Incidence and time trends for lymphomas, leukemias and myelomas: hypothesis generation. Working Group on the Epidemiology of Hematolymphopoietic Malignancies in Italy

Analysis of clinical characteristics and prognostic factors of multiple myeloma: a retrospective single-center study of 787 cases

OBJECTIVE

This study aims to explore the clinical features of multiple myeloma (MM) and the influence of various prognostic factors on survival.

METHODS

A retrospective analysis, consisting of clinical characteristics analysis and laboratory examinations, was performed on 787 MM patients. Clinical and laboratory parameters were analyzed by multivariate process and compared across different groups.

RESULTS

Of the 787 patients enrolled (median age, 61 years old, range 29-89 years old), 491 (62.4%) were male. Two most common complaints were bone pain (51.2%) and fatigue (48.0%). Anemia (hemoglobin (Hb) ≤100 g/L in female, Hb ≤110 g/L in male) was present initially in 69.4% patients. IgG was the most common type (46.6%). 52.2% of the patients were diagnosed on stage IIIA according to Durie-Salmon (D-S) system, 44.6% are on stage III according to International Staging System (ISS). Multivariate analysis suggested that age, serum calcium, LDH, percentage of abnormal plasma cells in bone marrow were all independent prognostic factors for OS.

CONCLUSION

The MM patients in China are relatively younger, have higher rate on stage III according to D-S system. Older age, high serum calcium, high LDH, high percentage of abnormal plasma cells in bone marrow were highly related to poor prognosis.

Investigation of spatio-temporal cancer clusters using residential histories in a case-control study of non-Hodgkin lymphoma in the United States

BACKGROUND

Non-Hodgkin lymphoma (NHL) is an enigmatic disease with few known risk factors. Spatio-temporal epidemiologic analyses have the potential to reveal patterns that may give clues to new risk factors worthy of investigation. We sought to investigate clusters of NHL through space and time based on life course residential histories.

METHODS

We used residential histories from a population-based NHL case-control study of 1300 cases and 1044 controls with recruitment centers in Iowa, Detroit, Seattle, and Los Angeles, and diagnosed in 1998-2000. Novel methods for cluster detection allowing for residential mobility, called Q-statistics, were used to quantify nearest neighbor relationships through space and time over the life course to identify cancer clusters. Analyses were performed on all cases together and on two subgroups of NHL: Diffuse large B-cell lymphoma and follicular lymphoma. These more homogenous subgroups of cases might have a more common etiology that could potentially be detected in cluster analysis. Based on simulation studies designed to help account for multiple testing across space and through time, we required at least four significant cases nearby one another to declare a region a potential cluster, along with confirmatory analyses using spatial-only scanning windows (SaTScan).

RESULTS

Evidence of a small cluster in southeastern Oakland County, MI was suggested using residences 10-18 years prior to diagnosis, and confirmed by SaTScan in a time-slice analysis 20 years prior to diagnosis, when all cases were included in the analysis. Consistent evidence of clusters was not seen in the two histologic subgroups.

CONCLUSIONS

Suggestive evidence of a small space-time cluster in southeastern Oakland County, MI was detected in this NHL case-control study in the USA.

Liver involvement in multiple myeloma: a hospital based retrospective study

OBJECTIVE

This study was to assess liver involvement in multiple myeloma with the aid of liver function tests.

MATERIALS AND METHODS

A hospital based retrospective study was undertaken using data retrieved of multiple myeloma from the register maintained in the Department of Biochemistry of the Manipal Teaching Hospital, Pokhara, Nepal between 1st January, 2007 and 28th February, 2012. We collected biomarkers of liver profiles including bilirubin (Total, Direct and Indirect), total protein, albumin, AG ratio, SGOT, SGPT, ALP, γGT, LDH, ferritin, renal profile and hematological profile. Descriptive statistics and testing of hypothesis were used for the analysis using EPI INFO and SPSS 16 software.

RESULTS

Out of 37 cases of multiple myeloma, serum level of AST, ALT, ALP, γGT and LDH were increased above the cut-off point in 22 (59.5%), 24 (64.86%), 13 (35.13%), 9 (24.3%) and 11 (29.7%) respectively. The mean values of AST (65.5±28.18 U/L), ALT (68.37±29.74 U/L), ALP (328.0±148.4 U/L), γGT (44.5±29.6 U/L) and LDH (361.7±116.5 U/L), total protein (9.79±1.03 gm/ dl) were significantly increased when compared with controls. In contrast, albumin (3.68±0.43 gm/dl) and the AG ratio (0.62±0.15) were significantly decreased. Similarly, anemia, hyperuricemia, azotemia, hypercalcaemia and Bence Jones proteinuria were found in 30 (78.9%), 27 (71.1%), 19 (51.5%), 15 (39.5%) and 16 (42.1%) respectively, in cases of multiple myeloma.

CONCLUSIONS

While clinical manifestation of liver disease among the multiple myeloma was not common, abnormalities in liver function were characteristic.

Vertebra plana with paraplegia in a middle-aged woman caused by B-cell lymphoma: a case report

Vertebra plana is a rare presentation of spinal lymphoma. When radiological picture of a patient of paraplegia presents vertebra plana, diagnosis becomes a challenge. In a developing country like India tuberculosis should also be a consideration. Even histology sometimes fails to conclude a diagnosis. Immunohistochemistry is of immense help in clinching a diagnosis.

Occupation and multiple myeloma: an occupation and industry analysis

BACKGROUND

Multiple myeloma (MM) is an incurable plasma cell malignancy with a poorly understood etiology. The purpose of our research was to examine the relationships between lifetime occupations and MM in a relatively large case-control study.

METHODS

MM cases (n = 180) were identified through cancer registries in the Seattle-Puget Sound area and Detroit. Population-based controls (n = 481) were identified using random digit dialing and Medicare and Medicaid Services files. In-person interviews were conducted to ascertain occupational histories. Standard occupational classification (SOC) and standard industrial classification (SIC) codes were assigned to each job held by each participant. Unconditional logistic regression was used to generate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between MM and having ever worked in each occupation/industry and according to duration of employment in an occupation/industry.

RESULTS

The risk of MM was associated with several manufacturing occupations and industries, including machine operators and tenders, not elsewhere classified (SOC 76) (OR = 1.8, CI = 1.0-3.3); textile, apparel, and furnishing machine operators and tenders (SOC 765) (OR = 6.0, CI = 1.7-21); and machinery manufacturing, except electrical (SIC 35) (OR = 3.3, CI = 1.7-6.7). Several service occupations and industries, such as food and beverage preparation (SOC 521) (OR = 2.0, CI = 1.1-3.8), were also associated with MM. One occupation that has been associated with MM in several previous studies, painters, paperhangers, and plasterers (SOC 644) was associated with a non-significantly elevated risk (OR = 3.6, CI = 0.7-19).

CONCLUSIONS

We found associations between the risk of MM and employment in several manufacturing and service-related occupations and industries.

Epidemiology of multiple myeloma in Taiwan

BACKGROUND

The incidence of multiple myeloma (MM) is lower in Asia than in western countries. However, no data are available on descriptive epidemiology of MM in Chinese.

METHODS

From 1979 to 2003, 3602 MM patients were registered in the Taiwan National Cancer Registry. The annual incidence and mortality were calculated and age-standardized to the world standard population in the year 2000. Age-period-cohort effects on incidence were analyzed. The salient clinical data of 526 MM patients in a single institute were also investigated.

RESULTS

From 1979 to 2003, the average age-adjusted incidence per 100,000 population was 0.75. The incidence increased with age to a peak of 5.2 in those aged 75-79 years. In addition to age, remarkable period and birth cohort effects were found to contribute to increased incidence of MM. The age-adjusted mortality also increased, which accounted for an average of 0.59 per 100,000 deaths; however, the fatality rate was steady at 80%. Clinical and laboratory characteristics and treatment outcomes of the 526 MM patients were similar to those reported elsewhere. Remarkably, extramedullary myeloma (extra-MM) at diagnosis was more common in patients younger than 55 years of age than in others (43% vs 13%, P < .001).

CONCLUSIONS

Incidence of MM in Taiwan has dramatically increased in recent years and is associated with a birth-cohort effect. There are no apparent differences in treatment outcome between MM patients in Taiwan and in other countries. However, prevalence of extra-MM is higher in patients younger than 55 years of age.

Distinct B-cell and T-cell lymphoproliferative disease prevalence among dog breeds indicates heritable risk

Immunophenotypes in lymphoproliferative diseases (LPD) are prognostically significant, yet causative factors for these conditions, and specifically those associated with heritable risk, remain elusive. The full spectrum of LPD seen in humans occurs in dogs, but the incidence and lifetime risk of naturally occurring LPD differs among dog breeds. Taking advantage of the limited genetic heterogeneity that exists within dog breeds, we tested the hypothesis that the prevalence of LPD immunophenotypes would differ among different breeds. The sample population included 1,263 dogs representing 87 breeds. Immunophenotype was determined by the presence of clonal rearrangements of immunoglobulin heavy chain or T-cell receptor gamma chain. The probability of observing the number of B-cell or T-cell tumors in a particular breed or breed group was compared with three reference populations. Significance was computed using chi2 test, and logistic regression was used to confirm binomial predictions. The data show that, among 87 breeds tested, 15 showed significant differences from the prevalence of LPD immunophenotypes seen across the dog population as a whole. More significantly, elevated risk for T-cell LPD seems to have arisen ancestrally and is retained in related breed groups, whereas increased risk for B-cell disease may stem from different risk factors, or combinations of risk factors, arising during the process of breed derivation and selection. The data show that domestic dogs provide a unique and valuable resource to define factors that mediate risk as well as genes involved in the initiation of B-cell and T-cell LPD.

Metabolic enzyme polymorphisms and susceptibility to acute leukemia in adults

Genetic approaches to understanding the etiology of the acute leukemias are beginning to deliver meaningful insights. Polymorphic variants in xenobiotic metabolizer loci were a natural starting point to study the relevance of these changes. The finding that glutathione S-transferase (GST) T1 null variants increase leukemia risk has implicated oxidative stress in hematopoietic stem cells as an important etiological factor in acute myeloid leukemia (AML). The importance of these enzyme systems in handling specific substrates has also been confirmed by the finding of an increased risk of therapy-related leukemia in individuals with underactive variants of GSTP1 who have been exposed to a chemotherapeutic agent metabolized by this enzyme. Benzene is a well-recognized leukemogen, and genetic variants in its metabolic pathway can modulate the risk of leukemia following exposure. In particular, underactive variants of the NAD(P)H:quinone oxidoreductase 1 gene (NQO1) seem to increase the risk of AML. Other enzymes within the pathway are proving more difficult to study because of the absence of variants that significantly affect the biological activity of the enzyme under study. No effect of the myeloperoxidase (MPO) gene variants in altering the risk of AML has been seen in our studies. Another pathway recently shown to be important in determining leukemia risk is folic acid metabolism, particularly important in predisposition to acute lymphocytic leukemia (ALL). Polymorphic variants of the methylenetetrahydrofolate reductase gene (MTHFR) which impair its activity have been shown to be associated with a protective effect. This is thought to be due to an increased availability of nucleotide precursors for incorporation into DNA. This finding implicates misincorporation of uracil into DNA as an important mechanism of leukemic change in lymphoid precursors. Future studies will extend these observations but will require biological material collected from large well-controlled epidemiological studies. The technological challenges imposed by the high throughput of samples required by these studies are currently being addressed.

Identification of the neoplastically transformed cells in Marek's disease herpesvirus-induced lymphomas: recognition by the monoclonal antibody AV37

Understanding the interactions between herpesviruses and their host cells and also the interactions between neoplastically transformed cells and the host immune system is fundamental to understanding the mechanisms of herpesvirus oncology. However, this has been difficult as no animal models of herpesvirus-induced oncogenesis in the natural host exist in which neoplastically transformed cells are also definitively identified and may be studied in vivo. Marek's disease (MD) herpesvirus (MDV) of poultry, although a recognized natural oncogenic virus causing T-cell lymphomas, is no exception. In this work, we identify for the first time the neoplastically transformed cells in MD as the CD4(+) major histocompatibility complex (MHC) class I(hi), MHC class II(hi), interleukin-2 receptor alpha-chain-positive, CD28(lo/-), phosphoprotein 38-negative (pp38(-)), glycoprotein B-negative (gB(-)), alphabeta T-cell-receptor-positive (TCR(+)) cells which uniquely overexpress a novel host-encoded extracellular antigen that is also expressed by MDV-transformed cell lines and recognized by the monoclonal antibody (MAb) AV37. Normal uninfected leukocytes and MD lymphoma cells were isolated directly ex vivo and examined by flow cytometry with MAb recognizing AV37, known leukocyte antigens, and MDV antigens pp38 and gB. CD28 mRNA was examined by PCR. Cell cycle distribution and in vitro survival were compared for each lymphoma cell population. We demonstrate for the first time that the antigen recognized by AV37 is expressed at very low levels by small minorities of uninfected leukocytes, whereas particular MD lymphoma cells uniquely express extremely high levels of the AV37 antigen; the AV37(hi) MD lymphoma cells fulfill the accepted criteria for neoplastic transformation in vivo (protection from cell death despite hyperproliferation, presence in all MD lymphomas, and not supportive of MDV production); the lymphoma environment is essential for AV37(+) MD lymphoma cell survival; pp38 is an antigen expressed during MDV-productive infection and is not expressed by neoplastically transformed cells in vivo; AV37(+) MD lymphoma cells have the putative immune evasion mechanism of CD28 down-regulation; AV37(hi) peripheral blood leukocytes appear early after MDV infection in both MD-resistant and -susceptible chickens; and analysis of TCR variable beta chain gene family expression suggests that MD lymphomas have polyclonal origins. Identification of the neoplastically transformed cells in MD facilitates a detailed understanding of MD pathogenesis and also improves the utility of MD as a general model for herpesvirus oncology.

Acquired immune deficiency syndrome and the increase in non-Hodgkin lymphoma incidence in New Jersey from 1979 to 1996

BACKGROUND

In New Jersey, the age-adjusted incidence rate of non-Hodgkin lymphoma (NHL) increased more than a third from 1979 to 1996, the largest increase among the major cancers.

METHODS

Data from a linkage of New Jersey's population-based cancer and acquired immune deficiency syndrome (AIDS) registries were used to obtain two sets of annual age specific incidence rates and estimated average annual percentage changes in the incidence rates, for each of five adult age groups within each gender, from Poisson regression models that 1) included all the NHL cases and 2) excluded the cases of AIDS-NHL.

RESULTS

During 1979-1996, of the NHL cases aged 15 years and older reported to the cancer registry, 687 (6%) of the 11,725 male cases and 139 (1%) of the 10,785 female cases were AIDS-NHL. The highest percentages of AIDS-NHL were in the younger age groups--15-29, 30-39, and 40-49 years. Among both men and women, average annual percentage increases in NHL occurred overall (3.1 and 3.0, respectively), and in each age group, ranging from 1.6 and 1.9, respectively, in the 50-59 years age group to 6.6 and 4.2, respectively, in the 30-39 years age group (P <<0.01). Excluding AIDS-NHL, the estimated average annual percentage increases in NHL were greatest in the 30-39 and the 60 years and older age groups among men, and these two age groups plus the 15-29 years age group among women, ranging between 2.4 and 2.9 (P < 0.05).

CONCLUSIONS

As elsewhere, factors in addition to AIDS are involved in the increasing incidence of NHL in New Jersey. Because diagnostic and classification changes probably do not explain the entire increase unrelated to AIDS, other risk factors are likely responsible. Public health interventions to reduce the incidence of NHL not related to AIDS are problematic until more is known about the causes of NHL.

Rising incidence of post-transplant lymphoproliferative disease in kidney transplant recipients

BACKGROUND

The purpose of this study was to determine whether the incidence of post-transplant lymphoproliferative disease (PTLD) has been increasing in renal transplant recipients in this centre.

METHODS

Prospectively gathered data were analysed to establish trends in the epidemiology of PTLD in 1537 patients.

RESULTS

Overall, PTLD occurred in 2.3 per cent of renal transplant recipients. An increase in its incidence coincided with the introduction of cyclosporin in the 1980s. However, there was a further increase in the incidence of PTLD in the 1990s when the only change in immunosuppressive policy was the abandonment of pretransplantation blood transfusion. The latter increase was particularly pronounced in patients with early-onset PTLD in whom it presented within 600 days after transplantation.

CONCLUSION

The incidence of PTLD has been increasing in renal transplant recipients. The recent increase appears to be independent of cyclosporin and may reflect the reduction in pretransplant blood transfusion. Changes in the incidence of PTLD may also mirror changes in the epidemiology of non-Hodgkin lymphoma in the general population.

Non-Hodgkin's lymphoma risk derived from exposure to organic solvents: a review of epidemiologic studies

The rate of non-Hodgkin's lymphomas (NHL) has increased around the world during the last decades. Apart from the role of the human immunodeficiency virus (HIV) infection in the development of NHL, exposure to chemical agents like phenoxyacetic pesticides, hair dyes, metal fumes and organic solvents are suspected to be involved. The present review evaluates the results of studies that directly or indirectly searched for an association between solvent exposure and NHL. The selected studies comprised those published from 1979 to 1997, designed to investigate risk factors for NHL, whether specifically looking for solvent exposure or for general risks in which solvent exposure could be included. In 25 of the 45 reviewed studies (55.5%), fifty-four statistically significant associations between NHL and solvent exposure related occupations or industries were reported. Statistical significance was more frequently shown in studies where solvent exposure was more accurately defined. In eighteen of such studies, 13 (72.2%) defined or suggested organic solvents as possible risk factors for NHL.