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O'Sullivan DE, Hillier TWR, Brenner DR, Peters CE, King WD. Time spent in the sun and the risk of developing non-Hodgkin lymphoma: a Canadian cohort study. Cancer Causes Control 2023; 34:791-799. [PMID: 37264255 DOI: 10.1007/s10552-023-01719-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE The objective was to explore the relationship of sun behavior patterns with the risk of developing non-Hodgkin lymphoma (NHL). METHODS Sun behavior information from Alberta's Tomorrow Project, CARTaGENE, and Ontario Health Study were utilized. The relationship between time in the sun during summer months and risk of NHL was assessed using Cox proportional hazard models with age as the time scale and adjustment for confounders. Cohorts were analyzed separately and hazard ratios (HR) pooled with random effects meta-analysis. Joint effects of time in the sun and use of sun protection were examined. Patterns of exposure were explored via combinations of weekday and weekend time in the sun. RESULTS During an average follow-up of 7.6 years, 205 NHL cases occurred among study participants (n = 79,803). Compared to < 30 min daily in the sun, we observed HRs of 0.84 (95% CI 0.55-1.28) for 30-59 min, 0.63 (95% CI 0.40-0.98) for 1-2 h, and 0.91 (95% CI 0.61-1.36) for > 2 h. There was suggestive evidence that > 2 h was protective against NHL with use of sun protection, but not without it. Compared to < 30 min daily, moderate exposure (30 min to 2 h on weekdays or weekend) was associated with a lower risk of NHL (HR 0.63, 95% CI 0.43-0.92), while intermittent (< 30 min on weekdays and > 2 h on weekends) and chronic (> 2 h daily) were not. CONCLUSION This study provides evidence of a protective effect of moderate time spent in the sun on NHL risk.
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Affiliation(s)
- Dylan E O'Sullivan
- Department of Oncology, University of Calgary, Calgary, AB, Canada.
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada.
- Holy Cross Centre, Box ACB, 2210 2nd St SW, Calgary, AB, T2S 3C3, Canada.
| | | | - Darren R Brenner
- Department of Oncology, University of Calgary, Calgary, AB, Canada
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada
| | - Cheryl E Peters
- BC Centre for Disease Control & BC Cancer, Vancouver, BC, Canada
| | - Will D King
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
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Melnik BC, Stadler R, Weiskirchen R, Leitzmann C, Schmitz G. Potential Pathogenic Impact of Cow’s Milk Consumption and Bovine Milk-Derived Exosomal MicroRNAs in Diffuse Large B-Cell Lymphoma. Int J Mol Sci 2023; 24:ijms24076102. [PMID: 37047075 PMCID: PMC10094152 DOI: 10.3390/ijms24076102] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/05/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
Epidemiological evidence supports an association between cow’s milk consumption and the risk of diffuse large B-cell lymphoma (DLBCL), the most common non-Hodgkin lymphoma worldwide. This narrative review intends to elucidate the potential impact of milk-related agents, predominantly milk-derived exosomes (MDEs) and their microRNAs (miRs) in lymphomagenesis. Upregulation of PI3K-AKT-mTORC1 signaling is a common feature of DLBCL. Increased expression of B cell lymphoma 6 (BCL6) and suppression of B lymphocyte-induced maturation protein 1 (BLIMP1)/PR domain-containing protein 1 (PRDM1) are crucial pathological deviations in DLBCL. Translational evidence indicates that during the breastfeeding period, human MDE miRs support B cell proliferation via epigenetic upregulation of BCL6 (via miR-148a-3p-mediated suppression of DNA methyltransferase 1 (DNMT1) and miR-155-5p/miR-29b-5p-mediated suppression of activation-induced cytidine deaminase (AICDA) and suppression of BLIMP1 (via MDE let-7-5p/miR-125b-5p-targeting of PRDM1). After weaning with the physiological termination of MDE miR signaling, the infant’s BCL6 expression and B cell proliferation declines, whereas BLIMP1-mediated B cell maturation for adequate own antibody production rises. Because human and bovine MDE miRs share identical nucleotide sequences, the consumption of pasteurized cow’s milk in adults with the continued transfer of bioactive bovine MDE miRs may de-differentiate B cells back to the neonatal “proliferation-dominated” B cell phenotype maintaining an increased BLC6/BLIMP1 ratio. Persistent milk-induced epigenetic dysregulation of BCL6 and BLIMP1 expression may thus represent a novel driving mechanism in B cell lymphomagenesis. Bovine MDEs and their miR cargo have to be considered potential pathogens that should be removed from the human food chain.
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Boyle T, Kleinstern G, Bracci PM, Cerhan JR, Benavente Y, Casabonne D, Chiu BCH, Habermann TM, Holly EA, Liebow M, Norman A, Paltiel O, Robinson D, Rothman N, Abu Seir R, Slager SL, Villeneuve PJ, Wang SS, Weisenburger DD, Spinelli JJ. Physical activity and the risk of non-Hodgkin lymphoma subtypes: A pooled analysis. Int J Cancer 2023; 152:396-407. [PMID: 36054546 DOI: 10.1002/ijc.34266] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/03/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023]
Abstract
Non-Hodgkin lymphoma (NHL) is composed of a heterogeneous collection of subtypes with considerable differences in genetics, biology and aetiology. Studies to date on physical activity and NHL risk have not had sufficient sample size to evaluate whether associations differ by subtype. We pooled data from nine case-control studies to examine the association between moderate-to-vigorous intensity physical activity (MVPA) and risk of NHL overall and by subtype (diffuse large B-cell lymphoma, follicular lymphoma, chronic lymphocytic leukaemia/small lymphocytic lymphoma, marginal zone lymphoma and mature T-cell lymphoma). A total of 5653 cases and 9115 controls were included in the pooled analysis. Physical activity was harmonised across nine studies and modelled as study-specific tertiles. Multinomial logistic regression was used to estimate the association between physical activity and NHL, adjusting for confounders. The overall odds of NHL was 13% lower among participants in the most active tertile of MVPA compared to the least active tertile (adjusted odds ratio = 0.87, 95% CI = 0.80, 0.95). Similar decreases were observed across NHL subtypes. In summary, in this pooled analysis of case-control studies, physical activity was associated with a modest risk reduction for each NHL subtype examined and with overall NHL.
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Affiliation(s)
- Terry Boyle
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.,Cancer Control Research, BC Cancer Agency, Vancouver, British Columbia, Canada.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | | | - Paige M Bracci
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Yolanda Benavente
- Unit of Molecular and Genetic Epidemiology in Infections and Cancer (UNIC-Molecular), Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet De Llobregat, Spain.,Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP, Madrid, Spain
| | - Delphine Casabonne
- Unit of Molecular and Genetic Epidemiology in Infections and Cancer (UNIC-Molecular), Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet De Llobregat, Spain.,Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP, Madrid, Spain
| | - Brian C-H Chiu
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | | | - Elizabeth A Holly
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Mark Liebow
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron Norman
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Ora Paltiel
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel.,Department of Hematology, Hadassah-Hebrew University, Jerusalem, Israel
| | - Dennis Robinson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Rania Abu Seir
- Department of Medical Laboratory Sciences, Faculty of Health Professions, Al-Quds University, Palestine
| | - Susan L Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul J Villeneuve
- School of Mathematics and Statistics and Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
| | - Sophia S Wang
- Department of Health Analytics, Division of Computational and Quantitative Medicine, Beckman Research Institute, City of Hope, Duarte, California, USA
| | - Dennis D Weisenburger
- Department of Pathology, City of Hope National Medical Center, Duarte, California, USA
| | - John J Spinelli
- Cancer Control Research, BC Cancer Agency, Vancouver, British Columbia, Canada
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Ataei M, Abdollahi M. A systematic review of mechanistic studies on the relationship between pesticide exposure and cancer induction. Toxicol Appl Pharmacol 2022; 456:116280. [DOI: 10.1016/j.taap.2022.116280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 01/01/2023]
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Serological and hematological characteristics of Sjogren's syndrome and dry eye syndrome patients using a novel immune serology technique. PLoS One 2021; 15:e0244712. [PMID: 33382786 PMCID: PMC7774976 DOI: 10.1371/journal.pone.0244712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/16/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To compare hematologic and serological parameters among patients with Sjogren's syndrome (SS), dry eye syndrome (DES) and controls, and validate a novel multiplex-serology method for identifying auto-antibodies in these populations. METHODS In a clinic-based case-control study a total of 422 participants were recruited, including 91 with SS, 120 DES, and 211 controls (age and sex frequency-matched). We measured blood counts, anti-nuclear-antibodies (ANA), anti-SSA/SSB, anti-ribonucleoprotein (RNP), anti-double-stranded-DNA (DS-DNA), and rheumatoid factor (RF) using the "Immunodot" qualitative-ELISA assay. Immunoglobulins, C3 and C4 were measured by immune-fluorescence. Autoantibodies were also quantified with a newly-developed method using glutathione-S-transferase fusion proteins of SSA/Ro 52 and 60kD and SSB/La (multiplex-serology), measuring median fluorescence intensity (MFI). RESULTS Among DES patients, only 2% (95%CI: 0.36-6.3) had positive immune serology. SS patients had lower lymphocyte, hemoglobin and C3 levels but higher prevalence of RF, ANA, anti-SSA/B and higher IgG and MFI levels, compared to DES and controls (P<0.001). Presence of anti-SSA/Ro-52kD was associated with SS [odds ratio (OR) = 2.05, 95% confidence interval (CI): 1.46-2.88]. Anti-SSB/La was inversely associated with DES (OR = 0.81, 95%CI: 0.65-1.00) compared to controls. Positivity to RF (adjusted for age, gender and ethnicity OR = 5.03, 95%CI: 1.78-14.21), ANA (OR = 14.75, 95%CI: 4.09-53.17), or combination of anti-SSA/B (OR = 20.97, 95%CI: 4.60-95.54) were more likely in SS compared to DES. The novel multiplex-serology method correctly identified anti-SSA/B autoantibodies by ELISA among SS, DES patients and controls (sensitivity = 1.0, negative-predictive-value = 1.0). CONCLUSIONS Serologic parameters distinguish SS from DES patients and controls. A newly-developed multiplex-serology technique may be useful to detect autoantibodies in large epidemiologic studies.
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Odutola MK, Nnakelu E, Giles GG, van Leeuwen MT, Vajdic CM. Lifestyle and risk of follicular lymphoma: a systematic review and meta-analysis of observational studies. Cancer Causes Control 2020; 31:979-1000. [DOI: 10.1007/s10552-020-01342-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 08/13/2020] [Indexed: 12/21/2022]
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Park HY, Hong YC, Lee K, Koh J. Vitamin D status and risk of non-Hodgkin lymphoma: An updated meta-analysis. PLoS One 2019; 14:e0216284. [PMID: 31034511 PMCID: PMC6488072 DOI: 10.1371/journal.pone.0216284] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 04/17/2019] [Indexed: 01/11/2023] Open
Abstract
Purpose This meta-analysis aimed to extensively investigate the association between various measures of vitamin D status and non-Hodgkin lymphoma (NHL) and its subtypes. Methods We searched MEDLINE (PubMed), Embase, and the Cochrane Library in February 2018. Two authors independently reviewed and selected articles based on predetermined criteria. Results A total of 30 studies with 56,458 NHL cases were finally selected, with 24, 9, and 3 studies on sunlight/ultraviolet radiation (UVR) exposure, dietary intake, and serum/plasma 25-hydroxyvitamin D levels, respectively. Significant protective effects of overall sunlight/UVR exposure on NHL and subtypes were observed, with summary relative risks (RRs) ranging from 0.67–0.80 (RR for NHL = 0.80; 95% confidence interval [CI]: 0.71–0.90) among subjects with high exposure compared to those with low exposure. The results were consistent with various classifications of sunlight/UVR exposure. In contrast, when exposure measures of dietary vitamin D intake (RR for NHL = 1.03; 95% CI: 0.90–1.19) and serum/plasma 25-hydroxyvitamin D levels (RR for NHL = 0.97; 95% CI: 0.82–1.15) were used, risk estimates were inconsistent or non-significant for NHL and the subtypes. Conclusion While risk estimates varied by different measures of vitamin D status, a protective effect of sunlight/UVR exposure on NHL incidence was verified, across most of the tested subtypes as well as exposure categories.
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Affiliation(s)
- Hye Yin Park
- Samsung Health Research Institute, Samsung Electronics Co. Ltd., Hwaseong-si, Gyeonggi-do, Korea
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Korea
- * E-mail:
| | - Yun-Chul Hong
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Environment Health Center, Seoul National University, Seoul, Korea
| | - Kyoungho Lee
- Samsung Health Research Institute, Samsung Electronics Co. Ltd., Hwaseong-si, Gyeonggi-do, Korea
| | - Jaewoo Koh
- Samsung Health Research Institute, Samsung Electronics Co. Ltd., Hwaseong-si, Gyeonggi-do, Korea
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Shared Medical and Environmental Risk Factors in Dry Eye Syndrome, Sjogren's Syndrome, and B-Cell Non-Hodgkin Lymphoma: A Case-Control Study. J Immunol Res 2019; 2019:9060842. [PMID: 30805374 PMCID: PMC6360537 DOI: 10.1155/2019/9060842] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 11/10/2018] [Accepted: 12/16/2018] [Indexed: 12/13/2022] Open
Abstract
Objectives To assess whether there are shared exposures associated with Sjogren's syndrome (SS), dry eye syndrome (DES), and B-cell non-Hodgkin lymphoma (B-NHL), in order to determine whether they are etiologically related. Methods In a clinic-based case-control study, 702 participants (91 SS, 120 DES, 211 (age and sex frequency-matched) controls, and 280 B-NHL cases) were recruited and interviewed regarding exposures, medical history, and family history. Results Female predominance was noted in SS (ratio 9.2 : 1). Eye dryness was severest in SS compared to DES and controls (P < 0.001). Compared to controls, alcohol consumption was inversely associated with NHL, DES, and SS (odds ratio (OR) = 0.47, 95% confidence interval (CI): 0.31-0.71; OR = 0.54, 95% CI: 0.33-0.88; and OR = 0.26, 95% CI: 0.14-0.49, respectively), while a previous history of infection requiring hospitalization was positively associated with all three conditions: NHL (OR = 1.92; 95% CI: 1.23-2.99), DES (OR = 3.29; 95% CI: 1.97-5.47), and SS (OR = 4.74; 95% CI: 2.66-8.44). NHL patients were more likely to report first-degree relatives with hematologic cancer, while having first-degree relatives with an autoimmune disease (AID) was associated with SS (OR = 5.25; 95% CI: 2.59-10.63) and DES (OR = 3.55; 95% CI: 1.83-6.91) compared to controls. Conclusions Some exposures are associated with all three conditions (such as an inverse association with alcohol consumption and a positive association with serious past infection), while a family history of AID appears to be shared by DES and SS, but not NHL subjects. Shared risk factors for all three conditions indicate possible mutual etiological pathways.
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Klil-Drori AJ, Kleinstern G, Seir RA, Choshen-Cohen L, Abdeen Z, Hussein E, Aqel M, Göen T, Perlman R, Ben-Yehuda D, Paltiel O. Serum organochlorines and non-Hodgkin lymphoma: A case-control study in Israeli Jews and Palestinians. CHEMOSPHERE 2018; 213:395-402. [PMID: 30241084 DOI: 10.1016/j.chemosphere.2018.09.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 06/08/2023]
Abstract
Associations of organochlorine (OC) pesticides and polychlorinated biphenyls (PCBs) with non-Hodgkin lymphoma are controversial. We compared serum levels of 6 OC pesticides and 38 PCBs in Israeli Jews (IJ) and Palestinian Arabs (PA) and assessed possible associations with B-cell non-Hodgkin lymphoma (B-NHL). Ninety B-NHL cases (50 IJ and 40 PA) and 120 controls (65 IJ and 55 PA) were included. Median concentrations of analytes in controls were compared across ethnic groups using quantile regression, adjusting for age and sex. We used logistic regression to derive odds ratios (OR) and 95% confidence intervals (CI) for detectable analytes and B-NHL, adjusting for age, ethnic group, faming and body mass index. Median values of PCBs and dichlorodiphenyldichloroethylene (DDE) were higher in IJ vs PA controls (P = 0.0007), as were several PCBs (74, 99, 118, 138, 146, 153, 156, 163, 170, and 180). Overall, OC pesticide and PCB exposures were comparable with reports from high-income countries. B-NHL was associated with PCB 146 (OR 1.70, 95% CI: 1.02, 2.83), PCB 156 (OR 1.75, 95% CI: 1.06, 2.89), and high-chlorinated PCBs (OR 1.55, 95% CI: 1.00, 2.40) in all study subjects. These associations were robust in quantile as well as sensitivity analyses. An association of DDE with B-NHL was noted in PA (OR 1.72, 95% CI: 1.07, 2.77), but not in IJ (OR 0.87, 95% CI: 0.59, 1.27). Although high-chlorinated PCB concentrations did not indicate high exposure levels, our findings indicate that B-NHL may be associated with this exposure.
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Affiliation(s)
- Adi J Klil-Drori
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.
| | - Geffen Kleinstern
- Braun School of Public Health, Hadassah-Hebrew University, Jerusalem, Israel; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Rania Abu Seir
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Faculty of Health Professions, Dept. of Medical Laboratory Sciences, Al-Quds University, Abu Deis, West Bank, Israel
| | - Lotan Choshen-Cohen
- Braun School of Public Health, Hadassah-Hebrew University, Jerusalem, Israel
| | - Ziad Abdeen
- Al-Quds Nutrition and Health Research Institute, Al-Quds University, Abu Deis, West Bank, Israel
| | - Elyan Hussein
- Department of Hematology, Beit Jala Hospital, West Bank, Israel
| | - Mohammad Aqel
- Augusta Victoria Hospital, Jerusalem, West Bank, Israel
| | - Thomas Göen
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Riki Perlman
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dina Ben-Yehuda
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ora Paltiel
- Braun School of Public Health, Hadassah-Hebrew University, Jerusalem, Israel; Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Tong Y, Xiang Y, Li B, Bao S, Zhou Y, Yuan W, Ling Y, Hao D, Zhu H, Sun Z. Association of ERCC2 Gene Polymorphisms with Susceptibility to Diffuse Large B-Cell Lymphoma. Med Sci Monit 2018; 24:7015-7022. [PMID: 30279407 PMCID: PMC6179170 DOI: 10.12659/msm.908813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The objective of this study was to detect the association between ERCC excision repair 2, TFIIH core complex helicase subunit (ERCC2) gene polymorphisms and diffuse large B-cell lymphoma (DLBCL) susceptibility. MATERIAL AND METHODS This study used a case-control design. ERCC2 gene rs1799793 (Asp312Asn) and rs13181 (Lys751Gln) polymorphisms were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) both in DLBCL patients and healthy controls. The association between ERCC2 gene polymorphisms and DLBCL risk was assessed by χ² test. Odds ratios (ORs) with corresponding 95% confidence intervals (95% CIs) were used to address the association strength. Subgroup analyses were also performed to investigate the genetic effects of ERCC2 polymorphisms on clinical characteristics of DLBCL patients. RESULTS A significant association was discovered between the rs1799793 A allele and increased DLBCL risk (P=0.031, OR=1.928, 95% CI=1.052-3.534). The C allele of rs13181 was obviously associated with elevated DLBCL susceptibility (P=0.047, OR=1.820, 95% CI=1.002-3.305). The subgroup analysis demonstrated that rs1799793 and rs13181 polymorphisms had no relationship with serum lactate dehydrogenase level, nidus number, B-symptoms, Ann Arbor stages, or immunological types in DLBCL cases (P>0.05 for all). CONCLUSIONS Minor allele carriers of ERCC2 gene rs1799793 (Asp312Asn) and rs13181 (Lys751Gln) polymorphisms had higher susceptibility to DLBCL.
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Affiliation(s)
- Yong Tong
- Department of Hematology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China (mainland)
| | - Yinzhou Xiang
- Department of Otolaryngology, China Three Gorges University People's Hospital, Yichang, Hubei, China (mainland)
| | - Bao Li
- Department of Hematopathology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China (mainland)
| | - Shijie Bao
- Department of Hematology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China (mainland)
| | - Ying Zhou
- Department of Hematology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China (mainland)
| | - Wen Yuan
- Department of Hematology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China (mainland)
| | - Yu Ling
- Department of Hematology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China (mainland)
| | - Dan Hao
- Department of Hematology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China (mainland)
| | - Huamin Zhu
- Department of Hematology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China (mainland)
| | - Zhiqiang Sun
- Department of Hematology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China (mainland)
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Kleinstern G, Averbuch M, Abu Seir R, Perlman R, Ben Yehuda D, Paltiel O. Presence of autoimmune disease affects not only risk but also survival in patients with B-cell non-Hodgkin lymphoma. Hematol Oncol 2018; 36:457-462. [PMID: 29469175 DOI: 10.1002/hon.2498] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/21/2017] [Accepted: 01/10/2018] [Indexed: 12/26/2022]
Abstract
Although autoimmune diseases (AIDs) are known to predispose to non-Hodgkin lymphoma (NHL), their association with NHL prognosis has rarely been investigated. We examined associations between autoimmunity and B-cell NHL onset by comparing AID history (determined by self-report and medication review and supplemented by chart review where possible) among 435 adult B-NHL patients in Hadassah-Hebrew University Medical Center, diagnosed 2009-2014, and 414 age-and-sex frequency-matched controls. We examined AIDs as a whole, B- and T-cell-mediated AIDs, and autoimmune thyroid diseases. Among cases, we used Kaplan-Meier and Cox regression models to assess the association of AID with overall survival and relapse-free survival, adjusting for prognostically important patient and disease characteristics such as Ki67% staining, International Prognostic Index, rituximab treatment, and histological subgroup. Autoimmune diseases were associated with B-NHL (odds ratio [OR] = 1.95; 95% confidence interval (CI), 1.31-2.92), especially AIDs mediated by B-cell activation (OR = 5.20; CI, 1.90-14.3), which were particularly associated with marginal zone lymphoma (OR = 19.3; CI, 4.59-80.9). We found that time to relapse for all B-NHL patients with AIDs was significantly shorter (mean of 49.21 mo [±3.22]) than among patients without AID (mean of 59.74 mo [±1.62]), adjusted hazard ratio [HRadj ] = 1.69 (CI, 1.03-2.79). Specifically, in patients with diffuse large B-cell lymphoma, of whom 91.8% had received rituximab, a history of B-cell-mediated AIDs was associated with shorter relapse-free survival and overall survival, HRadj = 8.34 (CI, 3.01-23.1) and HRadj = 3.83 (CI, 1.20-12.3), respectively. Beyond confirming the well-known association between AIDs and B-NHL, we found that AID is an adverse prognostic factor in B-cell lymphoma, associated with a shortened time to relapse, suggesting that there are specific therapeutic challenges in the subgroup of patients suffering from both these diseases. Further work is required to address mechanisms of resistance to standard treatment in the setting of AID-associated B-NHL. In the era of immunotherapy, these findings have particular relevance.
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Affiliation(s)
- Geffen Kleinstern
- School of Public Health, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Mor Averbuch
- School of Public Health, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Rania Abu Seir
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Department of Medical Laboratory Sciences, Al Quds University, Abu Deis, Jerusalem
| | - Riki Perlman
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dina Ben Yehuda
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ora Paltiel
- School of Public Health, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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New developments in the pathology of malignant lymphoma: a review of the literature published from January to April 2017. J Hematop 2017; 10:25-33. [PMID: 28819461 PMCID: PMC5537309 DOI: 10.1007/s12308-017-0295-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Clarfield AM, Manor O, Nun GB, Shvarts S, Azzam ZS, Afek A, Basis F, Israeli A. Health and health care in Israel: an introduction. Lancet 2017; 389:2503-2513. [PMID: 28495109 DOI: 10.1016/s0140-6736(17)30636-0] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 11/21/2022]
Abstract
Starting well before Independence in 1948, and over the ensuing six decades, Israel has built a robust, relatively efficient public system of health care, resulting in good health statistics throughout the life course. Because of the initiative of people living under the British Mandate for Palestine (1922-48), the development of many of today's health services predated the state's establishment by several decades. An extensive array of high-quality services and technologies is available to all residents, largely free at point of service, via the promulgation of the 1994 National Health Insurance Law. In addition to a strong medical academic culture, well equipped (albeit crowded) hospitals, and a robust primary-care infrastructure, the country has also developed some model national projects such as a programme for community quality indicators, an annual update of the national basket of services, and a strong system of research and education. Challenges include increasing privatisation of what was once largely a public system, and the underfunding in various sectors resulting in, among other challenges, relatively few acute hospital beds. Despite substantial organisational and financial investment, disparities persist based on ethnic origin or religion, other socioeconomic factors, and, regardless of the country's small size, a geographic maldistribution of resources. The Ministry of Health continues to be involved in the ownership and administration of many general hospitals and the direct payment for some health services (eg, geriatric institutional care), activities that distract it from its main task of planning for and supervising the whole health structure. Although the health-care system itself is very well integrated in relation to the country's two main ethnic groups (Israeli Arabs and Israeli Jews), we think that health in its widest sense might help provide a bridge to peace and reconciliation between the country and its neighbours.
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Affiliation(s)
- A Mark Clarfield
- Medical School for International Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Orly Manor
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | - Gabi Bin Nun
- Department of Health Systems Management, Faculty of Business and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shifra Shvarts
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Zaher S Azzam
- Rambam Health Care Campus, Rapaport Faculty of Medicine, Technion University, Haifa, Israel
| | - Arnon Afek
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Fuad Basis
- Rambam Health Care Campus, Rapaport Faculty of Medicine, Technion University, Haifa, Israel
| | - Avi Israeli
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
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Abstract
The principle that global human identity and dignity supersede other values is a broadly accepted conviction that guides practice and policies in the realm of human health in most of the world. An assessment of the level of success that Israel has achieved in health, in the face of formidable challenges, including rapid population growth, diverse and often divided ethnic affiliations, and existential security threats, leads us to propose that extension of this principle of global human identity and dignity, together with the objective of a decent society, as overriding values beyond health to other domains of human endeavour within Israel and in its relations with neighbouring peoples, represents an entirely achievable imperative. The result will be to further advance Israel's aspiration to serve as a model for societal decency with wide international acceptance and engagement. We have identified several determinants of Israel's advancement in health, including: articulation of a clear vision, national purpose, and long-term commitment that seeks to take the health of its citizens seriously; a multi-ethnic population that brings diversity and energy to national progress; a political democracy, which is characterised by robust debate and discussion about the nation's future; national legislation governing cardinal health-care processes; cultural and religious histories that respect and revere scholarship, learning, research, and charitable donation; an expanding economy, with recent but increasing appreciation of the economic, social, and political underpinnings of health and health inequalities; a strong base of international support from the Diaspora Jewish community; and a strong desire for acceptance by the international community in key arenas, especially science and health. As a result, despite the fewer than seven decades since its establishment, Israel has achieved important milestones in health. Nevertheless, this trajectory of achievement is threatened by several serious challenges, including the capacity to sustain high-quality universal health coverage, especially for an ageing population living with multiple comorbidities in the face of a stagnant level of the percentage of treasury funding to health care at a level that is well below the average of the Organisation for Economic Co-operation and Development; ever-increasing transfer of services and care covered by the mandatory public health services basket to private programmes; insufficient progress in resolving health disparities among and between communities, populations, and regions of the country congruent with disparities in income and employment; gender inequities; a looming increase in the already alarming shortfall in health-care professionals; and failure to match inpatient and acute care facilities to manage growing needs. These challenges within Israel are magnified in the context of health disparities with the neighbouring Palestinian population, a situation in which ongoing-but fragile and limited-health cooperation and training arrangements cannot stand in for a solution that will address Palestinian national aspirations. We come away from this Series with a great sense of optimism, but with specific recommendations that are based on the foregoing challenges. We believe that by increasing the investment in the health sector, which includes investing in the societal, political, educational, and environmental underpinnings of health, far more can be achieved to move Israel to a model international leadership position in health care, education, and research, and turn health into an engine for economic wellbeing and development. Religious leadership in Israel, with its formidable political influence, can be harnessed to promote health initiatives in areas ranging from smoking cessation and healthy diet to organ transplantation, and most of all condemnation of hostility and its replacement by peaceful resolution of even the deepest conflicts. Most of all, this Series showed that there is an enormous opportunity, which Israel can lead, to leverage the universally accepted principles of health as a sanctuary against conflict and inequity, to achieve a brighter future for a deeply troubled region of the world.
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Affiliation(s)
- Karl Skorecki
- Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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