Risk of Second Malignancy After Non-Hodgkin's Lymphoma: A British Cohort Study

2006 ◽  
Vol 24 (10) ◽  
pp. 1568-1574 ◽  
Author(s):  
Nadejda Y. Mudie ◽  
Anthony J. Swerdlow ◽  
Craig D. Higgins ◽  
Paul Smith ◽  
Zongkai Qiao ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Second Malignancy ◽  
Relative Risks ◽  
Non Hodgkin’S Lymphoma ◽  
Increased Risk ◽  
Non Hodgkin's Lymphoma ◽  
British Cohort Study ◽  
Drug Treatments

Purpose To assess long-term site-specific risks of second malignancy following non-Hodgkin's lymphoma (NHL) in relation to treatment and demographic factors. Patients and Methods A cohort of 2,456 patients with NHL who were first treated from 1973 to 2000 and were younger than 60 years from centers in the British National Lymphoma Investigation were observed, and occurrences of second malignancy was compared with expectations based on general population cancer rates in England and Wales. Results In total, 123 second malignancies occurred. Relative risks (RRs) were significantly elevated for all malignancies combined (RR = 1.3; 95% CI, 1.1 to 1.6) and for leukemia (RR = 8.8; 95% CI, 5.1 to 14.1) and lung cancer (RR = 1.6; 95% CI, 1.1 to 2.3). RRs of malignancy overall diminished significantly with increasing age at first treatment. Leukemia risk was significantly increased after chemotherapy (RR = 10.5; 95% CI, 5.0 to 19.3) and mixed-modality treatment (RR = 13.0; 95% CI, 5.2 to 26.7). Relative risks of lung (RR = 1.9; 95% CI, 1.1 to 3.1) and colorectal (RR = 2.1; 95% CI, 1.1 to 3.6) cancers were significantly raised following chemotherapy. Conclusion NHL patients are at elevated risk of developing second malignancy, particularly leukemia and lung cancer. The relative risk is greater with patients who are younger at first treatment. Chemotherapy predisposes patients toan increased risk of leukemia, and possibly lung and colorectal cancers. The role of specific drug treatments in the etiology of solid cancers after NHL deserves further investigation.

Methylenetetrahydrofolate Reductase and Methionine Synthase Polymorphism and Risk of Non-Hodgkin’s Lymphoma.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4691-4691
Author(s):  
Hee Nam ◽  
Yeo-Kyeoung Kim ◽  
Il-Kwon Lee ◽  
Deok-Hwan Yang ◽  
Kyeong-Soo Park ◽  
...  
Keyword(s):  
B Cell ◽  
Hodgkin’S Lymphoma ◽  
Methylenetetrahydrofolate Reductase ◽  
Methionine Synthase ◽  
Hodgkin's Lymphoma ◽  
B Cell Lymphomas ◽  
Mthfr Polymorphism ◽  
Non Hodgkin’S Lymphoma ◽  
Increased Risk ◽  
Non Hodgkin's Lymphoma

Abstract Methylenetetrahydrofolate reductase (MTHFR) and methionine synthase (MTR) are key enzymes in folate metabolism, which is essential for DNA methylation and synthesis. It is known that polymorphisms in its genes have been associated with some forms of cancer including lymphoma. Previous studies have shown MTHFR 677TT was associated with decreased risk of non-Hodgkin’s lymphoma(NHL). However, recent two reports have shown MTHFR 677TT was associated with increased risk. To evaluate the association between the MTHFR C677T and MTR A2756G polymorphisms and risk of non-Hodgkin’s lymphoma, large-scale population-based case-control study was conducted in Chonnam University Hwasun Hospital between March 1997 and June 2005. Three hundreds sixty-five patients with histologically comfirmed lymphoma and 1,162 controls were evaluated. Genotyping was done using PCR-RFLP. The cases consisted of 203 diffuse large B-cell lymphomas(DLBCL), 77 T-cell lymphomas, 62 other B-cell lymphomas, and 23 unclassifiable lymphomas. The MTHFR 677CT and 677TT genotypes were inversely associated with NHL and DLBCL, respectively. Using subjects with the MTHFR 677CC as reference group, the odds ratio of MTHFR 677CT and 677TT were (0.70, 95% CI 0.54–0.90) and (0.46, 95% CI 0.32–0.68) for NHL. The association was more evident for DLBCL (OR 0.56, 95% CI 0.40–0.78 for 677CT; OR 0.40, 95% CI 0.24–0.65 for 677TT). Dose-response effect was evident for the MTHFR T-allele (p < 0.01). There was no significant association of MTR A2756G with NHL. These results suggest that the MTHFR polymorphism may play an important role in the pathogenesis of NHL, particularly DLBCL.

Tonsil Lymphoma Presenting As Tonsillitis After Bone Marrow Transplantation

1995 ◽  
Vol 112 (4) ◽  
pp. 544-548 ◽  
Author(s):  
Seth A. Yellin ◽  
Michael H. Weiss ◽  
Dennis H. Kraus ◽  
Esperanza B. Papadopoulos
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Medical Therapy ◽  
Marrow Transplantation ◽  
Hodgkin’S Lymphoma ◽  
Cervical Lymphadenopathy ◽  
Hodgkin's Lymphoma ◽  
Non Hodgkin’S Lymphoma ◽  
Increased Risk ◽  
Non Hodgkin's Lymphoma

Bone marrow transplantation for the treatment of leukemia is increasingly successful in rendering patients disease free. However, it has become evident that the associated severe immunosuppression predisposes this population to an increased risk for other neoplastic disorders. We report on six patients in whom non-Hodgkin's lymphoma of the tonsillar region developed within 5 months after T-cell-depleted bone marrow transplantation for the treatment of leukemia at Memorial Sloan-Kettering Cancer Center from October 1990 to October 1992. These patients initially had what appeared to be infectious exudative pharyngitis/tonsillitis; however, they did not improve with medical therapy. Because of the persistence of pharyngitis/tonsillitis in association with cervical lymphadenopathy and odynophagia, the patients underwent definitive biopsy in the form of tonsillectomy, cervical lymph node biopsy, or both. Histopathologic review revealed non-Hodgkin's lymphoma. An association with Epstein-Barr virus has been noted in five of these patients. This article is aimed at alerting the clinician to consider the diagnosis of lymphoma in a patient with persistent pharyngitis/tonsillitis despite adequate medical therapy after bone marrow transplantation.

Obesity and the Risk of Non-Hodgkin's Lymphoma – A Meta-Analysis Involving More Than 40,000 Cases

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 5089-5089
Author(s):  
Nishant Tageja ◽  
Ivo Ditah ◽  
Zartash Gul
Keyword(s):  
Body Weight ◽  
Hodgkin’S Lymphoma ◽  
Meta Analysis ◽  
Epidemiological Studies ◽  
Hodgkin's Lymphoma ◽  
Inclusion Criteria ◽  
Case Control Studies ◽  
Non Hodgkin’S Lymphoma ◽  
Increased Risk ◽  
Non Hodgkin's Lymphoma

Abstract Abstract 5089 Background – Obesity is linked with altered immune function and chronic inflammatory response; multiple studies have related autoimmune and chronic inflammatory processes with an increased risk of non-Hodgkin's lymphoma. However, epidemiological studies on the relation between excess body weight and risk of non-Hodgkin's lymphoma have yielded inconsistent results. The objective of this study is to examine the relationship between obesity, as measured by body mass index (BMI), and risk of non-Hodgkin's lymphoma in a meta-analysis of epidemiological studies. Methods – We performed a comprehensive search of MEDLINE, EMBASE and CINAHL databases for studies on BMI and non-Hodgkin's lymphoma that were published from 1966 to June 2010. Search terms included body mass index, BMI, or obesity combined with lymphoma. The reference lists of identified articles were manually reviewed to identify additional papers. Key Inclusion Criteria - cohort or case–control studies reporting NHL incidence or mortality as an outcome, BMI (body weight in kilograms divided by the square of height in meters) as the exposure of interest, and relative risks (RRs) or odds ratios with their 95% confidence intervals (CIs) as the outcome measures. Data Extraction and Statistical analysis - Two reviewers independently extracted study information and data. Where multiple outcome measures were reported, the most adjusted for was used. Before analysis, all studies were tested for publication bias using the Begg's and Egger's test. Pooled RRs with 95% confidence intervals (CI) were calculated using the random-effects meta-analysis model if heterogeneity was present; otherwise, the fixed-effects model was used. All statistical analyses were performed using Stata software, version 9.0 (Stata-Corp, College Station, TX). Results – Twenty-five studies (17 cohort and 8 case-control studies) with 40,279 participants met the inclusion criteria. Compared to individuals with BMI < 25.0 kg/m2, the summary RRs for non-Hodgkin's lymphoma were 1.05 (95% CI, 1.01–1.10) and 1.15 (95% CI, 1.06–1.25) for overweight (BMI between 25 and 30 kg/m2) and obese (BMI > 30.0 kg/m2) individuals respectively. By histological subtypes, obesity was associated with a statistically significant increase risk of diffuse large B-cell lymphoma (RR, 1.23; 95% CI, 1.11–1.37; n = 13 studies) but not with follicular lymphoma (RR, 1.11; 95% CI, 0.97–1.27; n = 13 studies) or small lymphocytic lymphoma/chronic lymphocytic leukemia (RR, 0.95; 95% CI, 0.84–1.07; n = 8 studies). There was no evidence of publication bias. Conclusions – The results of this meta-analysis suggest that compared to normal weight individuals, overweight and obese individuals have a 5% and 15% increased risk of non-Hodgkin's lymphoma respectively. Though statistically significant, these proportions are relatively small and perhaps may be accounted for by residual confounding. Larger, long term prospective studies will be needed to conclusively define the magnitude and strength of the association between body weight and non-Hodgkin lymphoma. Disclosures: Off Label Use: High dose Melphalan is not FDA approved as conditioning regimen for Autologous stem cell transplant.

Detection of Chromosome Abnormalities Pre–High-Dose Treatment in Patients Developing Therapy-Related Myelodysplasia and Secondary Acute Myelogenous Leukemia After Treatment for Non-Hodgkin’s Lymphoma

2001 ◽  
Vol 19 (9) ◽  
pp. 2472-2481 ◽  
Author(s):  
Debra M. Lillington ◽  
Ivana N.M. Micallef ◽  
Emily Carpenter ◽  
Michael J. Neat ◽  
John A.L. Amess ◽  
...  
Keyword(s):  
Acute Myelogenous Leukemia ◽  
Hodgkin’S Lymphoma ◽  
Myelogenous Leukemia ◽  
Hodgkin's Lymphoma ◽  
High Dose ◽  
Non Hodgkin’S Lymphoma ◽  
Increased Risk ◽  
Non Hodgkin's Lymphoma ◽  
Acute Myelogenous ◽  
Abnormal Cells

PURPOSE: To assess whether pre–high-dose therapy (HDT)–related factors play a critical role in the development of therapy-related myelodysplasia (tMDS) or secondary acute myelogenous leukemia (sAML). PATIENTS AND METHODS: Twenty-nine of 230 patients with a primary diagnosis of non-Hodgkin’s lymphoma (NHL) developed tMDS/sAML after HDT comprising cyclophosphamide and total-body irradiation (TBI) supported by autologous hematopoietic progenitor cells. G-banding and fluorescence in-situ hybridization (FISH) were used to detect clonal cytogenetic abnormalities. RESULTS: The majority of patients showed complex karyotypes at diagnosis of tMDS/sAML containing, in particular, complete or partial loss of chromosomes 5 and/or 7. Using single locus–specific FISH probes, significant levels of clonally abnormal cells were found before HDT in 20 of 20 tMDS/sAML patients screened, compared with three of 24 patients screened who currently have not developed tMDS/sAML, at a median follow-up of 5.9 years after HDT. CONCLUSION: Prior cytotoxic therapy may play an important etiologic role and may predispose to the development of tMDS/sAML. Using a triple FISH assay designed to detect loss of chromosomal material from 5q31, 7q22, or 13q14, significant levels of abnormal cells can be detected before HDT and may predict which patients are at increased risk of developing secondary disease. Further prospective evaluation of this FISH assay is warranted to determine its predictive power in this setting.

scholarly journals Frequency of Use and Standards of Care for the Use of Azathioprine and 6-Mercaptopurine in Treatment of Inflammatory Bowel Disease: A Systematic Review of the Literature and a Survey of Canadian Gastroenterologists

2001 ◽  
Vol 15 (1) ◽  
pp. 21-28 ◽  
Author(s):  
Thomas M Wallace ◽  
Sander JO Veldhuyzen van Zanten
Keyword(s):  
Inflammatory Bowel Disease ◽  
Adverse Effects ◽  
Bowel Disease ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Non Hodgkin’S Lymphoma ◽  
Frequency Of Use ◽  
Increased Risk ◽  
Non Hodgkin's Lymphoma ◽  
Inflammatory Bowel

OBJECTIVE: To identify the frequency of use and appropriate monitoring guidelines for the adverse effects of azathioprine and 6-mercaptopurine (6-MP) in the therapy of patients with inflammatory bowel disease (IBD).METHODS: Surveys were sent to all physician members of the Canadian Association of Gastroenterology. Physicians were asked to describe their monitoring practices for IBD patients receiving azathioprine or 6-MP. A systematic literature search was also performed using MEDLINE for articles published in English between 1966 and 1999 using the MeSH terms 'azathioprine', '6-mercaptopurine', 'inflammatory bowel disease' and 'drug monitoring'.RESULTS: Azathioprine and 6-MP were used to treat an average of 7% of patients - a surprisingly low number given the proven efficacy of these agents. All respondents reported monitoring complete blood counts (CBC), while liver enzyme and pancreatic enzyme levels were monitored by 62% and 29% of respondents, respectively. The most commonly reported initial CBC testing frequencies were weekly (42%), monthly (26%) and biweekly (23%). From the literature, it was determined that severe leukopenia (less than 2.10 g/L) occurs in less than 2% of cases and is sometimes associated with serious outcomes, including death. Most cases of severe leukopenia occurred abruptly, early in treatment. Other reported adverse effects and incidences were pancreatitis (3% to 5%), hepatotoxicity (less than 1%) and hypersensitivity (2% to 3%). Data concerning an increased risk of non-Hodgkin's lymphoma were equivocal.CONCLUSIONS: Use of azathioprine or 6-MP is low in pa 6, 8 and 12, with subsequent testing every eight weeks for the duration of azathioprine or 6-MP treatment. The evidence in support of pancreatic and hepatic monitoring is weak. The risk of non-Hodgkin's lymphoma is likely low.

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