Blood Transfusion, Anesthesia, Surgery and Risk of Non-Hodgkin Lymphoma.

Abstract Background. The incidence of non-Hodgkin lymphoma (NHL) has increased dramatically since at least the 1950s, and only a fraction of this increase can be explained by established risk factors. During this timeframe, there has been a major increase in the use of blood transfusions, anesthesia, and invasive surgical procedures, all of which can impact immune function. Methods. We conducted a population-based case-control study from 1998–2000 using SEER cancer registries in Detroit, Iowa, Los Angeles and Seattle. NHL cases (N=759) were newly diagnosed, HIV-negative, and aged 20–74 years. Controls (N=589) were identified through random digit dialing (<65 years old) and Medicare files (age 65 years and older), and were frequency matched to cases on sex, age, race, and study site. Data on history of blood transfusions, anesthetics (general and regional), and surgeries (type, frequency, and age for 21 anatomic regions) >1 year before diagnosis (or date of enrollment for controls) were collected during in-person interviews. Unconditional logistic regression was used to estimate the odds ratio (OR) and 95% confidence intervals (CI), adjusted for the matching factors. NHL subtypes (follicular and diffuse) were designated according to SEER cancer registry pathology reports, and risk of each subtype was estimated using polychotomous logistic regression. Results. History of blood transfusion was weakly associated with increased risk of NHL (OR=1.26; 95% CI 0.91–1.73), and the elevated risk was specific to transfusions first given 5 to 29 years before diagnosis (OR=1.69; 95% CI 1.08–2.62). Risk was also specific to blood transfusions given for a medical indication (OR=2.09; 95% CI 1.03–4.26), while transfusions given for trauma, obstetric or surgical indications were not associated with risk. Exposure to general or regional anesthesia (OR=1.35 for 24+ times compared to 0–6; 95% CI 0.91–2.02) and total number of surgeries (OR=1.22 for 7+ surgeries compared to 0; 95% CI 0.77–1.93) were weakly and positively associated with risk of NHL, although neither association achieved statistical significance. Results were similar for general versus regional anesthesia. In analysis of surgeries at specific anatomic sites, there were no associations with NHL risk, except for a suggestive positive association for surgery involving the appendix, stomach or bowel (OR=1.24; 95% CI 0.98–1.58). When blood transfusion, anesthesia, and total number of surgeries were included in the same model, ORs for time since first transfusion and total number of surgeries remained unchanged, while the association for anesthesia weakened. These results were generally similar for both diffuse and follicular subtypes, with the exception that total number of surgeries showed a suggestive positive association with follicular (OR=1.61 for 7+ surgeries compared to 0; 95% CI 0.74–3.51) but not diffuse NHL. Conclusion: History of blood transfusion was associated with an increased risk of NHL. Total number of surgeries, type of surgery, and use of anesthesia were only weakly associated with risk, although the suggestive positive association for number of surgeries with follicular lymphoma warrants further investigation.

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Abstract 190: Predictors and Outcome of Anthracycline-induced Cardiomyopathy among Lymphoma Patients

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.190 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Jennifer R Brown ◽

Christopher R Flowers ◽

Tian Dai ◽

Susmita Parashar

Keyword(s):

Statistical Significance ◽

Therapeutic Benefit ◽

Logistic Regression Models ◽

Non Hodgkin Lymphoma ◽

Increased Risk ◽

Before And After ◽

Tobacco Abuse ◽

History Of ◽

Imaging Surveillance ◽

Artery Disease

Background: Anthracyclines (AC) are one of the most potent anti-neoplastic agents in the treatment of lymphoid malignancies. However their therapeutic benefit is limited by cardiotoxicity. Among patients receiving AC, it is unclear whether traditional cardiovascular markers predict cardiomyopathy (CMP) and whether patients with AC-CMP have higher mortality compared with non-CMP patients. Methods: We performed a retrospective analysis of a cohort of Non-Hodgkin lymphoma (NHL) patients evaluated by the Emory Lymphoma program who received AC between 1992 and 2013. We assessed cardiac function by echocardiogram or equilibrium radionuclide imaging. We examined the prevalence of AC-CMP (defined as an absolute decrease in LVEF > 10% with a decline <50%, or an LVEF reduction of at least 15% with absolute LVEF > 50%). Analyses only included patients who received assessment of LVEF both pre and post-AC. Statistical analysis was performed by univariable and multivariable logistic regression models of clinical characteristics potentially associated with a decrease in LVEF. Results: Of 218 patients who received AC (median dose 300 mg/m2), 41% (89 of 218) had imaging surveillance before and after AC. Twenty seven percent of patients had AC-CMP. In the multivariate analyses after adjusting for demographics and traditional cardiac comorbidites, among patients receiving AC, patients with tobacco abuse [OR, 2.4; 95% CI, 0.8 to 7.0; P = 0.12], coronary artery disease [OR, 2.6; 95% CI, 0.8 to 7.9; P = 0.10] and diabetes [OR, 2.9; 95% CI, 0.9 to 9.9; P = 0.08] were more likely to have CMP although the association did not reach statistical significance. Mortality among CMP patients was numerically higher compared with non-CMP patients (50% vs. 35%; P = 0.28). Conclusions: Among patients receiving AC for lymphoma, there is a trend towards increased risk of CMP in patients with history of tobacco abuse, CAD and diabetes. Additionally, AC-CMP patients had numerically higher mortality compared with non-CMP patients. Future studies are needed to confirm these important findings in larger samples to ascertain predictors and outcome of AC induced CMP in cancer patients.

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Childhood Crowding, Atopy and Risk of Non-Hodgkin Lymphoma.

Blood ◽

10.1182/blood.v108.11.4648.4648 ◽

2006 ◽

Vol 108 (11) ◽

pp. 4648-4648

Author(s):

Wendy Cozen ◽

Engels A. Eric ◽

James R. Cerhan ◽

Martha Linet ◽

Leslie Bernstein ◽

...

Keyword(s):

Immune Response ◽

Los Angeles ◽

Follicular Lymphoma ◽

Hodgkin Lymphoma ◽

Health Care Financing ◽

B Cell Lymphoma ◽

Cancer Registries ◽

Non Hodgkin Lymphoma ◽

Increased Risk ◽

History Of

Abstract Subtle differences in immune response may play a role in non-Hodgkin lymphoma (NHL) etiology. Because adult immune response may be influenced by early childhood exposures, we examined the role of childhood crowding, history of atopic disease, and other childhood immune-related exposures on the risk of non-Hodgkin lymphoma in a multi-center case-control study. Interviews were completed with 1,321 cases ascertained from population-based cancer registries in Seattle, Detroit, Los Angeles and Iowa, and with 1,057 frequency-matched controls, selected by random-digit dialing and from the Health Care Financing Administration (HCFA) database. The association between NHL risk in relation to atopy and other exposures was assessed using multivariable logistic regression methods. Most types of allergy were associated with protection from NHL, with hay fever especially protective against all NHL combined (Odds Ratio [OR] = 0.71, 95% confidence interval [CI]= 0.54–0.94), diffuse large B-cell lymphoma [DLBCL] (OR=0.61, 95% CI=0.41–0.91), and follicular lymphoma (OR=0.70, 95% CI=0.45–1.09). A history of eczema increased risk of follicular lymphoma (OR=1.92, 95% CI= 1.08–3.41) but not DLBCL (OR=1.06, 95% CI= 0.55.2.04). Asthma in childhood was not associated with risk of NHL. Risk of DLBCL (OR =1.72, 95% CI=1.17–2.52), but not follicular lymphoma (OR=1.15, 95% CI=0.75–1.76) was elevated for the youngest compared to the oldest of siblings. Neither number of siblings nor years between births of siblings were significantly associated with risk. These results suggest that some immune-related exposures may affect NHL risk.

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Childhood infection experience and risk of Young Adult Hodgkin Lymphoma.

Blood ◽

10.1182/blood.v112.11.1457.1457 ◽

2008 ◽

Vol 112 (11) ◽

pp. 1457-1457

Author(s):

Wendy Cozen ◽

Ann S. Hamilton ◽

Peng Zhao ◽

Muhammed Towhid Salam ◽

Dennis M. Deapen ◽

...

Keyword(s):

Logistic Regression ◽

Young Adult ◽

Young Child ◽

Hodgkin Lymphoma ◽

Confidence Intervals ◽

Conditional Logistic Regression ◽

Oral Exposure ◽

Increased Risk ◽

History Of ◽

Discordant Twin

Abstract The risk pattern of adolescent/young adult Hodgkin lymphoma (HL) is consistent with causation by a relatively late infection to a common childhood virus. However a causal virus has not yet been convincingly found. Susceptibility is known to be heritable, and a lower genetically determined interleukin-12 [IL-12] response is a risk factor. A lower IL-12 response can also be produced by diminished gastrointestinal exposure to the environmental microbiome, with resulting persistence of a Th2-skewed cytokine phenotype. We have therefore studied twin pairs discordant for HL to search for early life differences in sources of both viral and non-viral infection. HL-discordant twin pairs volunteered for the International Twin Study in ignorance of specific hypotheses. 70% of the questionnaires sent to individual twins were returned producing 188 informative pairs. The Kappa statistic was used to assess between-twin agreement. Designating the twin with HL as the case and the unaffected twin as the control, odds ratios (ORs) and 95% confidence intervals (CI) were calculated using conditional logistic regression for matched pairs. Tonsillectomy or appendectomy at least 5 years prior to diagnosis were associated respectively with a 2- and 3-fold statistically significant increase in risk. Infection with 3 or more childhood exanthems was associated with a 60% decreased risk (95% confidence intervals 0.2, 0.9). Behaviors likely to produce oral exposure to the environmental microbiome conveyed statistically significant decreases in risk (OR=0.2–0.5). A history of eczema increased risk (OR= 2.8, 95% CI= 1.0, 7.8). Kappa statistics were high (>0.8) for significant findings. Our evidence supports a role for early exposure to various infections in the etiology of adolescent/young adult Hodgkin lymphoma. Table 1. History of infections, immune-related surgeries and other childhood experience at least 5 years prior to diagnosis and risk of adolescent-young adult Hodgkin Lymphoma diagnosed between 13–50 years of age in disease-discordant twin pairs from the International Twin International Twin Registry (n = 188 total pairs). Exposures Kappa1 Ratio of Exposure Discordant Pairs2 Odds Ratio3 95% CI4 1. Kappa calculated from the 93 double respondent twin pairs (pairs in whom both twins returned questionnaires) 2 Total number of twin pairs in which case-twin was exposed and the unaffected co-twin was unexposed/Total number of twin pairs in which unaffected co-twin was exposed and the case-twin was unexposed 3 Odds ratio estimated using conditional logistic regression using SAS Version 8.1 4 Confidence interval estimated using conditional logistic regression 3 or more childhood exanthems - 6/15 0.4 0.2, 0.9 Infectious mononucleosis 0.72 22/19 1.2 0.6, 2.1 Cold Sores (Herpes Simplex 1) 0.70 18/10 1.8 0.8, 3.9 Tonsillectomy 0.86 25/12 2.1 1.1, 4.1 Appendectomy 0.84 33/11 3.0 1.5, 5.9 Eczema 0.79 14/5 2.8 1.0, 7.8 Sucked pacifier/thumb/fingers more as an infant/young child? 0.87 18/34 0.5 0.3, 0.9 Put more things in mouth as an infant/young child? 0.86 10/30 0.3 0.2, 0.7

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Lymphoproliferative malignancies in patients with neurofibromatosis 1

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01856-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Christina Bergqvist ◽

François Hemery ◽

Arnaud Jannic ◽

Salah Ferkal ◽

Pierre Wolkenstein

Keyword(s):

General Population ◽

Medical History ◽

Hodgkin Lymphoma ◽

Incidence Rate ◽

Population Based ◽

Neurofibromatosis 1 ◽

Population Based Study ◽

Non Hodgkin Lymphoma ◽

History Of

AbstractNeurofibromatosis 1 (NF1) is an inherited, autosomal-dominant, tumor predisposition syndrome with a birth incidence as high as 1:2000. A patient with NF1 is four to five times more likely to develop a malignancy as compared to the general population. The number of epidemiologic studies on lymphoproliferative malignancies in patients with NF1 is limited. The aim of this study was to determine the incidence rate of lymphoproliferative malignancies (lymphoma and leukemia) in NF1 patients followed in our referral center for neurofibromatoses. We used the Informatics for Integrated Biology and the Bedside (i2b2) platform to extract information from the hospital’s electronic health records. We performed a keyword search on clinical notes generated between Jan/01/2014 and May/11/2020 for patients aged 18 years or older. A total of 1507 patients with confirmed NF1 patients aged 18 years and above were identified (mean age 39.2 years; 57% women). The total number of person-years in follow-up was 57,736 (men, 24,327 years; women, 33,409 years). Mean length of follow-up was 38.3 years (median, 36 years). A total of 13 patients had a medical history of either lymphoma or leukemia, yielding an overall incidence rate of 22.5 per 100,000 (0.000225, 95% confidence interval (CI) 0.000223–0.000227). This incidence is similar to that of the general population in France (standardized incidence ratio 1.07, 95% CI 0.60–1.79). Four patients had a medical history leukemia and 9 patients had a medical history of lymphoma of which 7 had non-Hodgkin lymphoma, and 2 had Hodgkin lymphoma. Our results show that adults with NF1 do not have an increased tendency to develop lymphoproliferative malignancies, in contrast to the general increased risk of malignancy. While our results are consistent with the recent population-based study in Finland, they are in contrast with the larger population-based study in England whereby NF1 individuals were found to be 3 times more likely to develop both non-Hodgkin lymphoma and lymphocytic leukemia. Large-scale epidemiological studies based on nationwide data sets are thus needed to confirm our findings.

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Melanoma is associated with an increased risk of bullous pemphigoid: a large population-based longitudinal study

Archives of Dermatological Research ◽

10.1007/s00403-021-02211-4 ◽

2021 ◽

Author(s):

Khalaf Kridin ◽

Jennifer E. Hundt ◽

Ralf J. Ludwig ◽

Kyle T. Amber ◽

Dana Tzur Bitan ◽

...

Keyword(s):

Bullous Pemphigoid ◽

Statistical Significance ◽

Large Population ◽

Underlying Mechanism ◽

Population Based ◽

Control Subjects ◽

Increased Risk ◽

Bidirectional Association ◽

History Of ◽

Incident Cases

AbstractThe association between bullous pemphigoid (BP) and melanoma is yet to be investigated. We aimed to assess assess the bidirectional association between BP and melanoma and to delineate the epidemiological features of patients with both diagnoses. A population-based cohort study was performed comparing BP patients (n = 3924) with age-, sex- and ethnicity-matched control subjects (n = 19,280) with regard to incident cases of melanoma. A case–control design was additionally adopted to estimate the risk of BP in individuals with a preexisting diagnosis of melanoma. The prevalence of preexisting melanoma was higher in patients with BP than in control subjects (1.5% vs. 1.0%, respectively; P = 0.004). A history of melanoma confers a 50% increase in the risk of subsequent BP (OR 1.53; 95% CI 1.14–2.06). This risk was higher among males (OR 1.66; 95% CI 1.09–2.54) and individuals older than 80 years (OR 1.63; 95% CI 1.11–2.38), and persisted after adjustment for multiple putative confounders including PD-1/PDL-1 antagonists (adjusted OR 1.53; 95% CI 1.14–2.06). Conversely, the risk of melanoma among patients with BP was slightly elevated, but did not reach the level of statistical significance (adjusted HR 1.13; 95% CI 0.73–1.74). Patients with a dual diagnosis of BP and melanoma were older at the onset of BP and had lower body mass index. A history of melanoma is associated with a 50% increase in the incidence of subsequent BP. Physicians managing patients with both conditions should be aware of this association. Further research is warranted to reveal the underlying mechanism of these findings.

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Recurrence Risk After Organ Transplantation in Patients with a History of Hodgkin Disease or Non-Hodgkin Lymphoma

Transplantation Journal ◽

10.1097/01.tp.0000140845.10630.4f ◽

2004 ◽

Vol 78 (7) ◽

pp. 972-977 ◽

Cited By ~ 14

Author(s):

Jennifer Trofe ◽

Joseph F. Buell ◽

E Steve Woodle ◽

Thomas M. Beebe ◽

Michael J. Hanaway ◽

...

Keyword(s):

Hodgkin Lymphoma ◽

Organ Transplantation ◽

Recurrence Risk ◽

Hodgkin Disease ◽

Non Hodgkin Lymphoma ◽

History Of

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Identification and Prevention of Antiepileptic Drug Noncompliance: The Collaborative Use of State-Supplied Pharmaceutical Data

ISRN Pediatrics ◽

10.1155/2014/734689 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Joseph C. Hodges ◽

Janet Treadwell ◽

Amy D. Malphrus ◽

Xuan G. Tran ◽

Angelo P. Giardino

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Medication Compliance ◽

Statistical Significance ◽

Seizure Disorder ◽

Secondary Diagnosis ◽

Careful Monitoring ◽

Multivariate Statistical ◽

Increased Risk ◽

Epileptic Patients

Background. Antiepileptic drugs (AEDs) noncompliance is associated with increased risk of seizures and morbidity in seizure disorder patients. Objective. To identify risk factors that correlated to higher levels of morbidity, measured by emergency room (ER) utilization by seizure disorder members taking AED. Methods. Patients with primary or secondary diagnosis of seizures, convulsions, and/or epilepsy and prescribed AEDs during an 11-month period were included in the study. Variables were analyzed using multivariate statistical analysis including logistic regression. Results. The study identified 201 members. No statistical significance (NS) between age, gender, number of tablets, type of drug, or other risk factors was associated with increased mortality. Statistical significance resulted with medication compliance review of 0–14 days, 15–60 days, and 61+ days between refills. 68% of patients with ER visit had noncompliance refill between 0 and 14 days compared to 52% of patients in non-ER group (P=0.04). Contrastingly, 15% of ER group had refills within 15–60 days compared with 33% of non-ER group (P=0.01). There was NS difference between two groups when noncompliance was greater than 60 days (P=0.66). Conclusions. The study suggests that careful monitoring of pharmaceutical refill information could be used to identify AED noncompliance in epileptic patients.

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History of kidney stones and risk of chronic kidney disease: a meta-analysis

PeerJ ◽

10.7717/peerj.2907 ◽

2017 ◽

Vol 5 ◽

pp. e2907 ◽

Cited By ~ 9

Author(s):

Weifeng Shang ◽

Lixi Li ◽

Yali Ren ◽

Qiangqiang Ge ◽

Ming Ku ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Kidney Stones ◽

Meta Analysis ◽

Positive Association ◽

Significant Heterogeneity ◽

Adjusted Risk ◽

Increased Risk ◽

Subgroup Analyses ◽

History Of

Background Although the relationship between a history of kidney stones and chronic kidney disease (CKD) has been explored in many studies, it is still far from being well understood. Thus, we conducted a meta-analysis of studies comparing rates of CKD in patients with a history of kidney stones. Methods PubMed, EMBASE, and the reference lists of relevant articles were searched to identify observational studies related to the topic. A random-effects model was used to combine the study-specific risk estimates. We explored the potential heterogeneity by subgroup analyses and meta-regression analyses. Results Seven studies were included in this meta-analysis. Pooled results suggested that a history of kidney stones was associated with an increased adjusted risk estimate for CKD [risk ratio (RR), 1.47 95% confidence interval (CI) [1.23–1.76])], with significant heterogeneity among these studies (I2 = 93.6%, P < 0.001). The observed positive association was observed in most of the subgroup analyses, whereas the association was not significant among studies from Asian countries, the mean age ≥50 years and male patients. Conclusion A history of kidney stones is associated with increased risk of CKD. Future investigations are encouraged to reveal the underlying mechanisms in the connection between kidney stones and CKD, which may point the way to more effective preventive and therapeutic measures.

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Is congenital bony stenosis of the cervical spine associated with lumbar spine stenosis? An anatomical study of 1072 human cadaveric specimens

Journal of Neurosurgery Spine ◽

10.3171/2012.3.spine111080 ◽

2012 ◽

Vol 17 (1) ◽

pp. 24-29 ◽

Cited By ~ 13

Author(s):

Navkirat S. Bajwa ◽

Jason O. Toy ◽

Ernest Y. Young ◽

Nicholas U. Ahn

Keyword(s):

Logistic Regression ◽

Cervical Spine ◽

Lumbar Spine ◽

Linear Regression Analysis ◽

Large Population ◽

Positive Association ◽

Anatomical Study ◽

Lumbar Stenosis ◽

Increased Risk ◽

Tandem Stenosis

Object Congenital cervical and lumbar stenosis occurs when the bony anatomy of the spinal canal is smaller than expected, predisposing an individual to symptomatic neural compression. While tandem stenosis is known to occur in 5%–25% of individuals, it is not known whether this relationship is due to an increased risk of degenerative disease in these individuals or whether this finding is due to the tandem presence of a congenitally small cervical and lumbar canal. The purpose of the present study was to determine if the presence of congenital cervical stenosis is associated with congenital lumbar stenosis. Methods One thousand seventy-two adult skeletal specimens from the Hamann-Todd Collection in the Cleveland Museum of Natural History were selected. The canal area at each level was calculated using a formula that was verified by computerized measurements. Values that were 2 standard deviations below the mean were considered to represent congenitally stenotic regions. Linear regression analysis was used to determine the association between the sum of canal areas at all levels in the cervical and lumbar spine. Logistic regression was used to calculate odds ratios for congenital stenosis in one area if congenital stenosis was present in the other. Results A positive association was found between the additive area of all cervical (that is, the sum of C3–7) and lumbar (that is, the sum of L1–5) levels (p < 0.01). A positive association was also found between the number of cervical and lumbar levels affected by congenital stenosis (p < 0.01). Logistic regression also demonstrated a significant association between congenital stenosis in the cervical and lumbar spine, with an odds ratio of 0.2 (p < 0.05). Conclusions Based on the authors' findings in a large population of adult skeletal specimens, it appears that congenital stenosis of the cervical spine is associated with congenital stenosis of the lumbar spine. Thus, the presence of tandem stenosis appears to be, at least in part, related to the tandem presence of a congenitally small cervical and lumbar canal.

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