Season of birth and risk of Hodgkin and non-Hodgkin lymphoma

Improving outcomes of childhood and young adult non-Hodgkin lymphoma: 25 years of research and collaboration within the framework of the European Intergroup for Childhood Non-Hodgkin Lymphoma

The European Intergroup for Childhood Non-Hodgkin Lymphoma (EICNHL) was established 25 years ago with the goal to facilitate clinical trials and research collaborations in the field both within Europe and worldwide. Since its inception, much progress has been made whereby major improvements in outcomes have been achieved. In this Review, we describe the different diagnostic entities of non-Hodgkin lymphoma in children and young adults describing key features of each entity and outlining clinical achievements made in the context of the EICNHL framework. Furthermore, we provide an overview of advances in biopathology with an emphasis on the role of biological studies and how they have shaped available treatments. Finally, for each entity, we describe future goals, upcoming clinical trials, and highlight areas of research that require our focus going forward.

Hospital-Treated Infections and Increased Risk of Two EBV-Related Malignancies: A Nested Case-Control Study

BACKGROUND

To assess the association of hospital-treated infections with the subsequent risk of two Epstein-Barr virus (EBV)-related malignancies, namely Hodgkin's lymphoma (HL) and nasopharyngeal carcinoma (NPC).

METHODS

We performed a nested case-control study based on several national registers in Sweden. Cases were individuals newly diagnosed with HL or NPC during 1994-2016 in Sweden, according to the Swedish Cancer Register. For each case, we randomly selected five controls individually matched to the case on sex and year of birth from the general Swedish population. Hospital-treated infections (i.e., infections requiring either inpatient or outpatient hospital care) were identified from the Swedish Patient Register. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of HL and NPC, in relation to hospital-treated infections, after adjustment for age, sex, calendar period, educational achievement, and region of residence.

RESULTS

The study included a total of 890 cases of HL and 306 cases of NPC. A hospital-treated infection three years ago or earlier was associated with a higher risk of HL (OR = 1.49, 95%CI: 1.26-1.75) as well as NPC (OR = 1.36; 95%CI: 1.01-1.83). The positive association was noted for both bacterial and viral infections and primarily for respiratory and skin infections. A monotonous dose-response relationship was found between a number of hospital-treated infections and the risk of HL (p = 0.02) but less compelling for NPC (p = 0.06). Using a 5-year lag time rendered similar results (OR = 1.43, 95%CI: 1.21-1.70 for HL; OR = 1.43, 95%CI: 1.05-1.95 for NPC).

CONCLUSIONS

These findings suggest that infections requiring hospital treatment might contribute to the carcinogenesis of malignancies potentially related to EBV.

The effect of ultraviolet radiation on the incidence and severity of major mental illness using birth month, birth year, and sunspot data

Background and objectives

The evaluation of the severity of patients afflicted with major mental illness (MMI) has been problematic because of confounding variables and genetic variability. There have been multiple studies that suggest several human diseases, especially schizophrenia, are predisposed to be born in certain months or seasons. This observation implied an epigenetic effect of sunlight, likely ultraviolet radiation (UVR), which is damaging to DNA, especially in an embryo. This paper outlines a method to evaluate the severity of schizophrenia (SZ), bipolar disorder (BPD), and schizoaffective disorder (SZ-AFF) using the month/year of birth of those affected compared to the month/year of birth of the general population (GP).

Relevance

Our previous research found that more intense UVR (equal to or greater than 90 sunspot number (SSN)) had a negative effect on the average human lifespan. Also, human birth rates vary in frequency by month of birth reflecting variables like availability of food, sunlight, and other unknown epigenetic factors. We wanted to see if the patient month of birth varied from the average birth months of the general population and if UVR has an epigenetic effect promoting these diseases.

Methods

We obtained the month and year of birth of 1,233 patients admitted over a 15-year period to Maine's largest state psychiatric hospital and counted the months of birth for each diagnosis of SZ, BPD, and SZ-AFF, and compared these results to the general population's birth months of 4,265,555 persons from U. S. Census Year 2006. The number of patients in each month was normalized to August and compared with the normalized birth months of the general population (GP). Plots of the normalized months were considered rates of change (e.g., derivatives) and their respective integrals gave domains of each mental illness relative to the GP. Normalizing the GP to unity was then related to the factor 1.28, e.g., 28% more entropy, deduced from the Sun's fractal dimension imprinted on biological organisms.

Results

The percent of patients meeting our criterion for severity: SZ = 27%; BPD = 26%; SZ-AFF = 100%.

Conclusions

High UVR intensity or a rapid increase in UVR in early gestation are likely epigenetic triggers of major mental illness. BPD is more epigenetically affected than SZ or SZ-AFF disorders. We found that 52% of 1,233 patients comprised the core function of a tertiary-care psychiatric hospital. Also, mental illness exacerbated when the median SSN doubled. This work also validates the Kraeplinian dichotomy.

What is new in this research

This paper offers a new paradigm for evaluating the severity of MMI and supports significant epigenetic effects from UVR.

Season-of-birth phenomenon in health and longevity: epidemiologic evidence and mechanistic considerations

In many human populations, especially those living in regions with pronounced climatic differences between seasons, the most sensitive (prenatal and neonatal) developmental stages occur in contrasting conditions depending on the season of conception. The difference in prenatal and postnatal environments may be a factor significantly affecting human development and risk for later life chronic diseases. Factors potentially contributing to this kind of developmental programming include nutrition, outdoor temperature, infectious exposures, duration of sunlight, vitamin D synthesis, etc. Month of birth is commonly used as a proxy for exposures which vary seasonally around the perinatal period. Season-of-birth patterns have been identified for many chronic health outcomes. In this review, the research evidence for the seasonality of birth in adult-life disorders is provided and potential mechanisms underlying the phenomenon of early life seasonal programming of chronic disease and longevity are discussed.

Associations between birth season and the anatomic subsites of gastric cancer in Beijing, China

Birth season is an important risk factor for several cancers; for example, anatomic subsite risk factors for gastric cancer differ substantially by when patients were born. In this population-based retrospective study, we explored the relationship between birth season and gastric cancer of different anatomical sites, focusing on gastric cancer patients who were registered at the Beijing Institute for Cancer Research from 2003 to 2012. In total, 19,668 patients were divided into three groups according to the anatomical site of the primary lesion: cardia (n = 3911), noncardia (n = 5383) and unknown (n = 10,374). The 5383 patients in the noncardia group were further subdivided into the following subgroups: fundus (n = 455), corpus (n = 902), greater curvature (n = 110), lesser curvature (n = 512), antrum (n = 2635), pylorus (n = 106) and overlapping (n = 663). Finally, all gastric cancer cases, the three major groups, and the seven noncardia subgroups were, respectively, compared with inpatients from the Dongzhimen Hospital of Beijing from 2003 to 2013. A logistic regression method with sex and age as control factors was used to evaluate the relationship between birth season and gastric cancer with the level for statistical significance set at P < .05. Taking winter as the reference season, we found people born in summer had a lower probability of developing gastric cancer (summer: odds ratio [OR] = 0.925, 95% confidence interval [CI] = 0.875-0.978, P = .006). Among the three groups, the noncardia group had the lower probability of birth season being spring or summer (spring: OR = 0.917, 95% CI = 0.843-0.997, P = .042; summer: OR = 0.883, 95% CI = 0.810-0.962, P = .004), but the cardia and unknown anatomical groups showed no statistical significance for season of birth (P > .05). Among the seven subgroups, those born in summer were less likely to develop gastric cancer in the antrum and lesser curvature than those born in winter (antrum: OR = 0.861, 95% CI = 0.766-0.968, P = .012; lesser curvature: OR = 0.746, 95% CI = 0.579-0.961, P = .023); the other subgroups showed no significant differences by season of birth (P > .05). This study demonstrated that gastric cancer is related to birth season. For people born in summer, the risk of developing gastric cancer was comparatively lower than for people born in winter. Seasonal differences in immune function and maternal nutrition status during pregnancy may explain these findings; however, further large-scale prospective studies will be required to validate these findings.

LTA, LEP, and TNF-a Gene Polymorphisms are Associated with Susceptibility and Overall Survival of Diffuse Large B-Cell lymphoma in an Arab Population: A Case-Control Study

Objective:

In this study, we aimed to explore the relationship between five selected proinflammatory and immune-mediated genes (TNF rs1800629G>A, rs361525G>A, rs1799964T>C, LTA rs1800683G>A, rs909253A>G, TNFAIP8 rs1042541C>T, LEPR rs1327118G>C, and LEP rs2167270G>A) and the risk and overall survival of DLBCL patients within the Jordanian Arab population.

Methods:

One hundred twenty-five patients (125) diagnosed with DLBCL at the King Abdullah University Hospital (KAUH) between 2013 and 2018 and 238 healthy cancer-free control subjects with similar geographic and ethnic backgrounds to the patients were included in the study. Genomic DNA was extracted from the formalin-fixed paraffin-embedded tissues of the subjects and from peripheral blood samples of the controls. The Sequenom MassARRAY^® sequencer system (iPLEX GOLD) was used. The analyses included assessments of population variability and survival.

Results:

Our study showed significant differences in the distribution of the studied polymorphisms of DLBCL between the patients and controls for TNF rs1800629G>A, LTA rs909253 G>A and LEP rs2167270 G>A. TNF rs1800629G>A (p = 0.01), in which the G allele harbors a higher risk of DLBCL (GG and GA genotypes when compared with AA genotype) (p = 0.044). The LTA rs909253 A>G polymorphism is associated with a higher risk of DLBCL in the allelic model (p = .004). LEP rs2167270 G>A polymorphism is associated with a decreased risk of DLBCL in the recessive mode models (p = .03). Subjects with the dominant model for TNF-a rs1799964 (TT genotype in comparison with the combined TT/TC genotype) and patients with the homozygous genotype (GG) of rs361525 have better overall survival rates.

Conclusion:

Our results confirmed the diversity and the heterogeneity of the disease. Although the study has a limitation because of its relatively small size, it clearly emphasizes the significance of ancestry and genetic composition as the determinants of DLBCL risk and behavior.

The Impact of IL-6 and IL-10 Gene Polymorphisms in Diffuse Large B-Cell Lymphoma Risk and Overall Survival in an Arab Population: A Case-Control Study

B-cell lymphomas can be classified as Hodgkin and non-Hodgkin lymphomas. Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin Lymphoma (NHL). The incidence of NHL is variable and affected by age, gender, racial, and geographic factors. There is strong evidence that the immune-regulatory cytokines have a major role in hematologic malignancies. In this study, we analyzed the relationship between seven single nucleotide polymorphisms (SNPs) in two selected cytokines (IL-6 rs1800795G > C, rs1800796G > C, rs1800797G > A, IL-10 rs1800871G > A, rs1800872G > T, rs1800890A > T, rs1800896T > C) and the risk and overall survival of DLBCL patients in a Jordanian Arab population. One hundred and twenty-five DLBCL patients diagnosed at King Abdullah University Hospital (KAUH) from the period 2013–2018 and 238 matched healthy controls were included in the study. Genomic DNA was extracted from formalin-fixed paraffin-embedded tissues. Genotyping of the genetic polymorphisms was conducted using a sequencing protocol. Our study showed no significant differences in the distribution of all studied polymorphisms of DLBCL between patients and controls. The IL-6 rs1800797 was the only SNP to show significant survival results, DLBCL subjects with the codominant model (GG/AG/AA) genotypes and recessive model (AA genotype in comparison with the combined GG/GA genotype) had worse overall survival (p = 0.028 and 0.016, respectively).

Birth in winter can reduce the risk of lung cancer: A retrospective study of the birth season of patients with lung cancer in Beijing area, China

The season of birth is an important risk factor for several diseases. We explored the relationship between birth season and lung cancer. In this population-based retrospective study, we focused on patients with lung cancer who had registered at the Beijing Institute for Cancer Research from 2003 to 2012. In total, 33,025 patients were divided into five subgroups based on their histologic classification, and these five subgroups were compared with the general population (i.e., the permanent resident population of Beijing in 2013). A binary logistic regression method with sex and age as control factors was used to evaluate the relationship between birth season and lung cancer; P < 0.01 was statistically significant. Taking winter as a reference in our analysis of the relationship between season of birth and lung cancer, we found that people who were born in other seasons had a higher probability of developing lung cancer (spring: odds ratio [OR] = 1.06, 95% confidence interval [CI] = 1.03-1.09; summer: OR = 1.07, 95% CI = 1.04-1.10; autumn: OR = 1.06, 95% CI = 1.03-1.09) (P < 0.01). Among the five subgroups, persons with squamous cell carcinoma who were born in summer were more likely to develop lung cancer than those who were born in winter (OR = 1.09, 95% CI = 1.02-1.15, P = 0.006). The other subgroups showed no correlation with season of birth (P > 0.01). This study demonstrates that for people born in winter, the risks of developing lung cancer and squamous cell carcinoma are comparatively lower than those for people born in other seasons. Differences in immune function and the maternal nutrition status during pregnancy of people born in different seasons may explain this finding.

Perinatal light imprinting of circadian clocks and systems (PLICCS): A signature of photoperiod around birth on circadian system stability and association with cancer

Recent findings from animal models suggest that plasticity of human circadian clocks and systems may be differentially affected by different paradigms of perinatal photoperiod exposure to the detriment of health in later life, including cancer development. Focusing on the example of cancer, we carry out a series of systematic literature reviews concerning perinatal light imprinting of circadian clocks and systems (PLICCS) in animal models, and concerning the risk of cancer development with the primary determinants of the perinatal photoperiod, namely season of birth or latitude of birth. The results from these systematic reviews provide supporting evidence of the PLICCS and cancer rationale and highlight that investigations of PLICCS in humans are warranted. Overall, we discuss findings from experimental research and insights from epidemiological studies. Considerations as to how to "test" PLICCS in epidemiological studies and as to the potential for non-invasive preventative measures during perinatal periods close our synthesis. If the PLICCS rationale holds true, it opens the exciting prospect for amenable, early-life, preventative measures against cancer development (and other disorders) in later life. Indeed, non-invasive anthropogenic light exposure may have enormous potential to alleviate the public health and economic burden of circadian-related diseases.

Perinatal Light Imprinting of Circadian Clocks and Systems (PLICCS): The PLICCS and Cancer Hypothesis

Circadian disruption is associated with sleep, mood, and metabolic disorders, and—according to the International Agency for Research on Cancer—even with cancer. Mechanistically, the source of disease may be circadian system instability which likely arises during development. In animal experiments, both low perinatal light:dark ratios and chronic perinatal photoperiod phase shifting yield enduring, detrimental effects on neuroendocrine physiology via circadian system instability. Certainly, accumulating disturbances to neuroendocrine physiology and detrimental downstream effects could predispose to internal cancers. Epidemiologically, either season of birth or latitude of birth, both of which co-determine perinatal photoperiod-zeitgeber strengths, have been utilized independently as proxies for other environmental co-etiologies of cancer. Both have been independently associated with cancer; however, the evidence is inconclusive. We hypothesize that time of birth and location of birth, together determining perinatal photoperiod, contribute to cancer development through Perinatal Light Imprinting of Circadian Clocks and Systems.

Is Month of Birth a Risk Factor for Colorectal Cancer?

Introduction. The developmental origins of health and disease hypothesis and season of birth have been linked to a wide variety of later life conditions including cancer. Whether any relationship between month and season of birth and colorectal cancer exists is unknown. Methods. A case-control study was performed with month of birth extracted from a dedicated colorectal cancer database. Age and gender matched patients were used as a control group. Generalised linear models were fitted with Poisson and negative binomial responses and logarithmic links. A forward stepwise approach was followed adding seasonal components with 6- and 12-month periods. Results. 1019 colorectal cancer patients and 1277 randomly selected age and gender matched controls were included. For both men and women there is an excess of colorectal cancer in those born in autumn and a corresponding reduction of risk among those born in spring (p = 0.026). For the identified September peak, the excess risk for colorectal cancer was 14.8% (95% CI 5.6–32.3%) larger than the spring trough. Conclusion. There is a seasonal effect in the monthly birth rates of people who are operated for colorectal cancer with a disproportionate excess of cancer in those born in September. Further large studies are required to validate these findings.

Childhood determination of Hodgkin lymphoma among U.S. servicemen

BACKGROUND

Hodgkin lymphoma in young adults is inexplicably linked to economic development.

METHODS

We conducted a nested case-control study of the 656 servicemen with Hodgkin lymphoma diagnosed between ages 17 to 32 while on active duty in the U.S. military during 1950-68. Controls, chosen randomly from the servicemen on duty at the time, were matched on service, birth year, and induction date. Information came from preinduction records and military records for the period ending at onset or the equivalent date.

RESULTS

Risk was independently increased with small sib-ship size [OR, 2.3; confidence interval (CI), 1.6-3.5], low birth order (OR, 1.9; CI, 1.4-2.6), and an interval of at least 5 years between birth and that of a previous or subsequent sibling (OR, 2.1; CI, 1.5-3.1). Other factors independently and significantly associated with elevated risk of Hodgkin lymphoma were: tallness, high body mass index, more education (but not higher income) in the county of birth, BB or AB blood type, and past infectious mononucleosis (but a deficit of other childhood viral infections). Early fatherhood conveyed high risk (OR, 2.6; CI, 1.4-4.8), especially if with a high-risk sibling configuration. Factors unrelated to risk included personal education, preinduction or military occupation, induction test score, and rank. Findings were similar for nodular sclerosis and mixed cell histologic subtypes.

CONCLUSIONS

Protection from the environment in childhood, but not in adulthood, increases the likelihood of young adult Hodgkin lymphoma, which may result from nonspecific isolation from early infections and/or exposure to late infection by a specific but unidentified ubiquitous childhood virus.

IMPACT

Events in childhood protect against later Hodgkin lymphoma.

Perinatal risk factors for acute myeloid leukemia

Infectious etiologies have been hypothesized for acute leukemias because of their high incidence in early childhood, but have seldom been examined for acute myeloid leukemia (AML). We conducted the first large cohort study to examine perinatal factors including season of birth, a proxy for perinatal infectious exposures, and risk of AML in childhood through young adulthood. A national cohort of 3,569,333 persons without Down syndrome who were born in Sweden in 1973-2008 were followed up for AML incidence through 2010 (maximum age 38 years). There were 315 AML cases in 69.7 million person-years of follow-up. We found a sinusoidal pattern in AML risk by season of birth (P < 0.001), with peak risk among persons born in winter. Relative to persons born in summer (June-August), incidence rate ratios for AML were 1.72 (95 % CI 1.25-2.38; P = 0.001) for winter (December-February), 1.37 (95 % CI 0.99-1.90; P = 0.06) for spring (March-May), and 1.27 (95 % CI 0.90-1.80; P = 0.17) for fall (September-November). Other risk factors for AML included high fetal growth, high gestational age at birth, and low maternal education level. These findings did not vary by sex or age at diagnosis. Sex, birth order, parental age, and parental country of birth were not associated with AML. In this large cohort study, birth in winter was associated with increased risk of AML in childhood through young adulthood, possibly related to immunologic effects of early infectious exposures compared with summer birth. These findings warrant further investigation of the role of seasonally varying perinatal exposures in the etiology of AML.

Seasonal variation in the month of birth in patients with skin cancer

BACKGROUND

Month of birth influences the risk of developing several diseases. We investigated the influence of date of birth on melanoma skin cancer (MSC) and non-melanoma skin cancer (NMSC) incidence.

METHODS

Enhanced cancer registry data were analysed including 1751 MSC and 15 200 NMSC.

RESULTS

People born in February to April showed significantly elevated risks of NMSC compared with those born in summertime.

CONCLUSIONS

We demonstrated seasonality by date of birth for skin cancer incidence. Neonatal UV exposure may explain this finding.

The association between season of pregnancy and birth-sex among Chinese

Objective: although numerous studies have reported the association between birth season and sex ratio, few studies have been conducted in subtropical regions in a non-Western setting. The present study assessed the effects of pregnancy season on birth sex ratio in China. Methods: We conducted a national population-based retrospective study from 2006–2008 with 3175 children-parents pairs enrolled in the Northeast regions of China. Demographics and data relating to pregnancy and birth were collected and analyzed. A multiple logistical regression model was fitted to estimate the regression coefficient and 95% confidence interval (CI) of refractive error for mother pregnancy season, adjusting for potential confounders. Results: After adjusting for parental age (cut-off point was 30 years), region, nationality, mother education level, and mother miscarriage history, there is a significant statistical different mother pregnancy season on birth-sex. Compared with mothers who were pregnant in spring, those pregnant in summer or winter had a high probability of delivering girls (p < 0.05). The birth-sex ratio varied with months. Conclusions: Our results suggested that mothers pregnant in summer and winter were more likely to deliver girls, compared with those pregnant in spring. Pregnancy season may play an important role in the birth-sex.