive or other sex-specific factors.
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Affiliation(s)
- Christina A Clarke
- Northern California Cancer Center, 2201 Walnut Avenue, Suite 300, Fremont, California 94538, USA.
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26
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Benharroch D, Shemer-Avni Y, Myint YY, Levy A, Mejirovsky E, Suprun I, Shendler Y, Prinsloo I, Ariad S, Rager-Zisman B, Sacks M, Gopas J. Measles virus: evidence of an association with Hodgkin's disease. Br J Cancer 2004; 91:572-9. [PMID: 15226778 PMCID: PMC2409981 DOI: 10.1038/sj.bjc.6601900] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2003] [Revised: 04/05/2004] [Accepted: 04/08/2004] [Indexed: 11/08/2022] Open
Abstract
The quest for an infectious agent that may account for cases of Hodgkin's disease (HD) especially in young adults has proven vain until lately. We have recently reported findings that suggested the presence of measles virus (MV) antigens and MV RNA in the tissues of patients with HD. Support for an association between MV and HD has been provided by recent epidemiological findings relating the occurrence of HD to exposure to measles in pregnancy and the perinatal period. We now present further evidence of this putative association based on immunohistochemical, reverse transcriptase-polymerase chain reaction (RT-PCR) and in situ hybridisation studies (ISH) on HD tissues. Biopsies from 82 (54.3%) of our cohort of 154 patients showed a positive immunostain with at least two of the anti-measles antibodies used. Latent membrane protein-1 immunostaining for Epstein-Barr virus was positive in 46 (31.1%) of the patients examined. Reverse transcriptase-PCR and ISH for measles RNA were positive in seven and 10 of 28 patients, respectively. Preliminary clinicopathological associations between MV and HD are noted in this study, but no causal relationship can be claimed at this stage.
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Affiliation(s)
- D Benharroch
- Department of Pathology, The Soroka University Medical Center, PO Box 151, Beer-Sheva 84101, Israel.
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27
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Chang ET, Zheng T, Weir EG, Borowitz M, Mann RB, Spiegelman D, Mueller NE. Childhood Social Environment and Hodgkin's Lymphoma: New Findings from a Population-Based Case-Control Study. Cancer Epidemiol Biomarkers Prev 2004. [DOI: 10.1158/1055-9965.1361.13.8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Risk of Hodgkin's lymphoma in young adults has previously been associated with higher childhood socioeconomic status (SES) and other markers of delayed infection with common childhood pathogens, especially the Epstein-Barr virus. This study examines the current role of childhood social environment in the development of Hodgkin's lymphoma. Methods: A population-based case-control study of 565 Hodgkin's lymphoma cases and 679 controls was conducted in the Boston, MA metropolitan area and the state of Connecticut to investigate the viral etiology of Hodgkin's lymphoma. Results: A novel association was detected between attendance of nursery school or day care and reduced risk of Hodgkin's lymphoma among individuals ages 15 to 54 years. The odds ratio (95% confidence interval) for having attended preschool for at least 1 year was 0.64 (0.45-0.92). Risk of young-adult Hodgkin's lymphoma was also associated with family history of hematopoietic cancer, Jewish ethnicity, and cigarette smoking. Other indicators of childhood SES were not associated with young-adult Hodgkin's lymphoma. Among older adults ages 55 to 79 years, Hodgkin's lymphoma was associated with lower childhood SES but not with preschool attendance. Conclusions: Early exposure to other children at nursery school and day care seems to decrease the risk of Hodgkin's lymphoma in young adults, most likely by facilitating childhood exposure to common infections and promoting maturation of cellular immunity. This finding supports the delayed infection model of Hodgkin's lymphoma etiology in young adults while introducing a new major determinant of age at infection. Hodgkin's lymphoma seems to have a separate pathogenesis among older adults.
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Affiliation(s)
| | - Tongzhang Zheng
- 2Yale University School of Medicine, New Haven, Connecticut; and
| | | | | | - Risa B. Mann
- 3Johns Hopkins Medical Institute, Baltimore, Maryland
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28
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Abstract
Abstract
Background: Epidemiologic evidence indicates that risk of Hodgkin's lymphoma (HL) in young adults is associated with correlates of delayed exposure to infection during childhood. In contrast, HL among children and older adults may be associated with earlier childhood infection. This study examines the associations of HL risk with having older or younger siblings. Methods: We conducted a case-control study in Sweden comparing 2,140 HL patients identified from the Swedish Cancer Register with 10,024 controls identified from national population registers. The Swedish Multi-Generation Register was used to link individuals to their parents and siblings. Results: Among young adults ages 15 to 39 years, the odds ratios (OR) associated with having one, two, and three or more older siblings, compared with none, were 0.96 [95% confidence interval (CI), 0.82-1.13], 0.88 (95% CI, 0.72-1.09), and 0.72 (95% CI, 0.55-0.93), respectively (P value for trend = 0.01). In contrast, number of older siblings was not associated with HL risk among children or older adults. Number of younger or total siblings, mother's age at birth, and father's occupation were not associated with HL at any age. The decreased risk of young-adult HL did not vary appreciably by age difference or sex of older siblings. Conclusions: Risk of HL was lower among young adults with multiple older but not younger siblings. Having older siblings is associated with earlier exposure to common childhood pathogens. Pediatric and older-adult HL were not associated with number of siblings, suggesting a different pathogenesis of disease in these age groups.
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29
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Abstract
Survivors of Hodgkin's lymphoma (HL) frequently have many years to experience the long-term toxicities of combined modality therapies. Also, a significant proportion of HL patients will relapse or have refractory disease, and less than half of these patients will respond to current salvage strategies. 30-50% of HL cases are Epstein-Barr virus associated (EBV-positive HL). The virus is localized to the malignant cells and is clonal. EBV-positive HL is more frequent in childhood, in older adults (>45 years) and in mixed cellularity cases. The survival of EBV-positive HL in the elderly and the immunosuppressed is particularly poor. Despite improvements in our understanding of EBV-positive HL, the true contribution of EBV to the pathogenesis of HL remains unknown. Increased knowledge of the virus' role in the basic biology of HL may generate novel therapeutic strategies for EBV-positive HL and the presence of EBV-latent antigens in the malignant HL cells may represent a target for cellular immunotherapy.
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Affiliation(s)
- Maher K Gandhi
- Department of Tumour Immunology, Division of Infectious Diseases and Immunology, Queensland Institute of Medical Research, Herston, Brisbane, Queensland, Australia.
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30
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Abstract
This review considers in detail the descriptive and aetiological epidemiology of Hodgkin's disease and non-Hodgkin's lymphoma (NHL), with attention to histological subcategories when the literature allows. The aetiology of Hodgkin's disease remains only partially understood. There is evidence that Epstein-Barr virus (EBV) may be involved in the causation of some cases, and clinical immune deficiency is a risk factor for a few, but the evidence is not entirely consistent and other factors may also be important in causing the EBV-associated cases of Hodgkin's disease. The cause of EBV-unassociated cases remains obscure. For NHL, although it has been shown that some cases are related to immune deficiency and chronic antigenic stimulation, and especially to EBV in the context of immune deficiency, the causation of the majority of cases remains unknown. The increasing incidence of NHL, other than that related to AIDS, is also essentially unexplained. Epidemiological investigation of the aetiology of NHL and Hodgkin's disease is making steady progress, however, and there remain leads to be followed that may result in a better understanding and hence prevention.
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Affiliation(s)
- A J Swerdlow
- Section of Epidemiology, Institute of Cancer Research, Brookes Lawley Building, Sutton, Surrey, UK.
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