Common immune-related risk factors and incident non-Hodgkin lymphoma: the multiethnic cohort

Association of Obesity and Type 2 Diabetes with Non-Hodgkin Lymphoma: The Multiethnic Cohort

BACKGROUND

Given the role of the immune system in non-Hodgkin lymphoma (NHL) etiology, obesity and type 2 diabetes (T2D) may impact NHL development. We examined the association of body mass index (BMI) and T2D with NHL in the multiethnic cohort (MEC).

METHODS

The MEC recruited >215,000 participants in Hawaii and Los Angeles from five racial/ethnic groups; NHL cases were identified through cancer registry linkages. T2D status, and BMI at age 21 and cohort entry were derived from repeated self-reports; for T2D, Medicare claims were also applied. HRs and 95% confidence intervals (CI) for BMI and T2D as predictors of NHL were determined using Cox regression adjusted for relevant covariates.

RESULTS

Among 192,424 participants, 3,472 (1.8%) with NHL and 68,850 (36%) with T2D after 19.2 ± 6.6 years follow-up, no significant association between T2D and NHL (HR, 1.04; 95% CI, 0.96-1.13) was observed. Stratification by BMI at cohort entry showed a significant association of T2D with NHL among individuals with normal weight only (HR, 1.18; 95% CI, 1.03-1.37). In a model with both BMI values plus T2D, only overweight (HR, 1.13; 95% CI, 1.01-1.26) and obesity (HR, 1.25; 95% CI, 0.99-1.59) at age 21 were associated with NHL incidence. Stratification by sex, race/ethnicity, and NHL subtype indicated no differences.

CONCLUSIONS

Our findings suggest an association between T2D and NHL incidence in several subgroups but not in the total population and an elevated risk related to early-life BMI.

IMPACT

Excess body weight in early life, rather than T2D, may be a predictor of NHL incidence.

Aspirin and other nonsteroidal anti-inflammatory drugs, statins and risk of non-Hodgkin lymphoma

Non-steroidal anti-inflammatory drugs (NSAIDs) and statin drugs may protect against the development of non-Hodgkin lymphoma (NHL), but data are limited, particularly for NHL subtypes. Furthermore, some in vitro, animal and epidemiologic data suggest there may be a synergistic effect of these two agents, but there has been no test of this hypothesis in NHL. We evaluated the self-reported use of NSAIDs and statins in a clinic-based study of 1703 NHL patients and 2199 frequency-matched controls. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for potential confounding variables. We observed an inverse association of regular use of low-dose aspirin with risk of NHL (OR = 0.82; 95% CI 0.70-0.96) that was stronger with longer duration of use (P < .01). There were no associations for use of regular or extra-strength aspirin, ibuprofen, other NSAIDs, statins or other cholesterol-lowering drugs with NHL risk, while an inverse association with COX-2 inhibitors was equivocal. There was also no interaction of low-dose aspirin and statins on NHL risk. Inverse associations of similar magnitude to all NHL were observed for regular use of low-dose aspirin with diffuse large B-cell, follicular, marginal zone and all other lymphomas, although not all associations were statistically significant. In conclusion, low-dose aspirin but not regular/extra strength aspirin, other NSAIDs or statin use was associated with lower risk of NHL. Beyond the potential for the primary prevention of NHL, these data also point to a role of anti-platelet or other effects of low-dose aspirin in lymphomagenesis that warrant follow-up.

Epidemiology of Follicular Lymphoma

Follicular lymphoma (FL) is a common indolent lymphoma subtype in Western countries. FL incidence increases with age, and shows considerable variation by race/ethnicity and geography. In the United States and France, FL incidence has been stable since 2000, whereas in other Western and Asian countries it has been increasing. Five-year relative survival rates have been increasing in Western and Asian countries. Progress on identifying FL-specific risk factors has accelerated with the implementation of the InterLymph nested classification and the availability of larger epidemiologic studies and pooled analyses. Identification of risk factors for FL requires further research.

Birth Order, Sibship Size, Childhood Environment and Immune-Related Disorders, and Risk of Lymphoma in Lymphoid Cancer Families

BACKGROUND

Familial aggregation of lymphoid cancers and immune-related disorders suggests a role for genetic susceptibility; however, few studies examine environmental factors. According to the hygiene hypothesis, adult-onset immune-related diseases may be a consequence of reduced childhood infectious exposures and aberrant immune development. In a cohort of 196 multiple-case lymphoid cancer families, we analyzed environmental factors related to the hygiene hypothesis.

METHODS

Family structure, childhood environment, and immune-related disorders were examined among 196 lymphoid cancer families, in relation to risk of lymphoid cancer. We report on 450 lymphoid cancer cases and 1,018 unaffected siblings using logistic regression models with generalized estimating equations to estimate ORs and 95% confidence intervals (CI) for association.

RESULTS

The risk of lymphoma tended to decrease with later birth order (OR = 0.83; 95% CI, 0.78-0.89) and larger sibship size (OR = 0.82; 95% CI, 0.79-0.85). High maternal education, above average family income during childhood, allergies (OR = 2.25; 95% CI, 1.44-3.51), and tonsillectomy (OR = 1.78; 95% CI, 1.14-2.78) were independent risk factors for lymphoma. Familial lymphoid cancer cases were more likely to report environment (OR = 1.90; 95% CI, 1.21-2.98) and drug (OR = 2.30; 95% CI, 1.41-3.73) allergies.

CONCLUSIONS

These associations underscore the complex etiology of familial lymphoma. To our knowledge, this is the largest multiple-case family-based study that supports the hygiene hypothesis contributing to lymphoid cancer risk.

IMPACT

Understanding the mechanism by which environmental and lifestyle factors affect lymphoid cancer risk may advance cancer prevention, even in the familial context.

The association between gestational diabetes mellitus and cancer in women: A systematic review and meta-analysis of observational studies

AIM

Both type 1 and type 2 diabetes are associated with greater risk of a variety of cancers. However, the association between gestational diabetes mellitus (GDM) and risk of cancer has so far not been well addressed. This study aimed to summarize the epidemiological evidence of the association between GDM and subsequent risk of cancer.

METHODS

PubMed and Embase databases were searched for relevant studies, and a random-effects model was used to calculate the summary relative risks (RRs) along with the corresponding 95% confidence intervals (CIs).

RESULTS

A total of 17 observational studies were selected, comprising 7 case-control and 10 cohort studies. Pooled effect estimates retrieved from these 17 studies showed that GDM was associated with an increased risk of breast cancer in Asia (pooled RR: 1.31, 95% CI: 1.01-1.70), but not in other regions, and also with thyroid cancer (RR: 1.28, 95% CI: 1.16-1.42), stomach cancer (RR: 1.43, 95% CI: 1.02-2.00) and liver cancer (RR: 1.27, 95% CI: 1.03-1.55). However, GDM was not associated with any increased risk of colon (RR: 1.41, 95% CI: 0.90-2.21), colorectal (RR: 1.16, 95% CI: 0.95-1.41), ovarian (RR: 1.14, 95% CI: 0.90-1.44), cervical (RR: 1.02, 95% CI: 0.81-1.29), pancreatic (RR: 3.49, 95% CI: 0.80-15.23), brain and nervous system (RR: 1.26, 95% CI: 0.80-1.97), blood (leukaemia, RR: 0.77, 95% CI: 0.45-1.30), endometrial (RR: 0.77, 95% CI: 0.20-2.98), skin (RR: 1.13, 95% CI: 0.81-1.59) or urological (RR: 0.98, 95% CI: 0.73-1.31) cancers.

CONCLUSION

GDM is associated with a greater risk of cancer in women, including breast, thyroid, stomach and liver cancers. However, further investigation is nonetheless warranted.

Association of diabetes mellitus with non-Hodgkin lymphoma risk: a meta-analysis of cohort studies

Background: Diabetes mellitus (DM) is considered to be a risk factor in the prognosis of many types of cancer, but the effect of DM on the risk of non-Hodgkin lymphoma (NHL) is still under dispute. We performed this study to examine the association between DM and subsequent NHL risk. Methods: A systematically search had been performed in PubMed, EmBase, and the Cochrane Library to identify eligible studies from inception to September 2018. Results: Thirteen cohort studies were included, with a total of 9024761 participants. The results showed that DM was associated with an increased risk of NHL (RR = 1.15, 95%CI: 1.02, 1.30, P = .03). Subgroup analyses suggested that DM was significantly associated with patients aged less than 60 years old (RR = 1.65, 95%CI: 1.31, 2.09, P < .0001), follow-up duration within 8 years (RR = 1.23, 95%CI: 1.02, 1.48, P = .03), and studies adjusted for body mass index (RR = 1.35, 95%CI: 1.01, 1.79, P = .04). The analyses within DM patients indicated that DM men were more likely to develop NHL than DM women (RR = 1.31, 95%CI: 1.04, 1.65, P = .02). Conclusions: These results indicated that DM patients have significantly increased risk of NHL compared nondiabetics. Male DM patients were more likely to develop NHL compared with female. However, further large-scale studies are required to eliminate miscellaneous factors in all included studies.

Association between type 1 and type 2 diabetes and risk of non-Hodgkin's lymphoma: A meta-analysis of cohort studies

AIM

Diabetes mellitus (DM) is thought to be associated with an increased risk of non-Hodgkin's lymphoma (NHL), although the evidence so far remains inconsistent. Thus, our study aimed to further assess this association.

METHODS

Electronic searches were performed of the PubMed, Web of Science and Embase databases up to 11 March 2019. A random-effects model was used to calculate summary relative risks (RRs) with corresponding 95% confidence intervals (CIs).

RESULTS

A total of 20 articles including data from 35 cohort studies matched our inclusion criteria, and 31 RRs were calculated for type 2 DM; the summary RR was 1.20 (95% CI: 1.12-1.30, I² = 84.7%). Also, four RRs were calculated for type 1 DM, and the result was significant (RR: 1.55, 95% CI: 1.15-2.08, I² = 0.0%). The results of subgroup analyses demonstrated that the association between DM and NHL was much more substantial in an Asian population, while sensitivity analyses suggested the robustness of a positive association between DM and NHL risk. In addition, the RR of NHL correlated negatively with duration of DM, with the highest risk found in patients within 1-2 years of DM diagnosis.

CONCLUSION

Our study findings suggest a moderate increase in risk of NHL in type 1 and 2 DM patients. Future studies should investigate the effects of duration of DM and antidiabetes interventions on NHL risk.

Sex differences in the association between diabetes and cancer: a systematic review and meta-analysis of 121 cohorts including 20 million individuals and one million events

AIMS/HYPOTHESIS

Diabetes has been shown to be a risk factor for some cancers. Whether diabetes confers the same excess risk of cancer, overall and by site, in women and men is unknown.

METHODS

A systematic search was performed in PubMed for cohort studies published up to December 2016. Selected studies reported sex-specific relative risk (RR) estimates for the association between diabetes and cancer adjusted at least for age in both sexes. Random-effects meta-analyses with inverse-variance weighting were used to obtain pooled sex-specific RRs and women-to-men ratios of RRs (RRRs) for all-site and site-specific cancers.

RESULTS

Data on all-site cancer events (incident or fatal only) were available from 121 cohorts (19,239,302 individuals; 1,082,592 events). The pooled adjusted RR for all-site cancer associated with diabetes was 1.27 (95% CI 1.21, 1.32) in women and 1.19 (1.13, 1.25) in men. Women with diabetes had ~6% greater risk compared with men with diabetes (the pooled RRR was 1.06, 95% CI 1.03, 1.09). Corresponding pooled RRRs were 1.10 (1.07, 1.13) for all-site cancer incidence and 1.03 (0.99, 1.06) for all-site cancer mortality. Diabetes also conferred a significantly greater RR in women than men for oral, stomach and kidney cancer, and for leukaemia, but a lower RR for liver cancer.

CONCLUSIONS/INTERPRETATION

Diabetes is a risk factor for all-site cancer for both women and men, but the excess risk of cancer associated with diabetes is slightly greater for women than men. The direction and magnitude of sex differences varies by location of the cancer.

Associations between aspirin use and the risk of cancers: a meta-analysis of observational studies

Background

Epidemiological studies have clarified the potential associations between regular aspirin use and cancers. However, it remains controversial on whether aspirin use decreases the risk of cancers risks. Therefore, we conducted an updated meta-analysis to assess the associations between aspirin use and cancers.

Methods

The PubMed, Embase, and Web of Science databases were systematically searched up to March 2017 to identify relevant studies. Relative risks (RRs) with 95% confidence intervals (CIs) were used to assess the strength of associations.

Results

A total of 218 studies with 309 reports were eligible for this meta-analysis. Aspirin use was associated with a significant decrease in the risk of overall cancer (RR = 0.89, 95% CI: 0.87–0.91), and gastric (RR = 0.75, 95% CI: 0.65–0.86), esophageal (RR = 0.75, 95% CI: 0.62–0.89), colorectal (RR = 0.79, 95% CI: 0.74–0.85), pancreatic (RR = 0.80, 95% CI: 0.68–0.93), ovarian (RR = 0.89, 95% CI: 0.83–0.95), endometrial (RR = 0.92, 95% CI: 0.85–0.99), breast (RR = 0.92, 95% CI: 0.88–0.96), and prostate (RR = 0.94, 95% CI: 0.90–0.99) cancers, as well as small intestine neuroendocrine tumors (RR = 0.17, 95% CI: 0.05–0.58).

Conclusions

These findings suggest that aspirin use is associated with a reduced risk of gastric, esophageal, colorectal, pancreatic, ovarian, endometrial, breast, and prostate cancers, and small intestine neuroendocrine tumors.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-4156-5) contains supplementary material, which is available to authorized users.

The association between non-Hodgkin lymphoma and organophosphate pesticides exposure: A meta-analysis

Several epidemiological studies show the association between organophosphate pesticides (OPs) and the risk of non-Hodgkin lymphoma (NHL), yet various research results remain controversial. To explore the hazard of OPs exposure to human health, three kinds of OPs (Terbufos, Malathion, and Diazinon) that are non-halogenated aliphatic compounds were included in the meta-analysis. We searched PubMed and Web of Science Databases for articles published from 1985 to February 2017. The databases were also searched for eligible studies through a manual references search. The random-effect model was utilized to compute the odds ratios (ORs) and 95% confident intervals (CIs). A total of ten observational studies (five cohort, four case-control, and one nested case-control) were included in our meta-analysis, with a pooled OR of 1.22 (95% CI 1.04 to 1.43) of Malathion, Terbufos and Diazinion. The general heterogeneity for OR was moderate (P_h = 0.032, I² = 41.2%). The OR estimates in the subset analyses were utilized to compare the association between the three kinds of OPs and NHL; Terbufos (OR = 1.07, 95% CI 0.85 to 1.36) and Malathion (OR = 1.17, 95% CI 0.82 to 1.67) had a statistically non-significant relationship, whereas Diazinon (OR = 1.39, 95% CI 1.11 to 1.73) was significantly associated with an increased NHL risk. Because immune dysfunction was thought to increase NHL risk, the toxicity levels in the immune system of the three types of OPs were compared. Malathion attacked immune cells via a direct effect and Diazinon disrupted the neuro-immune system, which involves the cholinergic system of lymphocytes via indirect immune damage, whereas an immunotoxic effect involving Terbufos was not reported. Overall, the present meta-analysis indicated a statistically significant association between Diazinon exposure and NHL risk.

Allergic conditions are not associated with the risk of non-Hodgkin's lymphoma or Hodgkin's lymphoma: a systematic review and meta-analysis

We aimed to systematically evaluate the association between allergic conditions and the risk of Hodgkin’s lymphoma (HL) and non-HL (NHL). Systematic literature searches in PubMed and Embase were conducted up to October 2015 to identify eligible studies. Either a fixed-effects model or a random-effects model was adopted to estimate overall odds ratios (ORs) according to heterogeneity across studies. Subgroup and publication bias analyses were applied. A total of 24 case–control studies and 13 cohort studies (conducted from 1987 to 2015) were included in the analysis of the risk of NHL. History of any allergic condition was inversely associated with the risk of NHL in case–control studies (OR =0.83, 95% CI 0.76–0.91), while the reduction in the risk of NHL was not observed in cohort studies (OR =1.18, 95% CI 0.98–1.42). Significant association with the risk of NHL was found for asthma, hay fever, food allergy, allergic rhinitis, and hives. In the pooled analysis of the risk of HL, 12 studies (two were cohort studies) were included. The pooled OR was 0.96 (95% CI 0.84–1.09) for case–control studies and 1.46 (95% CI 0.63–3.38) for cohort studies. For specific allergic condition, we observed a reduced risk of HL in individuals with hay fever and food allergy. In conclusion, history of any allergic condition was not significantly associated with the risk of NHL or HL. Several specific allergic conditions, including asthma, hay fever, food allergy, and allergic rhinitis, might be associated with a reduced risk of NHL, while individuals with hay fever or food allergy may have a reduced risk of HL.

Hyperglycemia is associated with poor survival in primary central nervous system lymphoma patients

PURPOSE

Primary central nervous system lymphoma (PCNSL) is a type of non-Hodgkin lymphoma (NHL), and it has been postulated that metabolic disorder may contribute to NHL etiology. We retrospectively investigated the prognostic significance of hyperglycemia in patients with PCNSL. We evaluated glucose transporter type 1 (GLUT1) expression by immunohistochemistry and analyzed its association with hyperglycemia and survival.

METHODS

The medical and neuroradiologic records of 50 patients with PCNSL at our institution over the past 15 years were analyzed. Patients were divided into 3 groups based on mean fasting plasma glucose (FPG) levels: normal (<110 mg/dL), prediabetes (110-125 mg/dL), and diabetes (≥126 mg/dL). We defined prediabetes and diabetes groups as hyperglycemia.

RESULTS

Forty-four percent of patients were in the prediabetes and diabetes groups. One-year survival rates were 73%, 66%, and 43% in normal, prediabetes, and diabetes groups, respectively. Univariate analysis revealed that high age, female sex, poor performance status, high mean FPG, and monotherapy were associated with shorter survival. Multivariable Cox regression analyses showed that high mean FPG and monotherapy were significant predictors of shorter survival (p = 0.036 and p = 0.000, respectively). The GLUT1 immunohistopathologic staining was performed in 34 cases, 20 of which (58%) showed variable levels of GLUT1 expression at the cell membrane and/or cytoplasm. Prediabetes and diabetes groups had a higher percentage of GLUT1-positive cells compared with the normal group (p = 0.015).

CONCLUSIONS

These findings indicate that hyperglycemia is associated with poor survival. The putative biological mechanism might involve differential GLUT1 expression between hyperglycemic and normal states in patients with PCNSL.

Type 2 diabetes and the risk of non-Hodgkin's lymphoma: a report from two population-based cohort studies in China

Coinciding with the increased incidence of non-Hodgkin's lymphoma (NHL) during the past decades, there has been a significant increase in the prevalence of diabetes mellitus in mainland China. We therefore evaluated whether type 2 diabetes (T2D) is associated with the risk of NHL using data from the Shanghai Men's Health Study (SMHS) and the Shanghai Women's Health Study (SWHS). The SMHS and SWHS are two on-going, prospective, population-based cohorts of more than 130 000 Chinese adults in urban Shanghai. Self-reported diabetes was recorded on the baseline questionnaire and updated in follow-up surveys. Cox regression models with T2D as a time-varying exposure were used to estimate hazard ratios and 95% confidence intervals, adjusting for covariates. After a median follow-up of 12.9 years for SWHS and 7.4 years for SMHS, 172 NHL cases were identified. Patients with T2D have a higher risk of incident NHL with a hazard ratio of 2.00 (95% confidence interval: 1.32-3.03) compared with those without diabetes. This positive association remained when the analysis was restricted to untreated diabetes or after excluding NHL cases that occurred within 3 years after the onset of diabetes. No interaction effect was found in the development of NHL between T2D and other potential risk factors. A linear inverse association was found between T2D duration and the risk of NHL in both men and women (Pfor linearity<0.01), with a highest risk of incident NHL in the first 5 years after the diagnosis of diabetes. Our study suggested that T2D might be associated with an increased risk of NHL.

Mortality in Patients with Myalgic Encephalomyelitis and Chronic Fatigue Syndrome

BACKGROUND

There is a dearth of research examining mortality in individuals with myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS). Some studies suggest there is an elevated risk of suicide and earlier mortality compared to national norms. However, findings are inconsistent as other researchers have not found significant increases in all-cause mortality for patients.

OBJECTIVE

This study sought to determine if patients with ME or CFS are reportedly dying earlier than the overall population from the same cause.

METHODS

Family, friends, and caregivers of deceased individuals with ME or CFS were recruited through social media, patient newsletters, emails, and advocate websites. This study analyzed data including cause and age of death for 56 individuals identified as having ME or CFS.

RESULTS

The findings suggest patients in this sample are at a significantly increased risk of earlier all-cause (M = 55.9 years) and cardiovascular-related (M = 58.8 years) mortality, and they had a directionally lower mean age of death for suicide (M = 41.3 years) and cancer (M =66.3 years) compared to the overall U.S. population [M = 73.5 (all-cause), 77.7 (cardiovascular), 47.4 (suicide), and 71.1 (cancer) years of age].

CONCLUSIONS

The results suggest there is an increase in risk for earlier mortality in patients with ME and CFS. Due to the small sample size and over-representation of severely ill patients, the findings should be replicated to determine if the directional differences for suicide and cancer mortality are significantly different from the overall U.S. population.

Medical history, lifestyle, family history, and occupational risk factors for follicular lymphoma: the InterLymph Non-Hodgkin Lymphoma Subtypes Project

BACKGROUND

Follicular lymphoma (FL) has been linked with cigarette smoking and, inconsistently, with other risk factors.

METHODS

We assessed associations of medical, hormonal, family history, lifestyle, and occupational factors with FL risk in 3530 cases and 22639 controls from 19 case-control studies in the InterLymph consortium. Age-, race/ethnicity-, sex- and study-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression.

RESULTS

Most risk factors that were evaluated showed no association, except for a few modest or sex-specific relationships. FL risk was increased in persons: with a first-degree relative with non-Hodgkin lymphoma (OR = 1.99; 95% CI = 1.55 to 2.54); with greater body mass index as a young adult (OR = 1.15; 95% CI = 1.04 to 1.27 per 5 kg/m(2) increase); who worked as spray painters (OR = 2.66; 95% CI = 1.36 to 5.24); and among women with Sjögren syndrome (OR = 3.37; 95% CI = 1.23 to 9.19). Lower FL risks were observed in persons: with asthma, hay fever, and food allergy (ORs = 0.79-0.85); blood transfusions (OR = 0.78; 95% CI = 0.68 to 0.89); high recreational sun exposure (OR = 0.74; 95% CI = 0.65 to 0.86, fourth vs first quartile); who worked as bakers or millers (OR = 0.51; 95% CI = 0.28 to 0.93) or university/higher education teachers (OR = 0.58; 95% CI = 0.41 to 0.83). Elevated risks specific to women included current and longer duration of cigarette use, whereas reduced risks included current alcohol use, hay fever, and food allergies. Other factors, including other autoimmune diseases, eczema, hepatitis C virus seropositivity, hormonal drugs, hair dye use, sun exposure, and farming, were not associated with FL risk.

CONCLUSIONS

The few relationships observed provide clues suggesting a multifactorial etiology of FL but are limited in the extent to which they explain FL occurrence.

Lack of association between using aspirin and development of non-Hodgkins lymphoma: a meta-analysis

BACKGROUND

Non-Hodgkins lymphoma (NHL) is a heterogeneous group of malignancies, originating in the lymphatic organs, whose incidence is increasing in developed as well as developing countries. Epidemiological evidence suggests that aspirin may reduce the incidence and mortality of several cancers. The main objective of this study was to evaluate the potential relationship between using aspirin and development of NHL with a meta-analysis.

MATERIALS AND METHODS

A total of 7 studies were included. Outcome was calculated and reported as odds ratios (ORs). Heterogeneity was assessed with Cochrane Q and I2 statistics. Dissemination bias was evaluated by funnel plot visualization and trim-and-fill analysis.

RESULTS

Our analysis showed OR of developing NHL overall of 1(95% CI: 0.87-1.16, p=0.9), and in females this was 0.81 (95%CI: 0.72-.92, p=0.001) and in males 1.01 (95%CI: 0.82-1.26, p=0.86). The odds ratio (OR) of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) was 0.85 (95%CI: 0.75-0.97, p=0.02), The ORs of follicular lymphoma (FL) and large B-cell lymphoma (DLBCL) in individuals exposed to aspirin were 1.12 (95%CI: 0.86-1.45, p=0.37) and 1.03 (95%CI: 0.9-1.19, p=0.6) respectively.

CONCLUSIONS

In conclusion, individuals taking aspirin do not demonstrate any change in risk of Non-Hodgkins lymphoma.

Farm characteristics, allergy symptoms, and risk of non-hodgkin lymphoid neoplasms in the agricultural health study

BACKGROUND

Because of unique exposures, studies among farmers may yield insights into the relationship between allergies and non-Hodgkin lymphoid (NHL) neoplasms. We evaluated farm characteristics, allergic symptoms and conditions, and risk of NHL including specific subtypes in the Agricultural Health Study, a prospective cohort of farmers and spouses from North Carolina and Iowa.

METHODS

We identified 710 incident cases of NHL (including chronic lymphocytic leukemia and multiple myeloma) among 82,370 participants with baseline data on crop and animal exposures, including 454 cases among 52,850 participants with baseline data on recent allergy symptoms (rhinitis) and living on a farm during childhood. HR and 95% confidence intervals (CI) were calculated using multivariable-adjusted proportional hazards models.

RESULTS

We observed reduced risks of NHL among farmers and spouses with rhinitis at baseline (HR, 0.63; 95% CI, 0.51-0.79), related to growing soybeans (HR, 0.80; 95% CI, 0.67-0.96), and among farmers who handled stored grains or hay (HR, 0.66; 95% CI, 0.52-0.82). Growing up on a farm was associated with increased NHL risk (HR, 1.51; 95% CI, 1.15-1.98). Results did not differ significantly by NHL subtype.

CONCLUSIONS

Both the reduced risk of NHL among those with allergy symptoms and specific farm exposures in adulthood, and the increased risk among those who grew up on a farm suggest that the host immune response to agricultural allergens may influence NHL development.

IMPACT

This prospective study is, to our knowledge, the first to investigate the relationship between allergy symptoms and NHL risk in farmers; confirmation of these findings in other farming populations is warranted. Cancer Epidemiol Biomarkers Prev; 24(3); 587-94. ©2015 AACR.

Use of non-steroidal anti-inflammatory drugs and risk of non-Hodgkin lymphoma: a systematic review and meta-analysis

Epidemiological study findings regarding the association between use of non-steroidal anti-inflammatory drugs (NSAIDs) and risk of non-Hodgkin lymphoma (NHL) have been inconsistent. We aimed to systematically review epidemiological studies of the association and calculate pooled relative risks using meta-analytic methods. We searched eight electronic literature databases and three clinical trial registers to identify all studies (including observational studies and randomized clinical trials) of the association published prior to October 2013. Identified studies were independently reviewed by two researchers. We used a random effects model to calculate pooled odds ratio (PORs). Heterogeneity amongst studies was examined using Cochran's Q and I-squared (I(2)) tests; and sources of heterogeneity were explored using subgroup and meta-regression analyses. A total of 17 studies (12 case-control studies and five cohort studies), all adult studies, were included. Use of NSAIDs was not associated with overall risk of NHL [POR = 1.05, and 95% confidence interval (95% CI) 0.90-1.22] or NHL subtypes including B-cell lymphoma, T-cell lymphoma, follicular lymphoma, diffuse large B-cell lymphoma and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). Aspirin use was associated with reduced risk of CLL/SLL (POR = 0.70, 95% CI 0.54-0.91) but not with the risk of all NHLs (POR = 1.02, 95% CI 0.89-1.17). Use of non-aspirin NSAIDs was associated with increased risk of NHL (POR = 1.41, 95% CI 1.01-1.97) amongst females only. The epidemiologic evidence remains inconclusive. Effects of NSAIDs may differ by drug type, NHL subtype, and sex and more studies taking into consideration these differences are needed.

CARING (CAncer Risk and INsulin analoGues): the association of diabetes mellitus and cancer risk with focus on possible determinants - a systematic review and a meta-analysis

Background:

Patients suffering from diabetes mellitus (DM) may experience an increased risk of cancer; however, it is not certain whether this effect is due to diabetes per se.

Objective:

To examine the association between DM and cancers by a systematic review and meta-analysis according to the PRISMA guidelines.

Data Sources:

The systematic literature search includes Medline at PubMed, Embase, Cinahl, Bibliotek.dk, Cochrane library, Web of Science and SveMed+ with the search terms: “Diabetes mellitus”, “Neoplasms”, and “Risk of cancer”.

Study Eligibility Criteria:

The included studies compared the risk of cancer in diabetic patients versus non-diabetic patients. All types of observational study designs were included.

Results:

Diabetes patients were at a substantially increased risk of liver (RR=2.1), and pancreas (RR=2.2) cancer. Modestly elevated significant risks were also found for ovary (RR=1.2), breast (RR=1.1), cervix (RR=1.3), endometrial (RR=1.4), several digestive tract (RR=1.1-1.5), kidney (RR=1.4), and bladder cancer (RR=1.1). The findings were similar for men and women, and unrelated to study design. Meta-regression analyses showed limited effect modification of body mass index, and possible effect modification of age, gender, with some influence of study characteristics (population source, cancer- and diabetes ascertainment).

Limitations:

Publication bias seemed to be present. Only published data were used in the analyses.

Conclusions:

The systematic review and meta-analysis confirm the previous results of increased cancer risk in diabetes and extend this to additional cancer sites. Physicians in contact with patients with diabetes should be aware that diabetes patients are at an increased risk of cancer.

Allergy and risk of hematologic malignancies: associations and mechanisms

Increasing evidence indicates that a dysregulated immune system, as the one found in allergic disorders, can affect survival of tumor cells. A possible association between allergies and risk of hematologic malignancies has been examined in several epidemiological studies; however, results were not always consistent. The aim of this review is to report the preclinical and clinical data, which support a correlation between allergy and hematologic neoplasms. Immune system modulation could represent a powerful tool in the prevention and treatment of hematologic malignancies.

Allergic diseases and risk of hematopoietic malignancies in a cohort of postmenopausal women: a report from the Iowa Women's Health Study

BACKGROUND

Allergic diseases signify immune dysregulation attributable to underlying genetics and environmental exposures. Associations between various allergies and hematopoietic cancers have been observed, albeit inconsistently; however, few prospective studies have examined the risk, and even fewer among older adults.

METHODS

We examined risk of incident hematopoietic cancers in those reporting allergic diseases in a population-based cohort of 22,601 older women (Iowa Women's Health Study). Self-reported allergic status, including asthma, hay fever, eczema, and/or other allergies, was determined via questionnaire in 1997 (mean age, 72 years; range, 63-81 years). Incident cancers were ascertained by linkage with the Iowa Cancer Registry from 1997 to 2011. Cox proportional hazards regression was performed to estimate multivariate-adjusted HR and 95% confidence intervals (CI) for myeloid (N = 177) and lymphoid (N = 437) malignancies, respectively.

RESULTS

Allergic diseases were not associated with risk of myeloid (HR, 1.00; 95% CI, 0.72-1.37) or lymphoid (HR, 0.99; 95% CI, 0.81-1.22) malignancies overall, or for most allergic and malignant subtypes examined. Self-reported asthma was positively associated with development of myelodysplastic syndrome (MDS; HR, 2.00; 95% CI, 0.93-4.32). In addition, there was a 30% to 40% decrease in risk of both lymphoid and myeloid cancers in those reporting rural residences but no association in those reporting urban residences; the interaction between residence and allergy was statistically significant for lymphoid malignancies (Pinteraction = 0.05).

CONCLUSIONS AND IMPACT

These results suggest that asthma may contribute to the pathogenesis of MDS, a finding consistent with the chronic antigen stimulation hypothesis. Susceptibility differences by location of residence are concordant with the hygiene hypothesis and merit additional exploration.

Associations between allergies and risk of hematologic malignancies: results from the VITamins and lifestyle cohort study

Immune dysregulations associated with allergies may affect cancer cell biology but studies on the relationship between allergies and risk of hematologic malignancies (HM) yielded inconsistent results. Herein, we used the vitamins and Lifestyle (VITAL) cohort to examine this association. From 2000 to 2002, 66,212 participants, aged 50-76, completed a baseline questionnaire on cancer risk factors, medical conditions, allergies, and asthma. Through 2009, incident HMs (n = 681) were identified via linkage to the surveillance, epidemiology, and end results cancer registry. After adjustment for factors possibly associated with HMs, a history of airborne allergy was associated with increased risk of HMs (hazard ratio [HR] = 1.19 [95% confidence interval: 1.01-1.41], P = 0.039) in Cox proportional hazards models. This association was limited to allergies to plants/grass/trees (HR = 1.26 [1.05-1.50], P = 0.011) and was strongest for some mature B-cell lymphomas (HR = 1.50 [1.14-2.00], P = 0.005). Gender-stratified analyses revealed that the associations between airborne allergies overall and those to plants, grass, and trees were only seen in women (HR = 1.47 [1.14-1.91], P = 0.004; and HR = 1.73 [1.32-2.25], P < 0.001) but not men (HR = 1.03 [0.82-1.29], P = 0.782; and HR = 0.99 [0.77-1.27], P = 0.960). Together, our study indicates a moderately increased risk of HMs in women but not men with a history of allergies to airborne allergens, especially to plant, grass, or trees.

Antihistamine use and immunoglobulin E levels in glioma risk and prognosis

OBJECTIVE

An inverse association between personal history of allergies/asthma and glioma risk has been fairly consistently reported in the epidemiologic literature. However, the role of regular antihistamine use remains controversial due to a small number of studies reporting contradictory findings. We evaluated the association between regular use of oral antihistamines and glioma risk, adjusting for a number of relevant factors (e.g., immunoglobulin E levels and history of chickenpox).

METHODS

We used a subset of the Harris County Case-Control Study, which included 362 pathologically confirmed glioma cases and 462 cancer-free controls, to evaluate this association using unconditional multivariable logistic regression. These models were run among the overall study population and stratified by allergy status. Cox regression was utilized to examine whether antihistamine use was associated with mortality among all cases and separately among high-grade cases.

RESULTS

Antihistamine use was strongly associated with glioma risk among those with a positive allergy/asthma history (OR: 4.19, 95% CI: 2.06-8.51), but not among those with a negative history (OR: 1.59, 95% CI: 0.95-2.67). There were no significant associations between antihistamine use and survival among cases.

CONCLUSION

The current study implies that regular antihistamine use may increase glioma risk. However, several larger studies are necessary before definitive conclusions can be drawn.

Risk of non-Hodgkin lymphoma in relation to tricyclic antidepressant use

PURPOSE

We investigated the relationship between use of tricyclic antidepressants (TCAs) and risk of non-Hodgkin lymphoma (NHL). Previous studies provided some evidence of an association, but did not assess risk of NHL subtypes.

METHODS

Cases and controls were members of Group Health, an integrated healthcare delivery system. Cases were persons diagnosed with NHL between 1980 and 2011 at age 25 years or older; eight control subjects were matched to each case on age, sex, and length of enrollment. Information on previous TCA use was ascertained from automated pharmacy data. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) for NHL, overall and for common subtypes, for various patterns of TCA use.

RESULTS

We identified 2768 cases and 22,127 matched control subjects. We did not observe an appreciably increased risk of NHL among TCA ever-users compared to non-users (OR, 1.1; 95% CI, 1.0-1.2). Overall risk of NHL was associated to at most a small degree with longer-term use (OR, 1.2; 95% CI, 1.0-1.4; ≥10 prescriptions), high-dose use (OR, 1.1; 95% CI, 0.8-1.5; ≥50 mg), or non-recent use (OR, 1.0; 95% CI, 0.9 = 1.2; >5 years previously). TCA use was not associated with NHL subtypes, except chronic lymphocytic leukemia/small lymphocytic lymphoma (OR, 1.5; 95% CI, 1.1-2.0; longer-term use).

CONCLUSIONS

We found little evidence that the use of TCAs increases the risk of NHL overall or for specific common subtypes of NHL.

Chronic fatigue syndrome and subsequent risk of cancer among elderly US adults

BACKGROUND

The cause of chronic fatigue syndrome (CFS) is unknown but is thought to be associated with immune abnormalities or infection. Because cancer can arise from similar conditions, associations between CFS and cancer were examined in a population-based case-control study among the US elderly.

METHODS

Using linked Surveillance, Epidemiology, and End Results (SEER)-Medicare registry data, approximately 1.2 million cancer cases and 100,000 controls (age range, 66-99 years; 1992-2005) were evaluated. CFS was identified in the period more than 1 year prior to selection, using linked Medicare claims. Unconditional logistic regression was used to estimate the odds ratios (ORs) comparing the CFS prevalence in cases and controls, adjusting for age, sex, and selection year. All statistical tests were 2-sided.

RESULTS

CFS was present in 0.5% of cancer cases overall and 0.5% of controls. CFS was associated with an increased risk of non-Hodgkin lymphoma (NHL) (OR = 1.29, 95% confidence interval [CI] = 1.16-1.43, P = 1.7 × 10(-6) ). Among NHL subtypes, CFS was associated with diffuse large B cell lymphoma (OR = 1.34, 95% CI = 1.12-1.61), marginal zone lymphoma (OR = 1.88, 95% CI = 1.38-2.57), and B cell NHL not otherwise specified (OR = 1.51, 95% CI = 1.03-2.23). CFS associations with NHL overall and NHL subtypes remained elevated after excluding patients with medical conditions related to CFS or NHL, such as autoimmune conditions. CFS was also associated, although not after multiple comparison adjustment, with cancers of the pancreas (OR = 1.25, 95% CI = 1.07-1.47), kidney (OR = 1.27, 95% CI = 1.07-1.49), breast (OR = 0.85, 95% CI = 0.74-0.98), and oral cavity and pharynx (OR = 0.70, 95% CI = 0.49-1.00).

CONCLUSIONS

Chronic immune activation or an infection associated with CFS may play a role in explaining the increased risk of NHL.

Current understanding of lifestyle and environmental factors and risk of non-hodgkin lymphoma: an epidemiological update

The incidence rates of non-Hodgkin lymphoma (NHL) have steadily increased over the last several decades in the United States, and the temporal trends in incidence can only be partially explained by the HIV epidemic. In 1992, an international workshop sponsored by the United States National Cancer Institute concluded that there was an “emerging epidemic” of NHL and emphasized the need to investigate the factors responsible for the increasing incidence of this disease. Over the past two decades, numerous epidemiological studies have examined the risk factors for NHL, particularly for putative environmental and lifestyle risk factors, and international consortia have been established in order to investigate rare exposures and NHL subtype-specific associations. While few consistent risk factors for NHL aside from immunosuppression and certain infectious agents have emerged, suggestive associations with several lifestyle and environmental factors have been reported in epidemiologic studies. Further, increasing evidence has suggested that the effects of these and other exposures may be limited to or stronger for particular NHL subtypes. This paper examines the progress that has been made over the last twenty years in elucidating the etiology of NHL, with a primary emphasis on lifestyle factors and environmental exposures.

Epidemiology: allergy history, IgE, and cancer

Numerous epidemiological studies have investigated potential associations between allergy history and cancer risk with strong inverse associations reported in studies of pancreatic cancer, glioma, and childhood leukemia. Recently, there has been a rapid expansion of the epidemiological literature both of studies evaluating self-reported allergy history in relation to cancer risk and of studies evaluating biological indicators of allergy history and immune function including levels of immunoglobulin (Ig) E. However, there are several potential methodological limitations associated with prior studies, and further research is required to clarify associations observed. This paper summarizes the recent epidemiological literature examining associations between allergy history and cancer risk. From 2008, a total of 55 epidemiological studies were identified that examined some aspect of the association between allergy and cancer. Although the majority of studies examined self-reported allergy history in relation to cancer risk, there were also studies examining allergy diagnoses or discharges as captured in existing administrative databases, levels of IgE, polymorphisms of allergy, inflammatory- or allergy-related cytokine genes, and concentrations of immune regulatory proteins. The most frequently studied cancer sites included brain and lymphatic and hematopoietic cancers. Potential methodological sources of bias are discussed as well as recommendations for future work.

Erythrocyte membrane fatty acid composition, serum lipids, and non-Hodgkin's lymphoma risk in a nested case-control study: the multiethnic cohort

PURPOSE

Composition of dietary fatty acid intake, which influences cytokine production, may contribute to the development of non-Hodgkin's lymphoma (NHL). Serum lipid levels may serve as biomarkers of inflammation associated with NHL risk.

METHODS

We conducted a case-control analysis (275 cases and 549 controls) nested within the Multiethnic Cohort Study (whites, Japanese Americans, Latinos, African Americans, and Native Hawaiians) to examine the association of prediagnostic, erythrocyte membrane phospholipid fatty acid composition, and serum cholesterol and triglyceride (TG) concentrations with the risk of NHL. Conditional logistic regression was used to calculate odds ratios (OR) and 95 % confidence intervals (CI) by tertiles of biomarker concentrations.

RESULTS

Higher total saturated fatty acids (SFA) were associated with an increase in NHL risk (OR(T3 vs. T1) = 1.57 [95 % CI: 1.03-2.39]; p(trend) = 0.01), whereas no associations were detected for total n-3 or n-6 polyunsaturated fatty acids. Inverse associations were observed for total cholesterol (TC; OR (T3 vs. T1) = 0.51 [95 % CI: 0.35-0.74]; p(trend) < 0.0001) and high-density lipoprotein cholesterol (HDL-C; OR (T3 vs. T1) = 0.47 [95 % CI: 0.31-0.71]; p(trend) = 0.0001) but not for low-density lipoprotein cholesterol or TG. Adjustment for the use of lipid-lowering medication did not modify the results substantially.

CONCLUSIONS

This prospective biomarker investigation offers supportive evidence for an adverse effect of higher erythrocyte membrane SFA levels on NHL risk, but preclinical effects cannot be excluded. Inverse relations between prediagnostic, circulating TC and HDL-C and NHL risk may be due to reverse causation or a result of protective actions of these lipids and lipoproteins.

Increased incidence of non-Hodgkin lymphoma, leukemia, and myeloma in patients with diabetes mellitus type 2: a meta-analysis of observational studies

Hematologic malignancies are a heterogeneous group of conditions with an unclear etiology. We hypothesized that diabetes mellitus type 2 is associated with increased risk of developing lymphoma, leukemia, and myeloma. A literature search identified 26 studies (13 case-control and 13 cohort studies) evaluating such an association. Outcome was calculated as the odds ratio (OR) using a random effects model. Heterogeneity and publication bias were evaluated using the I(2) index and the trim-and-fill analysis, respectively. Quality was assessed using the Newcastle-Ottawa scale. The OR for non-Hodgkin lymphoma was increased at 1.22 (95% confidence interval [CI], 1.07-1.39; P < .01) but the OR for Hodgkin lymphoma was not. There was an increased OR for peripheral T-cell lymphoma (OR = 2.42, 95% CI, 1.24-4.72; P = .009) but not for other non-Hodgkin lymphoma subtypes. The OR for leukemia was 1.22 (95% CI, 1.03-1.44; P = .02) and the OR for myeloma was 1.22 (95% CI, 0.98-1.53; P = .08). Although diabetes mellitus type 2 seems to increase the risk of developing lymphoma, leukemia, and myeloma, future studies should focus on evaluating other potential confounders such as obesity, dietary habits, physical activity, and/or antidiabetic therapy.

Racial differences in chronic immune stimulatory conditions and risk of non-Hodgkin's lymphoma in veterans from the United States

PURPOSE

To examine underlying etiologic factors that may explain the racial disparity in non-Hodgkin's lymphoma (NHL) incidence patterns.

PATIENTS AND METHODS

We assessed immune-related conditions and risk of developing NHL among more than 4 million hospitalized US veterans including 9,496 patients with NHL (7,999 white patients and 1,497 black patients) with up to 26 years of follow-up. We used time-dependent Poisson regression to estimate rate ratios (RRs) and 95% CIs for NHL risk among patients with a history of specific autoimmune diseases, infections, and allergies compared with patients without such history, adjusting for attained age, calendar year, race, number of hospital visits, and time between study entry and exit.

RESULTS

Patients with infectious conditions had an increased risk of developing NHL (RR, 1.2; 95% CI, 1.1 to 1.2), particularly for gastrohepatic, genital, and systemic infectious conditions. Patients with autoimmune disease were generally more likely to develop NHL than patients without autoimmune disease, especially for conditions that typically present with detectable autoantibodies with systemic involvement (RR, 2.0; 95% CI, 1.8 to 2.2). Allergies were also associated with increased risk (RR, 1.4; 95% CI, 1.3 to 1.5). Although the risk of NHL was lower for blacks than whites (RR, 0.87; 95% CI, 0.82 to 0.92), blacks had a slightly higher risk of NHL associated with infections than whites (likelihood ratio test, P = .002) and a tendency toward higher risk associated with allergies (likelihood ratio test, P = .05). Risks associated with autoimmune conditions were similar by race (likelihood ratio test, P = .5).

CONCLUSION

The observed difference in NHL risk by race supports a role for race-related differences in genes regulating immune/inflammatory response.

Association between red blood cell transfusions and development of non-Hodgkin lymphoma: a meta-analysis of observational studies

The incidence of non-Hodgkin lymphoma (NHL) has increased steadily for the past few decades. Previous studies have suggested an association between blood transfusions and NHL. The main objective of this study was to evaluate this relationship with a meta-analysis of observational studies. A literature search was undertaken, looking for case-control and cohort studies evaluating the risk of developing NHL in persons who received allogeneic blood transfusions; 14 studies were included. Outcome was calculated and reported as relative risk (RR). Heterogeneity was assessed with Cochrane Q and I2 statistics. Dissemination bias was evaluated by funnel plot visualization and trim-and-fill analysis. Quality assessment was performed with the Newcastle-Ottawa scale. Our analysis showed a RR of developing NHL of 1.05 (95% CI, 0.89-1.25; P = .42) and 1.34 (95% CI, 1.15-1.55; P < .01) in case-control and cohort studies, respectively. When pooling all studies, RR was 1.2 (95% CI, 1.07-1.35; P < .01). In subset analysis, RR of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) was 1.66 (95% CI, 1.08-2.56; P = .02). The RR of NHL was elevated in both men and women and in persons receiving transfusions either before or after 1992. Blood transfusions appear to increase the risk of developing NHL; however, the risk of CLL/SLL appears higher than for other NHL subtypes.

Blood transfusions and the subsequent risk of hematologic malignancies

BACKGROUND

Blood transfusions are associated with viral transmission and immunomodulation, perhaps increasing subsequent risk of hematologic malignancies (HMs). Prior studies of transfusion recipients have lacked details on specific HM subtypes.

STUDY DESIGN AND METHODS

Risk of HM after blood transfusion was evaluated in a US population-based case-control study (77,488 elderly HM cases identified through cancer registries, 154,509 controls). Transfusions were identified using linked Medicare hospitalization claims. Polytomous logistic regression was used to calculate odds ratios (ORs) associating transfusion and HM subtypes by features suggestive of a causal relationship.

RESULTS

A history of transfusion was present in 7.9% of HM cases versus 5.9% of controls. Associations for most HM subtypes suggested reverse causality: ORs were elevated only during the shortest latency periods; ORs for unspecified anemia and gastrointestinal bleeding, which may be related to undiagnosed HM, were stronger than for surgeries, which are unlikely to be related to HM; and/or there was no dose response. In contrast, risk for lymphoplasmacytic lymphoma (1397 cases) was elevated at long latency (OR, 1.56 at 10+ years after transfusion), after transfusions related to surgeries (OR, 1.22-1.47), and in a dose-response relationship with number of transfusion-related hospitalizations (OR, 1.53 with one hospitalization; OR, 1.80 with two or more hospitalizations, p trend < 0.0001). Risk for marginal zone lymphoma (1915 cases) was also elevated at 10+ years after transfusion (OR, 1.80).

CONCLUSION

Consistent with prior studies, blood transfusions did not increase risk of most HM subtypes. Patterns of elevated risk for lymphoplasmacytic and marginal zone lymphomas suggest an etiologic role for transfusion.