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Abstract
Sjögren's syndrome (SS) is characterised as keratoconjunctivitis sicca (dry eyes), xerostomia (dry mouth) commonly associated with salivary gland enlargement, and is referred to as Primary Sjögren's syndrome. It is known as Secondary Sjögren's syndrome when it occurs in patients, with connective tissue disease, such as rheumatoid arthritis, systemic lupus erythematosus, polyarthritis nodosa, polymyositis, and systemic sclerosis. SS has also been associated with chronic graft-versus-host disease after allogeneic bone marrow transplantation, human immunodeficiency syndrome (AIDS), hepatitis C infection (HCV), chronic biliary cirrhosis, neoplastic and myeloplastic syndromes, fibromyalgia, and chronic fatigue syndrome.
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Affiliation(s)
- Geza Balint
- 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Frankel Leó út 27-29, Budapest, 1023, Hungary
| | - W Watson Buchanan
- Department of Medicine, McMaster University, Hamilton, ON, L8P 1H6, Canada
| | - Colin A Kean
- Haldimand War Memorial Hospital, 400 Broad Street, Dunnville, ON, N1A 2P7, Canada
| | - Walter Kean
- Department of Medicine, McMaster University, Hamilton, ON, L8P 1H6, Canada.
- Haldimand War Memorial Hospital, 400 Broad Street, Dunnville, ON, N1A 2P7, Canada.
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Kolijn PM, Langerak AW. Immune dysregulation as a leading principle for lymphoma development in diverse immunological backgrounds. Immunol Lett 2023; 263:46-59. [PMID: 37774986 DOI: 10.1016/j.imlet.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/28/2023] [Accepted: 08/10/2023] [Indexed: 10/01/2023]
Abstract
Lymphoma is a heterogeneous group of malignancies arising from lymphocytes, which poses a significant challenge in terms of diagnosis and treatment due to its diverse subtypes and underlying mechanisms. This review aims to explore the shared and distinct features of various forms of lymphoma predisposing conditions, with a focus on genetic, immunological and molecular aspects. While diseases such as autoimmune disorders, inborn errors of immunity and iatrogenic immunodeficiencies are biologically and immunologically distinct, each of these diseases results in profound immune dysregulation and a predisposition to lymphoma development. Interestingly, the increased risk is often skewed towards a particular subtype of lymphoma. Patients with inborn errors of immunity in particular present with extreme forms of lymphoma predisposition, providing a unique opportunity to study the underlying mechanisms. External factors such as chronic infections and environmental exposures further modulate the risk of lymphoma development. Common features of conditions predisposing to lymphoma include: persistent inflammation, recurrent DNA damage or malfunctioning DNA repair, impaired tumor surveillance and viral clearance, and dysregulation of fundamental cellular processes such as activation, proliferation and apoptosis. Our growing understanding of the underlying mechanisms of lymphomagenesis provides opportunities for early detection, prevention and tailored treatment of lymphoma development.
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Affiliation(s)
- P Martijn Kolijn
- Laboratory Medical Immunology, Department of Immunology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Anton W Langerak
- Laboratory Medical Immunology, Department of Immunology, Erasmus Medical Center, Rotterdam, the Netherlands.
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Rashidi N, Arefi S, Sadri M, Delbandi AA. Effect of active vitamin D on proliferation, cell cycle and apoptosis in endometriotic stromal cells. Reprod Biomed Online 2023; 46:436-445. [PMID: 36588053 DOI: 10.1016/j.rbmo.2022.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/24/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
RESEARCH QUESTION What is the effect of vitamin D3 (1,25(OH)2D3) on proliferation, cell cycle and apoptosis of endometrial stromal cells (ESC) in endometriotic patients? DESIGN ESC isolated from 10 women with endometriosis and 10 healthy controls were treated with 1,25(OH)2D3. The proliferation of control endometrial stromal cells (CESC), eutopic endometrial stromal cells (EuESC) and ectopic endometrial stromal cells (EESC) was analysed 72 h after the treatment using methyl thiazolyl tetrazolium assay. Propidium iodide staining and flow cytometry were used to determine the cell cycle distribution in ESC. Annexin V/propidium iodide double staining was used to evaluate apoptosis in ESC. RESULTS In the presence of oestrogen, 1,25(OH)2D3 treatment inhibited the proliferation of ESC from all three origins (P = 0.009 for CESC, P = 0.005 for EuESC and P < 0.001 for EESC). The percentage of S phase cells in EESC was higher than in EuESC and CESC (P = 0.002 and P = 0.001, respectively). The percentage of S phase cells in EuESC was higher than in CESC (P = 0.005). The percentage of G1 phase cells in EESC was lower than that of EuESC and CESC (P = 0.003 and P = 0.002, respectively) and the percentage of G1 phase cells in EuESC was lower than that of CESC (P = 0.007). Moreover, 1,25(OH)2D3 inhibited cell cycle regardless of cell type (P = 0.002 in EESC, P = 0.001 in EuESC and P = 0.014 in CESC), but in the absence of oestrogen, inhibited cell cycle only in EuESC (P = 0.012). CONCLUSIONS Although 1,25(OH)2D3 increased apoptotic and necrotic cells and decreased live cells in the EuESC and EESC, it did not affect apoptosis in CESC and only increased necrotic cells. These findings indicate that 1,25(OH)2D3 potentially has a growth-inhibiting and pro-apoptotic effect on ESC from endometriotic patients.
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Affiliation(s)
- Nesa Rashidi
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Immunology Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Soheila Arefi
- Bahman Hospital Infertility Center, Tehran, Iran; Genetics and In Vitro Assisted Reproductive (GIVAR) Center, Erfan Hospital, Tehran, Iran
| | - Maryam Sadri
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Immunology Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Ali-Akbar Delbandi
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Immunology Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran.
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Radić M, Kolak E, Đogaš H, Gelemanović A, Bučan Nenadić D, Vučković M, Radić J. Vitamin D and Sjögren's Disease: Revealing the Connections-A Systematic Review and Meta-Analysis. Nutrients 2023; 15:nu15030497. [PMID: 36771203 PMCID: PMC9920259 DOI: 10.3390/nu15030497] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The aim of the present review was to summarize the current evidence about the impact of vitamin D deficiency on pathology and clinical manifestations of Sjögren's disease (SD). METHODS Databases PubMed, Web of Science, Scopus, and Cochrane library were searched for studies assessing the levels of vitamin D in SD patients using the following keywords: (vitamin D OR calciferol OR cholecalciferol OR 25-hydroxyvitamin D OR 25-hydroxycholecalciferol OR calcidiol OR calcitriol OR 1,25-dihydroxycholecalciferol) AND (Sjögren's Syndrome OR Sjögren's disease) accessed on 20 September 2022. Out of 248 retrieved studies, following the systematic review methodology and defined inclusion and exclusion criteria, 9 clinical studies were eligible to be included in the present review: 4 of them case-control, 4 cross-sectional, and 1 cohort study. RESULTS Nine studies totaling 670 SD patients and 857 healthy controls were eligible for meta-analysis with moderate to high methodological quality as determined by the Newcastle-Ottawa Quality Scale (NOS). According to the obtained results, a high prevalence of hypovitaminosis D was observed in SD patients when compared to healthy controls (95% CI -10.43, -2.39; p < 0.01). CONCLUSION Available evidence points to lower levels of vitamin D in patients with SD in comparison to healthy controls. However, further studies are necessary to understand the underlying mechanisms associated with the role of vitamin D in the development and disease severity of SD.
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Affiliation(s)
- Mislav Radić
- Internal Medicine Department, Rheumatology, Allergology, and Clinical Immunology Division, University Hospital of Split, 21000 Split, Croatia
- Department of Internal Medicine, School of Medicine, University of Split, 21000 Split, Croatia
- Correspondence:
| | - Ela Kolak
- Nutrition and Dietetics Department, University Hospital of Split, 21000 Split, Croatia
| | - Hana Đogaš
- Internal Medicine Department, Nephrology and Haemodialysis Division, University Hospital of Split, 21000 Split, Croatia
| | - Andrea Gelemanović
- Mediterranean Institute for Life Sciences (MedILS), 21000 Split, Croatia
| | - Dora Bučan Nenadić
- Nutrition and Dietetics Department, University Hospital of Split, 21000 Split, Croatia
| | - Marijana Vučković
- Internal Medicine Department, Nephrology and Haemodialysis Division, University Hospital of Split, 21000 Split, Croatia
| | - Josipa Radić
- Department of Internal Medicine, School of Medicine, University of Split, 21000 Split, Croatia
- Internal Medicine Department, Nephrology and Haemodialysis Division, University Hospital of Split, 21000 Split, Croatia
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Muñoz A, Grant WB. Vitamin D and Cancer: An Historical Overview of the Epidemiology and Mechanisms. Nutrients 2022; 14:nu14071448. [PMID: 35406059 PMCID: PMC9003337 DOI: 10.3390/nu14071448] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 02/07/2023] Open
Abstract
This is a narrative review of the evidence supporting vitamin D’s anticancer actions. The first section reviews the findings from ecological studies of cancer with respect to indices of solar radiation, which found a reduced risk of incidence and mortality for approximately 23 types of cancer. Meta-analyses of observational studies reported the inverse correlations of serum 25-hydroxyvitamin D [25(OH)D] with the incidence of 12 types of cancer. Case-control studies with a 25(OH)D concentration measured near the time of cancer diagnosis are stronger than nested case-control and cohort studies as long follow-up times reduce the correlations due to changes in 25(OH)D with time. There is no evidence that undiagnosed cancer reduces 25(OH)D concentrations unless the cancer is at a very advanced stage. Meta-analyses of cancer incidence with respect to dietary intake have had limited success due to the low amount of vitamin D in most diets. An analysis of 25(OH)D-cancer incidence rates suggests that achieving 80 ng/mL vs. 10 ng/mL would reduce cancer incidence rates by 70 ± 10%. Clinical trials have provided limited support for the UVB-vitamin D-cancer hypothesis due to poor design and execution. In recent decades, many experimental studies in cultured cells and animal models have described a wide range of anticancer effects of vitamin D compounds. This paper will review studies showing the inhibition of tumor cell proliferation, dedifferentiation, and invasion together with the sensitization to proapoptotic agents. Moreover, 1,25-(OH)2D3 and other vitamin D receptor agonists modulate the biology of several types of stromal cells such as fibroblasts, endothelial and immune cells in a way that interferes the apparition of metastases. In sum, the available mechanistic data support the global protective action of vitamin D against several important types of cancer.
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Affiliation(s)
- Alberto Muñoz
- Instituto de Investigaciones Biomédicas “Alberto Sols”, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, CIBERONC and IdiPAZ, 28029 Madrid, Spain;
| | - William B. Grant
- Sunlight, Nutrition and Health Research Center, P.O. Box 641603, San Francisco, CA 94164-1603, USA
- Correspondence: ; Tel.: +14-15-409-1980
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Ito Y, Honda A, Kurokawa M. Impact of vitamin D level at diagnosis and transplantation on the prognosis of hematological malignancy: a meta-analysis. Blood Adv 2021:bloodadvances. [PMID: 34496015 DOI: 10.1182/bloodadvances.2021004958] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022] Open
Abstract
Vitamin D deficiency impairs prognosis in many types of cancer; however, its significance in each subtype of hematological malignancies is unclear. In addition, data on the association between pretransplant vitamin D levels and outcomes of hematopoietic stem cell transplantation (HSCT) are inconsistent. This systematic review and meta-analysis aimed to elucidate the impact of vitamin D levels at diagnosis or pre-HSCT on the prognosis of hematological malignancies. Thirty articles and abstracts were extracted from PubMed, Embase, and Cochrane Library databases and conference proceedings. Fixed and random effect models were used to analyze primary outcomes: overall survival (OS) and progression-free survival (PFS). Lower vitamin D level was significantly associated with poorer OS and PFS in myeloid malignancies (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.06-1.82 and HR, 2.03; 95% CI, 1.23-3.32, respectively) and lymphoid malignancies (HR, 2.07; 95% CI, 1.79-2.40 and HR, 1.91; 95% CI, 1.61-2.25, respectively), as well as outcomes for several lymphoma subtypes individually. Furthermore, a lower pretransplant vitamin D level was associated with poorer OS in autologous and allogeneic HSCT (HR, 1.65; 95% CI, 1.04-2.61 and HR, 1.50; 95% CI, 1.03-2.18, respectively). Despite the relatively small number of studies evaluated, these data suggest the importance of vitamin D status in outcomes of hematological malignancies (PROSPERO registration number: CRD42020205821).
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Tao Y, Chen H, Zhou Y, Shi Y. Meta-analysis of the prognostic and clinical value of serum 25-hydroxyvitamin D levels in previously untreated lymphoma. Future Oncol 2021; 17:1825-1838. [PMID: 33728948 DOI: 10.2217/fon-2020-0914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background: This meta-analysis explored the prognostic and clinical value of serum 25-hydroxyvitamin D, 25(OH)D, levels in previously untreated lymphoma. Materials & methods: PubMed, Web of Science, Embase and the Cochrane Central Register of Controlled Trials databases were searched for eligible studies. Summary effect estimates and 95% CIs were pooled using random-effects or fixed-effects models. Results: Twelve studies with 4139 patients were included. Low level of serum 25(OH)D was associated with inferior progression-free survival (hazard ratio [HR]: 2.06; 95% CI: 1.82-2.32) and overall survival (HR: 1.94; 95% CI: 1.71-2.19), advanced disease (odds ratio [OR]: 1.52; 95% CI: 1.09-2.13) and elevated lactate dehydrogenase (OR: 1.84; 95% CI: 1.08-3.15). Conclusions: Low level of serum 25(OH)D is a prognostic risk factor for newly diagnosed lymphoma.
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Affiliation(s)
- Yunxia Tao
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs. No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Haizhu Chen
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs. No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yu Zhou
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs. No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yuankai Shi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs. No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
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Kim HB, Kim JH. Sunlight exposure in association with risk of lymphoid malignancy: a meta-analysis of observational studies. Cancer Causes Control 2021; 32:441-57. [PMID: 33606147 DOI: 10.1007/s10552-021-01404-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Several observational studies have shown contradictory results regarding the association between sunlight exposure and the risk of malignant lymphoma. Thus, we aimed to systematically determine the association between sunlight exposure and lymphoid malignancy risk through a meta-analysis. METHODS A thorough search of four electronic databases (PubMed, Embase, Web of Science, and Scopus) was performed to identify eligible studies until 13 August 2020. A random-effects model was used to calculate risk estimates of sunlight exposure. The main outcome measure was the risk of lymphoid malignancy subtypes with odds ratios (ORs) and 95% confidence intervals (CIs) according to various forms of solar ultraviolet radiation. RESULTS In total, 17 case-control studies and 9 cohort studies including 216,285 non-Hodgkin lymphoma (NHL) and 23,017 Hodgkin's lymphoma (HL) patients were included in the final analysis. Personal sunlight exposure was significantly associated with a decreased risk of HL (OR 0.77; 95% CI 0.68-0.87) and NHL (OR 0.81; 95% CI 0.71-0.92), including all subtypes except T-cell lymphoma. Ambient sunlight exposure at residence was associated with a reduced risk of HL (OR 0.88; 95% CI 0.81-0.95) and all NHL subtypes (OR 0.84; 95% CI 0.73-0.96), except for chronic lymphocytic leukemia/small lymphocytic lymphoma. As the number of sunburns and sunbaths increased, the risk of NHL tended to decrease. CONCLUSION While there was an observed protective effect both from case-control and prospective studies, substantial heterogeneity was found in the current study. Thus, more evidence is required to confirm that promoting sunlight exposure can prevent the development of lymphoid neoplasia.
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Mao J, Yin H, Wang L, Wu JZ, Xia Y, Zhu HY, Fan L, Li JY, Liang JH, Xu W. Prognostic value of 25-hydroxy vitamin D in extranodal NK/T cell lymphoma. Ann Hematol 2020; 100:445-453. [PMID: 33140135 DOI: 10.1007/s00277-020-04320-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022]
Abstract
25-hydroxy vitamin D [25-(OH)D] is widely used to determine vitamin D status in clinic. The aim of our study was to evaluate the prognostic value of 25-(OH)D in extranodal NK/T cell lymphoma (ENKTL). Ninety-three (93) ENKTL patients with available serum 25-(OH)D values were enrolled in our study. Vitamin D deficiency is defined as a 25-(OH)D below 50 nmol/L (20 ng/ml). Univariate and multivariate regression analyses were performed to determine independent risk factors for progression-free survival (PFS) and overall survival (OS). Receiver operator characteristic (ROC) curves were plotted, and corresponding areas under the curves (AUC) were calculated to estimate the accuracy of PINK-E (prognostic index of natural killer lymphoma added with Epstein-Barr virus-DNA status) and 25-(OH)D deficiency in ENKTL risk-stratification. Our results suggested that the vitamin D deficiency was an independent inferior prognostic factor for both PFS [hazard ratio (HR), 2.869; 95% confidence interval (CI), 1.540 to 5.346; P = 0.003] and OS (HR, 3.204; 95% CI, 1.559 to 6.583; P = 0.006) in patients with ENKTL. Additionally, we demonstrated that adding 25-(OH)D deficiency to PINK-E score system indeed has a superior prognostic significance than PINK-E alone for PFS [AUC: 0.796 (95% CI: 0.699 to 0.872) vs. 0.759 (95% CI: 0.659 to 0.841), P = 0.020] and OS [AUC: 0.755 (95% CI: 0.655 to 0.838) vs. 0.721 (95% CI: 0.618 to 0.809), P = 0.040]. In conclusion, our study proved that 25-(OH)D deficiency was associated with inferior survival outcome of ENKTL patients.
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Affiliation(s)
- Jin Mao
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Hua Yin
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Li Wang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jia-Zhu Wu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Yi Xia
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Hua-Yuan Zhu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Lei Fan
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jian-Yong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jin-Hua Liang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China.
| | - Wei Xu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China.
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Fernández-Barral A, Bustamante-Madrid P, Ferrer-Mayorga G, Barbáchano A, Larriba MJ, Muñoz A. Vitamin D Effects on Cell Differentiation and Stemness in Cancer. Cancers (Basel) 2020; 12:E2413. [PMID: 32854355 DOI: 10.3390/cancers12092413] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/21/2020] [Accepted: 08/22/2020] [Indexed: 12/14/2022] Open
Abstract
Vitamin D3 is the precursor of 1α,25-dihydroxyvitamin D3 (1,25(OH)2D3), a pleiotropic hormone that is a major regulator of the human genome. 1,25(OH)2D3 modulates the phenotype and physiology of many cell types by controlling the expression of hundreds of genes in a tissue- and cell-specific fashion. Vitamin D deficiency is common among cancer patients and numerous studies have reported that 1,25(OH)2D3 promotes the differentiation of a wide panel of cultured carcinoma cells, frequently associated with a reduction in cell proliferation and survival. A major mechanism of this action is inhibition of the epithelial–mesenchymal transition, which in turn is largely based on antagonism of the Wnt/β-catenin, TGF-β and EGF signaling pathways. In addition, 1,25(OH)2D3 controls the gene expression profile and phenotype of cancer-associated fibroblasts (CAFs), which are important players in the tumorigenic process. Moreover, recent data suggest a regulatory role of 1,25(OH)2D3 in the biology of normal and cancer stem cells (CSCs). Here, we revise the current knowledge of the molecular and genetic basis of the regulation by 1,25(OH)2D3 of the differentiation and stemness of human carcinoma cells, CAFs and CSCs. These effects support a homeostatic non-cytotoxic anticancer action of 1,25(OH)2D3 based on reprogramming of the phenotype of several cell types.
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Eicher F, Mansouri Taleghani B, Schild C, Bacher U, Pabst T. Reduced survival after autologous stem cell transplantation in myeloma and lymphoma patients with low vitamin D serum levels. Hematol Oncol 2020; 38:523-530. [PMID: 32594534 DOI: 10.1002/hon.2774] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/27/2020] [Accepted: 06/23/2020] [Indexed: 12/31/2022]
Abstract
High-dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT) is applied for consolidation in myeloma and relapsing lymphoma patients. Vitamin D (VitD) exerts effects during hematopoietic stem cell proliferation, differentiation and interactions with the immune system. VitD deficiency is frequent in patients with hematological malignancies, but its prognostic relevance after ASCT remains unclear. We investigated the effect of VitD serum levels in patients with lymphomas and myeloma at ASCT on progression-free (PFS) and overall survival (OS). The cohort (n = 183) was divided into two groups: 81 (44%) had VitD levels >52 nmol/L and 102 (56%) ≤52 nmol/L at ASCT. VitD levels >52 nmol/L were associated with better PFS (P = 0.0194) and OS (P = 0.011). Similarly, when evaluating myeloma patients alone, patients with lower VitD levels (≤52 nmol/L) had inferior PFS (P = 0.0412) and OS (P = 0.049). Finally, the multivariate analysis was consistent that varying VitD levels were significantly associated with OS (P = 0.0167), also when stratifying patients in groups with VitD levels > versus ≤52 nmol/L (P = 0.0421). Our data suggest that reduced serum VitD levels in myeloma and lymphoma patients undergoing HDCT/ASCT are associated with inferior outcome. Optimizing VitD levels before ASCT may be warranted.
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Affiliation(s)
- Florian Eicher
- Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | | | - Christof Schild
- Department of Clinical Chemistry, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Ulrike Bacher
- Department of Hematology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Thomas Pabst
- Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
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Xu DM, Liang JH, Wang L, Zhu HY, Xia Y, Fan L, Li JY, Xu W. 25-Hydroxy vitamin D deficiency predicts inferior prognosis in mantle cell lymphoma. J Cancer Res Clin Oncol 2020; 146:1003-1009. [DOI: 10.1007/s00432-020-03125-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/02/2020] [Indexed: 12/14/2022]
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13
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Han J, Tang Y, Zhong M, Wu W. Antitumor effects and mechanisms of 1,25(OH)2D3 in the Pfeiffer diffuse large B lymphoma cell line. Mol Med Rep 2019; 20:5064-5074. [PMID: 31638226 PMCID: PMC6854594 DOI: 10.3892/mmr.2019.10756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 08/06/2019] [Indexed: 12/12/2022] Open
Abstract
Diffuse large B cell lymphoma (DLBCL) represents the most common subtype of non-Hodgkin lymphoma in China. 1,25-Dihydroxyvitamin D3 [1,25(OH)2D3] has been shown to possess significant antitumor potential and is degraded by 25-hydroxyvitamin D-24-hydroxylase (CYP24A1). In the present study, the role of CYP24A1 and autophagy, and their underlying mechanisms in the anticancer effects of 1,25(OH)2D3 in DLBCL cells, were investigated. It was found that the levels of CYP24A1 in DLBCL lymph node tissues were higher than in hyperplasia lymphadenitis tissue. Moreover, the expression of CYP24A1 was positively associated with the Ann Arbor stage and the International Prognostic Index in patients with DLBCL, and negatively associated with the clinical response to treatment. Patients >60 years of age were found to have a higher level of CYP24A1. 1,25(OH)2D3 inhibited the proliferation of the Pfeiffer DLBCL cell line and increased the G1 phase population of Pfeiffer cells. Rapamycin (RAPA) in combination with 1,25(OH)2D3 increased the G1 phase distribution of Pfeiffer cells. Furthermore, RAPA blocked the increase of CYP24A1 and vitamin D receptor (VDR) expression induced by 1,25(OH)2D3. 1,25(OH)2D3 induced the formation of autophagosomes, increased the expression of autophagy related protein light chain (LC)3II/LC3I and reduced the expression of the ubiquitin binding protein P62. In addition, 1,25(OH)2D3 decreased the phosphorylation of AKT and mammalian target of RAPA (mTOR), and downstream targets eukaryotic translation imitation factor 4E-binding protein 1 and ribosomal protein S6 kinase β-1 in Pfeiffer cells. The results from the present study suggested that CYP24A1 may be a novel prognostic indicator for DLBCL. 1,25(OH)2D3 inhibited proliferation and induced autophagy of Pfeiffer cells. In addition, 1,25(OH)2D3 increased the G1 phase population of Pfeiffer cells. These effects may be mediated by inhibition of the AKT/mTOR/PI3K signaling pathway. RAPA increased the cell cycle arrest induced by 1,25(OH)2D3 by blocking the upregulated expression of CYP24A1 and VDR.
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Affiliation(s)
- Jing Han
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Yonghong Tang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Meizuo Zhong
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Wenlin Wu
- Department of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510000, P.R. China
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14
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Borchmann S, Cirillo M, Goergen H, Meder L, Sasse S, Kreissl S, Bröckelmann PJ, von Tresckow B, Fuchs M, Ullrich RT, Engert A. Pretreatment Vitamin D Deficiency Is Associated With Impaired Progression-Free and Overall Survival in Hodgkin Lymphoma. J Clin Oncol 2019; 37:3528-3537. [PMID: 31622132 DOI: 10.1200/jco.19.00985] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Vitamin D deficiency is described as a modifiable risk factor for the incidence of and mortality in many common cancers; however, data in Hodgkin lymphoma (HL) are lacking. PATIENTS AND METHODS We thus performed a study measuring pretreatment vitamin D levels in prospectively treated patients with HL and correlated this with clinical outcomes. A total of 351 patients from the German Hodgkin Study Group clinical trials (HD7, HD8, and HD9) were included. RESULTS Fifty percent of patients were vitamin D deficient (< 30 nmol/L) before planned chemotherapy. Pretreatment vitamin D deficiency was more common in relapsed/refractory patients than matched relapse-free controls (median baseline vitamin D, 21.4 nmol/L v 35.5 nmol/L; proportion with vitamin D deficiency, 68% v 41%; P < .001). Vitamin D-deficient patients had impaired progression-free survival (10-year difference, 17.6%; 95% CI, 6.9% to 28.4%; hazard ratio, 2.13; 95% CI, 1.84 to 2.48; P < .001) and overall survival (10-year difference, 11.1%; 95% CI, 2.1% to 20.2%; hazard ratio, 1.82; 95% CI, 1.53 to 2.15; P < .001), consistent across trials and treatment groups. We demonstrated that vitamin D status is an independent predictor of outcome and hypothesized that vitamin D status might be important for the chemosensitivity of HL. We subsequently performed experiments supplementing physiologic doses of vitamin D (calcitriol) to cultured HL cell lines and demonstrated increased antiproliferative effects in combination with chemotherapy. In an HL-xenograft animal model, we showed that supplemental vitamin D (dietary supplement, cholecalciferol) improves the chemosensitivity of tumors by reducing the rate of tumor growth compared with vitamin D or chemotherapy alone. CONCLUSION On the basis of our clinical and preclinical findings, we encourage that vitamin D screening and replacement be incorporated into future randomized clinical trials to properly clarify the role of vitamin D replacement therapy in HL.
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Affiliation(s)
- Sven Borchmann
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital of Cologne, Center for Molecular Medicine, Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital of Cologne, Else Kröner Forschungskolleg Clonal Evolution in Cancer, Cologne, Germany
| | - Melita Cirillo
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany
| | - Helen Goergen
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany
| | - Lydia Meder
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital of Cologne, Center for Molecular Medicine, Cologne, Germany
| | - Stephanie Sasse
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany
| | - Stefanie Kreissl
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany
| | - Paul Jan Bröckelmann
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany
| | - Bastian von Tresckow
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany
| | - Michael Fuchs
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany
| | - Roland Tillmann Ullrich
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital of Cologne, Center for Molecular Medicine, Cologne, Germany
| | - Andreas Engert
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany
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15
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Gharbaran R, Zhang B, Valerio L, Onwumere O, Wong M, Mighty J, Redenti S. Effects of vitamin D3 and its chemical analogs on the growth of Hodgkin's lymphoma, in vitro. BMC Res Notes 2019; 12:216. [PMID: 30961641 PMCID: PMC6454773 DOI: 10.1186/s13104-019-4241-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/01/2019] [Indexed: 01/24/2023] Open
Abstract
Objective Vitamin D receptor (VDR) activities have been noted for a number of B cell malignancies which showed varying sensitivities to vitamin D3 (1,25-dihydroxyvitamin D3, VD3, calcitriol) and its synthetic analogs. The objective of this study was to address the potential effects of VD3 and vitamin D3 analogs (VDAs) on the growth of Hodgkin’s lymphoma (HL), a malignant pathology of B cell origin, in vitro. Results Immunofluorescence staining showed the expression of VDR by primary Hodgkin’s (H) and Reed–Sternberg (RS)—HRS-tumor cells in HL histological sections. Western blot analyses revealed expression of VDR in the HL cell lines Hs445, HDLM2, KMH2, and L428. One-way analysis of variance (ANOVA) on data obtained from water-soluble tetrazolium 1 (WST-1) cell proliferation assay showed decreased cell growth in HDLM2 and L428, 72 h after treatment with 10 µM of either VD3 of VDAs. Western blot analyses showed that treatment of L428 cells with the VDAs (calcipotriol and EB1089) resulted in modest increases in nuclear accumulation of VDR (nuVDR) compared to either dimethyl sulfoxide (DMSO) or VD3 treatments. nuVDR for DMSO control and VD3 was comparable. These results suggest that VD3 or VDAs may affect growth of HL.
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Affiliation(s)
- Rajendra Gharbaran
- Department of Biological Sciences, Bronx Community College, The City University of New York, Bronx, NY, 10453, USA. .,Department of Biological Sciences, Lehman College, City University of New York, Bronx, NY, 10468, USA.
| | - Bo Zhang
- Department of Biological Sciences, Lehman College, City University of New York, Bronx, NY, 10468, USA
| | - Luis Valerio
- Department of Biological Sciences, Bronx Community College, The City University of New York, Bronx, NY, 10453, USA.,Department of Biological Sciences, Lehman College, City University of New York, Bronx, NY, 10468, USA
| | - Onyekwere Onwumere
- Department of Biological Sciences, Lehman College, City University of New York, Bronx, NY, 10468, USA.,Biology Doctoral Program, The Graduate School and University Center, City University of New York, 365 5th Avenue, New York, NY, 10016, USA
| | - Madeline Wong
- Department of Biological Sciences, Lehman College, City University of New York, Bronx, NY, 10468, USA
| | - Jason Mighty
- Department of Biological Sciences, Lehman College, City University of New York, Bronx, NY, 10468, USA.,Biology Doctoral Program, The Graduate School and University Center, City University of New York, 365 5th Avenue, New York, NY, 10016, USA
| | - Stephen Redenti
- Department of Biological Sciences, Lehman College, City University of New York, Bronx, NY, 10468, USA.,Biology Doctoral Program, The Graduate School and University Center, City University of New York, 365 5th Avenue, New York, NY, 10016, USA
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16
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Kumar A, Mohanty S, Das P, Sahu SK, Rajasubramaniam S, Choudhuri T. 1, 25(OH)2 D3 Induces Reactivation and Death of Kaposi's Sarcoma-Associated Herpesvirus of Primary Effusion Lymphoma cells. Sci Rep 2017; 7:12438. [PMID: 28963501 DOI: 10.1038/s41598-017-12676-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/05/2017] [Indexed: 12/31/2022] Open
Abstract
Kaposi's sarcoma associated herpesvirus (KSHV) a gammaherpesvirus establishes perennial latency in the host with periodic reactivation. Occasionally change in the physiological condition like hypoxia, host cell differentiation can trigger the lytic switch and reactivation of the virus. The biologically active form of 1, 25(OH)2 D3 plays a critical role in the regulation of various physiological processes (e.g. regulation of mineral homeostasis and control of bone metabolism). Apart from its role in host physiology, 1, 25(OH)2 D3 has been implicated as a potential agent for the prevention and/or treatment of many a tumors. Here we show that 1, 25(OH)2 D3 induces both death of Kaposi sarcoma associated herpesvirus infected PEL cells and KSHV replication. 1, 25(OH)2 D3 mediated inhibition of proliferation was associated with apoptosis of the PEL cells, and virus reactivation. In addition, p38 signalling is required for KSHV reactivation. Furthermore, treatment of PEL cells with p38 inhibitor abrogated the expression of ORF57, thus blocking lytic switch. Furthermore, silencing of VDR resulted in reduced ORF57 expression compared to the control cells, signifying the potential role of 1, 25(OH)2 D3 in KSHV reactivation. Thus, our studies have revealed a novel role of 1, 25(OH)2 D3 in the regulation of KSHV reactivation and PEL cell death.
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17
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Gascoyne DM, Lyne L, Spearman H, Buffa FM, Soilleux EJ, Banham AH. Vitamin D Receptor Expression in Plasmablastic Lymphoma and Myeloma Cells Confers Susceptibility to Vitamin D. Endocrinology 2017; 158:503-515. [PMID: 28001444 PMCID: PMC5460784 DOI: 10.1210/en.2016-1802] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/19/2016] [Indexed: 12/16/2022]
Abstract
Plasmablastic B-cell malignancies include plasmablastic lymphoma and subsets of multiple myeloma and diffuse large B-cell lymphomaDLBCL. These diseases can be difficult to diagnose and treat, and they lack well-characterized cell line models. Here, immunophenotyping and FOXP1 expression profiling identified plasmablastic characteristics in DLBCL cell lines HLY-1 and SU-DHL-9, associated with CTNNAL1, HPGD, RORA, IGF1, and/or vitamin D receptor (VDR) transcription. We demonstrated VDR protein expression in primary plasmablastic tumor cells and confirmed in cell lines expression of both VDR and the metabolic enzyme CYP27B1, which catalyzes active vitamin D3 production. Although Vdr and Cyp27b1 transcription in normal B cells were activated by interleukin 4 (IL-4) and CD40 signaling, respectively, unstimulated malignant plasmablastic cells lacking IL-4 expressed both VDR and CYP27B1. Positive autoregulation evidenced intact VDR function in all plasmablastic lines, and inhibition of growth by active vitamin D3 was both dependent on MYC protein inhibition and could be enhanced by cotreatment with a synthetic ROR ligand SR-1078. Furthermore, a VDR polymorphism, FOK1, was associated with greater vitamin D3-dependent growth inhibition. In summary, HLY-1 provides an important model of strongly plasmablastic lymphoma, and disruption of VDR pathway activity may be of therapeutic benefit in both plasmablastic lymphoma and myeloma.
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Affiliation(s)
- Duncan M Gascoyne
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford , Oxford , UK
| | - Linden Lyne
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford , Oxford , UK
| | - Hayley Spearman
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford , Oxford , UK
| | | | - Elizabeth J Soilleux
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford , Oxford , UK
| | - Alison H Banham
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford , Oxford , UK
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18
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Abstract
Commonly known for its critical role in calcium homeostasis and bone mineralization, more recently vitamin D has been implicated in hematological cancer pathogenesis and shows promise as an anti-cancer therapy. Serum levels of 25(OH)D3 , the precursor to the active form of vitamin D, calcitriol, are frequently lower in patients with hematological disease compared to healthy individuals. This often correlates with worse disease outcome. Furthermore, diseased cells typically highly express the vitamin D receptor, which is required for many of the anti-cancer effects observed in multiple in vivo and in vitro cancer models. In abnormal hematological cells, vitamin D supplementation promotes apoptosis, induces differentiation, inhibits proliferation, sensitizes tumor cells to other anti-cancer therapies, and reduces the production of pro-inflammatory cytokines. Although the dosage of vitamin D required to achieve these effects may induce hypercalcemia in humans, analogs and combinatorial treatments have been developed to circumvent this side effect. Vitamin D and its analogs are well tolerated in clinical trials, and thus, further investigation into the use of these agents in the clinic is warranted. Here, we review the current literature in this field.
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Affiliation(s)
- Paige M Kulling
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, USA.,Division of Hematology/Oncology, Department of Medicine, University of Virginia, Charlottesville, VA, USA.,Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | - Kristine C Olson
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, USA.,Division of Hematology/Oncology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Thomas L Olson
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, USA.,Division of Hematology/Oncology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - David J Feith
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, USA.,Division of Hematology/Oncology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Thomas P Loughran
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, USA.,Division of Hematology/Oncology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
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19
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Affiliation(s)
- Y Rosen
- Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA
| | - J Daich
- Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA
| | - I Soliman
- Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA
| | - E Brathwaite
- Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA
| | - Y Shoenfeld
- Zabludowicz Centre for Autoimmune Diseases, Sheba Medical Centre, Tel Hashomer, Israel
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20
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Wang J, Li X, Zhang D. Dairy Product Consumption and Risk of Non-Hodgkin Lymphoma: A Meta-Analysis. Nutrients 2016; 8:120. [PMID: 26927171 DOI: 10.3390/nu8030120] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/05/2016] [Accepted: 02/16/2016] [Indexed: 11/16/2022] Open
Abstract
Many epidemiologic studies have explored the association between dairy product consumption and the risk of non-Hodgkin lymphoma (NHL), but the results remain controversial. A literature search was performed in PubMed, Web of Science and Embase for relevant articles published up to October 2015. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated with a random-effects model. The dose-response relationship was assessed by restricted cubic spline. A total of 16 articles were eligible for this meta-analysis. The pooled RRs (95% CIs) of NHL for the highest vs. lowest category of the consumption of total dairy product, milk, butter, cheese, ice cream and yogurt were 1.20 (1.02, 1.42), 1.41 (1.08, 1.84), 1.31 (1.04, 1.65), 1.14 (0.96, 1.34), 1.57 (1.11, 2.20) and 0.78 (0.54, 1.12), respectively. In subgroup analyses, the positive association between total dairy product consumption and the risk of NHL was found among case-control studies (RR = 1.41, 95% CI: 1.17-1.70) but not among cohort studies (RR = 1.02, 95% CI: 0.88-1.17). The pooled RRs (95% CIs) of NHL were 1.21 (1.01, 1.46) for milk consumption in studies conducted in North America, and 1.24 (1.09, 1.40) for cheese consumption in studies that adopted validated food frequency questionnaires. In further analysis of NHL subtypes, we found statistically significant associations between the consumption of total dairy product (RR = 1.73, 95% CI: 1.22-2.45) and milk (RR = 1.49, 95% CI: 1.08-2.06) and the risk of diffuse large B-cell lymphoma. The dose-response analysis suggested that the risk of NHL increased by 5% (1.05 (1.00-1.10)) and 6% (1.06 (0.99-1.13)) for each 200 g/day increment of total dairy product and milk consumption, respectively. This meta-analysis suggested that dairy product consumption, but not yogurt, may increase the risk of NHL. More prospective cohort studies that investigate specific types of dairy product consumption are needed to confirm this conclusion.
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Chihara D, Nastoupil LJ, Williams JN, Lee P, Koff JL, Flowers CR. New insights into the epidemiology of non-Hodgkin lymphoma and implications for therapy. Expert Rev Anticancer Ther 2015; 15:531-44. [PMID: 25864967 PMCID: PMC4698971 DOI: 10.1586/14737140.2015.1023712] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Non-Hodgkin lymphoma (NHL) comprises numerous biologically and clinically heterogeneous subtypes, with limited data examining the risk factors for these distinct disease entities. Many limitations exist when studying lymphoma epidemiology; therefore, until recently, little was known regarding the etiology of NHL subtypes. This review highlights the results of recent pooled analyses examining the risk factors for NHL subtypes. We outline the heterogeneity and commonality among the risk factors for NHL subtypes, with proposed subtype-specific as well as shared etiologic mechanisms. In addition, we describe how the study of lymphoma epidemiology may translate into prevention or therapeutic targeting as we continue to explore the complexities of lifestyle and genetic factors that impact lymphomagenesis.
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Affiliation(s)
- Dai Chihara
- University of Texas, MD Anderson Cancer Center, Department of Lymphoma/Myeloma, Houston, TX, USA
| | - Loretta J. Nastoupil
- University of Texas, MD Anderson Cancer Center, Department of Lymphoma/Myeloma, Houston, TX, USA
| | - Jessica N. Williams
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Paul Lee
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Jean L. Koff
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
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22
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Kelly JL, Salles G, Goldman B, Fisher RI, Brice P, Press O, Casasnovas O, Maloney DG, Soubeyran P, Rimsza L, Haioun C, Xerri L, LeBlanc M, Tilly H, Friedberg JW. Low Serum Vitamin D Levels Are Associated With Inferior Survival in Follicular Lymphoma: A Prospective Evaluation in SWOG and LYSA Studies. J Clin Oncol 2015; 33:1482-90. [PMID: 25823738 DOI: 10.1200/jco.2014.57.5092] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Recent literature reports a potential association between high vitamin D and improved lymphoma prognosis. We evaluated the impact of pretreatment vitamin D on follicular lymphoma (FL) outcome. PATIENTS AND METHODS SWOG participants were previously untreated patients with FL enrolled onto SWOG clinical trials (S9800, S9911, or S0016) involving CHOP chemotherapy plus an anti-CD20 antibody (rituximab or iodine-131 tositumomab) between 1998 and 2008. Participants included in our second independent cohort were also previously untreated patients with FL enrolled onto the Lymphoma Study Association (LYSA) PRIMA trial of rituximab plus chemotherapy (randomly assigned to rituximab maintenance v observation) between 2004 and 2007. Using the gold-standard liquid chromatography-tandem mass spectrometry method, 25-hydroxyvitamin D was measured in stored baseline serum samples. The primary end point was progression-free survival (PFS). RESULTS After a median follow-up of 5.4 years, the adjusted PFS and overall survival hazard ratios for the SWOG cohort were 1.97 (95% CI, 1.10 to 3.53) and 4.16 (95% CI, 1.66 to 10.44), respectively, for those who were vitamin D deficient (< 20 ng/mL; 15% of cohort). After a median follow-up of 6.6 years, the adjusted PFS and overall survival hazard ratios for the LYSA cohort were 1.50 (95% CI, 0.93 to 2.42) and 1.92 (95% CI, 0.72 to 5.13), respectively, for those who were vitamin D deficient (< 10 ng/mL; 25% of cohort). CONCLUSION Although statistical significance was not reached in the LYSA cohort, the consistent estimates of association between low vitamin D levels and FL outcomes in two independent cohorts suggests that serum vitamin D might be the first potentially modifiable factor to be associated with FL survival. Further investigation is needed to determine the effects of vitamin D supplementation in this clinical setting.
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Affiliation(s)
- Jennifer L Kelly
- Jennifer L. Kelly and Jonathan W. Friedberg, James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon-1, Pierre Benite; Pauline Brice, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris; Olivier Casasnovas, Centre Hospitalo-Universitaire de Dijon, Dijon; Pierre Soubeyran, Institut Bergonié and Université Victor Segalen Bordeaux 2, Bordeaux; Corinne Haioun, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Luc Xerri, Institut Paoli Calmettes, Marseille; Hervé Tilly, Centre Henri Becquerel, Rouen, France; Bryan Goldman, Oliver Press, and Michael LeBlanc, SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Richard I. Fisher, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA; and Lisa Rimsza, University of Arizona, Tucson, AZ
| | - Gilles Salles
- Jennifer L. Kelly and Jonathan W. Friedberg, James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon-1, Pierre Benite; Pauline Brice, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris; Olivier Casasnovas, Centre Hospitalo-Universitaire de Dijon, Dijon; Pierre Soubeyran, Institut Bergonié and Université Victor Segalen Bordeaux 2, Bordeaux; Corinne Haioun, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Luc Xerri, Institut Paoli Calmettes, Marseille; Hervé Tilly, Centre Henri Becquerel, Rouen, France; Bryan Goldman, Oliver Press, and Michael LeBlanc, SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Richard I. Fisher, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA; and Lisa Rimsza, University of Arizona, Tucson, AZ
| | - Bryan Goldman
- Jennifer L. Kelly and Jonathan W. Friedberg, James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon-1, Pierre Benite; Pauline Brice, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris; Olivier Casasnovas, Centre Hospitalo-Universitaire de Dijon, Dijon; Pierre Soubeyran, Institut Bergonié and Université Victor Segalen Bordeaux 2, Bordeaux; Corinne Haioun, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Luc Xerri, Institut Paoli Calmettes, Marseille; Hervé Tilly, Centre Henri Becquerel, Rouen, France; Bryan Goldman, Oliver Press, and Michael LeBlanc, SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Richard I. Fisher, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA; and Lisa Rimsza, University of Arizona, Tucson, AZ
| | - Richard I Fisher
- Jennifer L. Kelly and Jonathan W. Friedberg, James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon-1, Pierre Benite; Pauline Brice, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris; Olivier Casasnovas, Centre Hospitalo-Universitaire de Dijon, Dijon; Pierre Soubeyran, Institut Bergonié and Université Victor Segalen Bordeaux 2, Bordeaux; Corinne Haioun, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Luc Xerri, Institut Paoli Calmettes, Marseille; Hervé Tilly, Centre Henri Becquerel, Rouen, France; Bryan Goldman, Oliver Press, and Michael LeBlanc, SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Richard I. Fisher, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA; and Lisa Rimsza, University of Arizona, Tucson, AZ
| | - Pauline Brice
- Jennifer L. Kelly and Jonathan W. Friedberg, James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon-1, Pierre Benite; Pauline Brice, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris; Olivier Casasnovas, Centre Hospitalo-Universitaire de Dijon, Dijon; Pierre Soubeyran, Institut Bergonié and Université Victor Segalen Bordeaux 2, Bordeaux; Corinne Haioun, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Luc Xerri, Institut Paoli Calmettes, Marseille; Hervé Tilly, Centre Henri Becquerel, Rouen, France; Bryan Goldman, Oliver Press, and Michael LeBlanc, SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Richard I. Fisher, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA; and Lisa Rimsza, University of Arizona, Tucson, AZ
| | - Oliver Press
- Jennifer L. Kelly and Jonathan W. Friedberg, James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon-1, Pierre Benite; Pauline Brice, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris; Olivier Casasnovas, Centre Hospitalo-Universitaire de Dijon, Dijon; Pierre Soubeyran, Institut Bergonié and Université Victor Segalen Bordeaux 2, Bordeaux; Corinne Haioun, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Luc Xerri, Institut Paoli Calmettes, Marseille; Hervé Tilly, Centre Henri Becquerel, Rouen, France; Bryan Goldman, Oliver Press, and Michael LeBlanc, SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Richard I. Fisher, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA; and Lisa Rimsza, University of Arizona, Tucson, AZ
| | - Olivier Casasnovas
- Jennifer L. Kelly and Jonathan W. Friedberg, James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon-1, Pierre Benite; Pauline Brice, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris; Olivier Casasnovas, Centre Hospitalo-Universitaire de Dijon, Dijon; Pierre Soubeyran, Institut Bergonié and Université Victor Segalen Bordeaux 2, Bordeaux; Corinne Haioun, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Luc Xerri, Institut Paoli Calmettes, Marseille; Hervé Tilly, Centre Henri Becquerel, Rouen, France; Bryan Goldman, Oliver Press, and Michael LeBlanc, SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Richard I. Fisher, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA; and Lisa Rimsza, University of Arizona, Tucson, AZ
| | - David G Maloney
- Jennifer L. Kelly and Jonathan W. Friedberg, James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon-1, Pierre Benite; Pauline Brice, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris; Olivier Casasnovas, Centre Hospitalo-Universitaire de Dijon, Dijon; Pierre Soubeyran, Institut Bergonié and Université Victor Segalen Bordeaux 2, Bordeaux; Corinne Haioun, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Luc Xerri, Institut Paoli Calmettes, Marseille; Hervé Tilly, Centre Henri Becquerel, Rouen, France; Bryan Goldman, Oliver Press, and Michael LeBlanc, SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Richard I. Fisher, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA; and Lisa Rimsza, University of Arizona, Tucson, AZ
| | - Pierre Soubeyran
- Jennifer L. Kelly and Jonathan W. Friedberg, James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon-1, Pierre Benite; Pauline Brice, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris; Olivier Casasnovas, Centre Hospitalo-Universitaire de Dijon, Dijon; Pierre Soubeyran, Institut Bergonié and Université Victor Segalen Bordeaux 2, Bordeaux; Corinne Haioun, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Luc Xerri, Institut Paoli Calmettes, Marseille; Hervé Tilly, Centre Henri Becquerel, Rouen, France; Bryan Goldman, Oliver Press, and Michael LeBlanc, SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Richard I. Fisher, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA; and Lisa Rimsza, University of Arizona, Tucson, AZ
| | - Lisa Rimsza
- Jennifer L. Kelly and Jonathan W. Friedberg, James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon-1, Pierre Benite; Pauline Brice, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris; Olivier Casasnovas, Centre Hospitalo-Universitaire de Dijon, Dijon; Pierre Soubeyran, Institut Bergonié and Université Victor Segalen Bordeaux 2, Bordeaux; Corinne Haioun, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Luc Xerri, Institut Paoli Calmettes, Marseille; Hervé Tilly, Centre Henri Becquerel, Rouen, France; Bryan Goldman, Oliver Press, and Michael LeBlanc, SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Richard I. Fisher, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA; and Lisa Rimsza, University of Arizona, Tucson, AZ
| | - Corinne Haioun
- Jennifer L. Kelly and Jonathan W. Friedberg, James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon-1, Pierre Benite; Pauline Brice, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris; Olivier Casasnovas, Centre Hospitalo-Universitaire de Dijon, Dijon; Pierre Soubeyran, Institut Bergonié and Université Victor Segalen Bordeaux 2, Bordeaux; Corinne Haioun, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Luc Xerri, Institut Paoli Calmettes, Marseille; Hervé Tilly, Centre Henri Becquerel, Rouen, France; Bryan Goldman, Oliver Press, and Michael LeBlanc, SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Richard I. Fisher, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA; and Lisa Rimsza, University of Arizona, Tucson, AZ
| | - Luc Xerri
- Jennifer L. Kelly and Jonathan W. Friedberg, James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon-1, Pierre Benite; Pauline Brice, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris; Olivier Casasnovas, Centre Hospitalo-Universitaire de Dijon, Dijon; Pierre Soubeyran, Institut Bergonié and Université Victor Segalen Bordeaux 2, Bordeaux; Corinne Haioun, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Luc Xerri, Institut Paoli Calmettes, Marseille; Hervé Tilly, Centre Henri Becquerel, Rouen, France; Bryan Goldman, Oliver Press, and Michael LeBlanc, SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Richard I. Fisher, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA; and Lisa Rimsza, University of Arizona, Tucson, AZ
| | - Michael LeBlanc
- Jennifer L. Kelly and Jonathan W. Friedberg, James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon-1, Pierre Benite; Pauline Brice, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris; Olivier Casasnovas, Centre Hospitalo-Universitaire de Dijon, Dijon; Pierre Soubeyran, Institut Bergonié and Université Victor Segalen Bordeaux 2, Bordeaux; Corinne Haioun, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Luc Xerri, Institut Paoli Calmettes, Marseille; Hervé Tilly, Centre Henri Becquerel, Rouen, France; Bryan Goldman, Oliver Press, and Michael LeBlanc, SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Richard I. Fisher, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA; and Lisa Rimsza, University of Arizona, Tucson, AZ
| | - Hervé Tilly
- Jennifer L. Kelly and Jonathan W. Friedberg, James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon-1, Pierre Benite; Pauline Brice, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris; Olivier Casasnovas, Centre Hospitalo-Universitaire de Dijon, Dijon; Pierre Soubeyran, Institut Bergonié and Université Victor Segalen Bordeaux 2, Bordeaux; Corinne Haioun, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Luc Xerri, Institut Paoli Calmettes, Marseille; Hervé Tilly, Centre Henri Becquerel, Rouen, France; Bryan Goldman, Oliver Press, and Michael LeBlanc, SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Richard I. Fisher, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA; and Lisa Rimsza, University of Arizona, Tucson, AZ
| | - Jonathan W Friedberg
- Jennifer L. Kelly and Jonathan W. Friedberg, James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon-1, Pierre Benite; Pauline Brice, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris; Olivier Casasnovas, Centre Hospitalo-Universitaire de Dijon, Dijon; Pierre Soubeyran, Institut Bergonié and Université Victor Segalen Bordeaux 2, Bordeaux; Corinne Haioun, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Luc Xerri, Institut Paoli Calmettes, Marseille; Hervé Tilly, Centre Henri Becquerel, Rouen, France; Bryan Goldman, Oliver Press, and Michael LeBlanc, SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Richard I. Fisher, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA; and Lisa Rimsza, University of Arizona, Tucson, AZ.
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Monnereau A, Glaser SL, Schupp CW, Ekström Smedby K, de Sanjosé S, Kane E, Melbye M, Forétova L, Maynadié M, Staines A, Becker N, Nieters A, Brennan P, Boffetta P, Cocco P, Glimelius I, Clavel J, Hjalgrim H, Chang ET. Exposure to UV radiation and risk of Hodgkin lymphoma: a pooled analysis. Blood 2013; 122:3492-9. [PMID: 24016459 DOI: 10.1182/blood-2013-04-497586] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Ultraviolet radiation (UVR) exposure has been inversely associated with Hodgkin lymphoma (HL) risk, but only inconsistently, only in a few studies, and without attention to HL heterogeneity. We conducted a pooled analysis of HL risk focusing on type and timing of UVR exposure and on disease subtypes by age, histology, and tumor-cell Epstein-Barr virus (EBV) status. Four case-control studies contributed 1320 HL cases and 6381 controls. We estimated lifetime, adulthood, and childhood UVR exposure and history of sunburn and sunlamp use. We used 2-stage estimation with mixed-effects models and weighted pooled effect estimates by inverse marginal variances. We observed statistically significant inverse associations with HL risk for UVR exposures during childhood and adulthood, sunburn history, and sunlamp use, but we found no significant dose-response relationships. Risks were significant only for EBV-positive HL (pooled odds ratio, 0.56; 95% confidence interval, 0.35 to 0.91 for the highest overall UVR exposure category), with a significant linear trend for overall exposure (P = .03). Pooled relative risk estimates were not heterogeneous across studies. Increased UVR exposure may protect against HL, particularly EBV-positive HL. Plausible mechanisms involving UVR induction of regulatory T cells or the cellular DNA damage response suggest opportunities for new prevention targets.
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24
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Tincani A, Andreoli L, Cavazzana I, Doria A, Favero M, Fenini MG, Franceschini F, Lojacono A, Nascimbeni G, Santoro A, Semeraro F, Toniati P, Shoenfeld Y. Novel aspects of Sjögren's syndrome in 2012. BMC Med 2013; 11:93. [PMID: 23556533 PMCID: PMC3616867 DOI: 10.1186/1741-7015-11-93] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 02/15/2013] [Indexed: 12/16/2022] Open
Abstract
Sjögren's syndrome (SS) is a systemic progressive autoimmune disease characterized by a complex pathogenesis requiring a predisposing genetic background and involving immune cell activation and autoantibody production. The immune response is directed to the exocrine glands, causing the typical 'sicca syndrome', but major organ involvement is also often seen. The etiology of the disease is unknown. Infections could play a pivotal role: compared to normal subjects, patients with SS displayed higher titers of anti-Epstein-Barr virus (EBV) early antigens, but lower titers of other infectious agent antibodies such as rubella and cytomegalovirus (CMV) suggest that some infections may have a protective role against the development of autoimmune disease. Recent findings seem to show that low vitamin D levels in patients with SS could be associated with severe complications such as lymphoma and peripheral neuropathy. This could open new insights into the disease etiology. The current treatments for SS range from symptomatic therapies to systemic immunosuppressive drugs, especially B cell-targeted drugs in cases of organ involvement. Vitamin D supplementation may be an additional tool for optimization of SS treatment.
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Affiliation(s)
- Angela Tincani
- Rheumatology and Clinical Immunology Unit, Spedali Civili, Piazzale Spedali Civili 1, 25100 Brescia, Italy.
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25
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van Leeuwen MT, Turner JJ, Falster MO, Meagher NS, Joske DJ, Grulich AE, Giles GG, Vajdic CM. Latitude gradients for lymphoid neoplasm subtypes in Australia support an association with ultraviolet radiation exposure. Int J Cancer 2013; 133:944-51. [PMID: 23382012 DOI: 10.1002/ijc.28081] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 01/16/2013] [Indexed: 01/04/2023]
Abstract
Given the uncertainty surrounding solar ultraviolet radiation (UVR) exposure and risk of lymphoid neoplasms, we performed an ecological analysis of national Australian data for incident cases diagnosed between 2002 and 2006. Subtype-specific incidence was examined by latitude band (<29°S, 29-36°S, ≥37°S), a proxy for ambient UVR exposure, using multiple Poisson regression, adjusted for sex, age-group and calendar year. Incidence increased with distance from the equator for several mature B-cell non-Hodgkin lymphomas, including diffuse large B-cell [incidence rate ratio (IRR) = 1.37; 95% confidence interval (CI): 1.16-1.61 for latitude ≥37°S relative to <29°S], lymphoplasmacytic (IRR = 1.34; 95% CI: 1.12-1.61), mucosa-associated lymphoid tissue (IRR = 1.32; 95% CI: 0.97-1.80) and mantle cell lymphoma (IRR = 1.29; 95% CI: 1.05-1.58), as well as plasmacytoma (IRR = 1.52; 95% CI: 1.09-2.11) and plasma cell myeloma (IRR = 1.15; 95% CI: 1.03-1.27). A similar pattern was observed for several mature cutaneous T-cell neoplasms, including primary cutaneous anaplastic large cell lymphoma (IRR = 4.26; 95% CI: 1.85-9.84), mycosis fungoides/Sézary syndrome (IRR = 1.72; 95% CI: 1.20-2.46), and peripheral T-cell lymphoma not otherwise specified (NOS) (IRR = 1.53; 95% CI: 1.17-2.00). Incidence of mixed cellularity/lymphocyte-depleted (IRR = 1.60; 95% CI: 1.16-2.20) and nodular sclerosis Hodgkin lymphoma (IRR = 1.57; 95% CI: 1.33-1.85) also increased with distance from the equator. Many of these subtypes have a known association with infection or immune dysregulation. Our findings support a possible protective effect of UVR exposure on the risk of several lymphoid neoplasms, possibly through vitamin D-related immune modulation critical in lymphomagenesis.
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Affiliation(s)
- Marina T van Leeuwen
- Adult Cancer Program, Lowy Cancer Research Centre, Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
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26
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Aref S, Ibrahim L, Azmy E. Prognostic impact of serum 25-hydroxivitamin D [25(OH)D] concentrations in patients with lymphoid malignancies. ACTA ACUST UNITED AC 2012; 18:20-5. [PMID: 22980447 DOI: 10.1179/1607845412y.0000000025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The incidence of lymphoid malignancies has been increasing rapidly. Despite growing evidence for a relationship between serum 25-hydroxivitamin D [25(OH)D] concentrations and solid tumor risk, far less is known about the relationship between 25(OH)D and the risk of hematologic malignancy. This study aimed to assess the prognostic relevance of serum 25(OH)D concentrations in patients with B chronic lymphocytic leukemia (B-CLL) and non Hodgkin's lymphoma (NHL). The study was carried out on 195 newly diagnosed patients (75 B-CLL and 120 NHL) as well as 30 normal healthy controls. For all patients and normal controls serum 25(OH)D concentrations were assayed by enzyme-linked immunosorbent assay. Serum 25(OH)D levels were significantly lower in B-CLL and NHL patients as compared with normal controls (P = 0.00 for both). Also, there are significant associations between serum 25(OH)D levels and positive CD 38, positive ZAP 70 as well as Binet stages (χ(2) = 16.071, 16.644, 21.134 respectively; P = 0.00 for all) in the B-CLL patient group. Moreover, there are significant associations between serum 25(OH)D status and international prognostic index (IPI), performance status (χ(2) = 6.994, 9.212, P = 0.02, 0.01 respectively), but not with clinical stages (χ(2) = 3.115, P = 0.539) in NHL. Multivariate analysis revealed that 25(OH)D insufficiency is an independent poor prognostic factor in both B-CLL and NHL patient groups. In conclusion, 25(OH)D insufficiency is an independent poor prognostic factor in patients with B-CLL and NHL. 25(OH)D might be a therapeutic target in lymphoid malignancies.
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Affiliation(s)
- Salah Aref
- Hematology Unit, Clinical Pathology Department, Mansoura University, Mansoura 3011, Egypt.
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27
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Agmon-Levin N, Kivity S, Tzioufas AG, López Hoyos M, Rozman B, Efes I, Shapira Y, Shamis A, Amital H, Youinou P, Shoenfeld Y. Low levels of vitamin-D are associated with neuropathy and lymphoma among patients with Sjögren's syndrome. J Autoimmun 2012; 39:234-9. [PMID: 22835660 DOI: 10.1016/j.jaut.2012.05.018] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 05/24/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND/PURPOSE Primary Sjögren's syndrome (SS) is a chronic autoimmune disease primarily involving the exocrine glands. The clinical picture of SS ranges from exocrinopathy to systemic disease affecting the lung, kidney, liver, skin, musculockeletal and nervous systems. The morbidity of SS is mainly determined by extraglandular disease and increased prevalence of lymphoma. Environmental and hormonal factors, such as vitamin-D may play a role in the pathogenic process and disease expression. Thus, we aimed to evaluate levels of vitamin-D and their association with manifestations of SS. METHODS Vitamin-D levels were determined in 176 primary SS patients and 163 matched healthy volunteers utilizing the LIAISON chemiluminescent immunoassays (DiaSorin-Italy). A correlation between vitamin-D levels and clinical and serological manifestations of SS was performed. RESULTS Mean vitamin-D levels were comparable between SS patients and control 21.2 ± 9.4 ng/ml and 22.4 ± 10 ng/ml, respectively. Peripheral neuropathy was diagnosed in 23% of SS patients and associated with lower vitamin-D levels (18.6 ± 5.5 ng/ml vs. 22.6±8 ng/ml (p = 0.04)). Lymphoma was diagnosed in 4.3% of SS patients, who had lower levels of vitamin-D (13.2 ± 6.25 ng/ml), compared to SS patients without lymphoma (22 ± 8 ng/ml), (p = 0.03). Other clinical and serological manifestations did not correlate with vitamin-D status. CONCLUSIONS In this study, low levels of vitamin-D correlated with the presence of peripheral neuropathy and lymphoma among SS patients. The link between vitamin-D and neuropathy or lymphoma was reported in other conditions, and may support a role for vitamin-D in the pathogenesis of these processes. Plausible beneficial effect for vitamin-D supplementation may thus be suggested.
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Affiliation(s)
- Nancy Agmon-Levin
- The Zabludowicz Center for Autoimmune Diseases, The Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel
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Abstract
Background Hodgkin lymphoma (HL) is one of the most frequent lymphoma in the western world. Despite a good overall prognosis, some patients suffer relapsing tumors which are difficult to cure. Over a long period Vitamin D has been shown to be a potential treatment for cancer. Vitamin D acts via the vitamin D receptor, a nuclear receptor, acting as an inducible transcription factor. We aimed to investigate the expression of vitamin D receptor as a possible diagnostic marker and potential therapeutic target in HL as well as in B-cell derived non-Hodgkin lymphoma (B-NHL). Methods We used a panel of 193 formalin fixed tissues of lymphoma cases consisting of 55 cases of HL and 138 cases on several B-NHL entities. Results Vitamin D receptor is strongly expressed in tumor cells of HL, regardless of the sub entity with an overall positivity of 80% of all HL cases. In contrast, only about 17% of the analyzed origin-NHL showed positivity for vitamin D receptor. The detection of nuclear localization of vitamin D receptor in the tumor cells of HL suggests activated status of the vitamin D receptor. Conclusions Our study suggests VDR as a specific marker for tumor cells of HL, but not of B-NHL subtypes. Further, the observed nuclear localization suggests an activated receptor status in tumor cells of HL. Further investigations of mutational status and functional studies may shed some light in functional relevance of vitamin D receptor signaling in HL.
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Affiliation(s)
- Christoph Renné
- Senckenberg Institute of Pathology, University of Frankfurt, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany.
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Kim M, Mirandola L, Pandey A, Nguyen DD, Jenkins MR, Turcel M, Cobos E, Chiriva-Internati M. Application of vitamin D and derivatives in hematological malignancies. Cancer Lett 2012; 319:8-22. [DOI: 10.1016/j.canlet.2011.10.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 10/15/2011] [Accepted: 10/17/2011] [Indexed: 11/16/2022]
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30
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Wong KY, Tai BC, Chia SE, Kuperan P, Lee KM, Lim ST, Loong S, Mow B, Ng SB, Tan L, Tan SY, Tan SH, Tao M, Wong A, Wong GC, Seow A. Sun exposure and risk of lymphoid neoplasms in Singapore. Cancer Causes Control 2012; 23:1055-64. [DOI: 10.1007/s10552-012-9974-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 04/16/2012] [Indexed: 12/23/2022]
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31
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Kelly JL, Drake MT, Fredericksen ZS, Asmann YW, Liebow M, Shanafelt TD, Feldman AL, Ansell SM, Macon WR, Herr MM, Wang AH, Nowakowski GS, Call TG, Habermann TM, Slager SL, Witzig TE, Cerhan JR. Early life sun exposure, vitamin D-related gene variants, and risk of non-Hodgkin lymphoma. Cancer Causes Control 2012; 23:1017-29. [PMID: 22544453 DOI: 10.1007/s10552-012-9967-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 04/09/2012] [Indexed: 12/21/2022]
Abstract
PURPOSE It has been hypothesized that vitamin D mediates the inverse relationship between sun exposure and non-Hodgkin lymphoma (NHL) risk reported in several recent studies. We evaluated the association of self-reported sun exposure at ages <13, 13-21, 22-40, and 41+ years and 19 single nucleotide polymorphisms (SNPs) from 4 candidate genes relevant to vitamin D metabolism (RXR, VDR , CYP24A1, CYP27B1) with NHL risk. METHODS This analysis included 1,009 newly diagnosed NHL cases and 1,233 frequency-matched controls from an ongoing clinic-based study. Odds ratios (OR), 95 % confidence intervals (CI), and tests for trend were estimated using unconditional logistic regression. RESULTS There was a significant decrease in NHL risk with increased sun exposure at ages 13-21 years (OR(≥15 vs. ≤3 h/week) = 0.68; 95 % CI, 0.43-1.08; p(trend) = 0.0025), which attenuated for older ages at exposure. We observed significant main effect associations for 3 SNPs in VDR and 1 SNP in CYP24A1: rs886441 (OR(per-allele) = 0.82; 95 % CI, 0.70-0.96; p = 0.016), rs3819545 (OR(per-allele) = 1.24; 95 % CI, 1.10-1.40; p = 0.00043), and rs2239186 (OR(per-allele) = 1.22; 95 % CI, 1.05-1.41; p = 0.0095) for VDR and rs2762939 (OR(per-allele) = 0.85; 95 % CI, 0.75-0.98; p = 0.023) for CYP24A1. Moreover, the effect of sun exposure at age 13-21 years on overall NHL risk appears to be modified by germline variation in VDR (rs4516035; p(interaction) = 0.0066). Exploratory analysis indicated potential heterogeneity of these associations by NHL subtype. CONCLUSION These results suggest that germline genetic variation in VDR, and therefore the vitamin D pathway, may mediate an association between early life sun exposure and NHL risk.
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Affiliation(s)
- Jennifer L Kelly
- School of Medicine and Dentistry, University of Rochester, NY, USA
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Abstract
The active metabolite of vitamin D, 1α, 25-dihydroxyvitamin D3 [1,25(OH)(2) D3], is involved in calcium and phosphate metabolism and exerts a large number of biological effects. Vitamin D3 inhibits parathyroid hormone secretion, adaptive immunity and cell proliferation, and at the same time promotes insulin secretion, innate immunity and stimulates cellular differentiation. The role of vitamin D3 in immunoregulation has led to the concept of a dual function as both as an important secosteroid hormone for the regulation of body calcium homeostasis and as an essential organic compound that has been shown to have a crucial effect on the immune responses. Altered levels of vitamin D3 have been associated, by recent observational studies, with a higher susceptibility of immune-mediated disorders and inflammatory diseases. This review reports the new developments with specific reference to the metabolic and signalling mechanisms associated with the complex immune-regulatory effects of vitamin D3 on immune cells.
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Bertrand KA, Chang ET, Abel GA, Zhang SM, Spiegelman D, Qureshi AA, Laden F. Sunlight exposure, vitamin D, and risk of non-Hodgkin lymphoma in the Nurses' Health Study. Cancer Causes Control 2011; 22:1731-41. [PMID: 21987081 DOI: 10.1007/s10552-011-9849-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 09/26/2011] [Indexed: 12/14/2022]
Abstract
PURPOSE Case-control studies suggest increased sun exposure reduces non-Hodgkin lymphoma (NHL) risk. Evidence from prospective cohort studies, however, is limited and inconsistent. We evaluated the association between ambient ultraviolet radiation (UV) exposure and NHL in a nationwide cohort of women, the Nurses' Health Study (NHS). METHODS Between 1976 and 2006, we identified 1064 incident NHL cases among 115,482 women in the prospective NHS. Exposures assessed included average annual UV-B flux based on residence at various times during life, vitamin D intake, and predicted plasma 25-hydroxyvitamin D levels. We estimated incidence rate ratios (RRs) and 95% confidence intervals (CIs) for risk of all NHL and histologic subtypes using Cox proportional hazards models. RESULTS NHL risk was increased for women residing in areas of high ambient UV radiation (UV-B flux >113 R-B count × 10(-4)) compared to those with lower exposure (<113), with positive linear trends at all time points. The multivariable-adjusted RR for high UV area at age 15 was 1.21 (95% CI: 1.00, 1.47; p-trend < 0.01). There was no evidence of statistical heterogeneity by subtype, although power was limited for subtype analyses. We observed no association between vitamin D measures and risk of NHL overall or by subtype. CONCLUSIONS Our findings do not support the hypothesis of a protective effect of UV radiation exposure on NHL risk. We found no association between vitamin D and NHL risk.
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Affiliation(s)
- Kimberly A Bertrand
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
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34
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Abstract
The active metabolite of vitamin D, 1α, 25-dihydroxyvitamin D3 [1,25(OH)(2) D3], is involved in calcium and phosphate metabolism and exerts a large number of biological effects. Vitamin D3 inhibits parathyroid hormone secretion, adaptive immunity and cell proliferation, and at the same time promotes insulin secretion, innate immunity and stimulates cellular differentiation. The role of vitamin D3 in immunoregulation has led to the concept of a dual function as both as an important secosteroid hormone for the regulation of body calcium homeostasis and as an essential organic compound that has been shown to have a crucial effect on the immune responses. Altered levels of vitamin D3 have been associated, by recent observational studies, with a higher susceptibility of immune-mediated disorders and inflammatory diseases. This review reports the new developments with specific reference to the metabolic and signalling mechanisms associated with the complex immune-regulatory effects of vitamin D3 on immune cells.
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35
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Chang ET, Canchola AJ, Cockburn M, Lu Y, Wang SS, Bernstein L, Clarke CA, Horn-Ross PL. Adulthood residential ultraviolet radiation, sun sensitivity, dietary vitamin D, and risk of lymphoid malignancies in the California Teachers Study. Blood 2011; 118:1591-9. [PMID: 21622649 PMCID: PMC3156047 DOI: 10.1182/blood-2011-02-336065] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 05/14/2011] [Indexed: 12/13/2022] Open
Abstract
To lend clarity to inconsistent prior findings of an inverse association between ultraviolet radiation (UVR) exposure and risk of lymphoid malignancies, we examined the association of prospectively ascertained residential ambient UVR exposure with risk of non-Hodgkin lymphomas (NHLs), multiple myeloma (MM), and classical Hodgkin lymphoma in the California Teachers Study cohort. Among 121 216 eligible women, 629 were diagnosed with NHL, 119 with MM, and 38 with Hodgkin lymphoma between 1995-1996 and 2007. Cox proportional hazards regression was used to estimate incidence rate ratios (RRs) with 95% confidence intervals (CIs). Residential UVR levels within a 20-km radius were associated with reduced risk of overall NHL (RR for highest vs lowest statewide quartile of minimum UVR [≥ 5100 vs < 4915 W-h/m(2)], 0.58; 95% CI, 0.42-0.80), especially diffuse large B-cell lymphoma (RR, 0.36; 95% CI, 0.17-0.78) and chronic lymphocytic leukemia/small lymphocytic lymphoma (RR, 0.46; 95% CI, 0.21-1.01), and MM (RR for maximum UVR, 0.57; 95% CI, 0.36-0.90). These associations were not modified by skin sensitivity to sunlight, race/ethnicity, body mass index, or neighborhood socioeconomic status. Dietary vitamin D also was not associated with risk of lymphoid malignancies. These results support a protective effect of routine residential UVR exposure against lymphomagenesis through mechanisms possibly independent of vitamin D.
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Affiliation(s)
- Ellen T Chang
- Cancer Prevention Institute of California, Fremont, CA, USA.
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36
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Affiliation(s)
- Ana Catarina Mamede
- a Biophysics/Biomathematics Institute, IBILI, Faculty of Medicine , University of Coimbra , Coimbra, Portugal
- b CICS-UBI, Health Sciences Research Centre, Faculty of Health Sciences , University of Beira Interior , Covilhã, Portugal
- c Centre of Investigation on Environment, Genetics, and Oncobiology, Faculty of Medicine , University of Coimbra , Coimbra, Portugal
| | - Sónia Dorilde Tavares
- a Biophysics/Biomathematics Institute, IBILI, Faculty of Medicine , University of Coimbra , Coimbra, Portugal
- d Faculty of Sciences and Technology , University of Coimbra , Coimbra, Portugal
| | - Ana Margarida Abrantes
- a Biophysics/Biomathematics Institute, IBILI, Faculty of Medicine , University of Coimbra , Coimbra, Portugal
- c Centre of Investigation on Environment, Genetics, and Oncobiology, Faculty of Medicine , University of Coimbra , Coimbra, Portugal
| | - Joana Trindade
- a Biophysics/Biomathematics Institute, IBILI, Faculty of Medicine , University of Coimbra , Coimbra, Portugal
- d Faculty of Sciences and Technology , University of Coimbra , Coimbra, Portugal
| | - Jorge Manuel Maia
- e Faculty of Sciences , University of Beira Interior , Covilhã, Portugal
| | - Maria Filomena Botelho
- a Biophysics/Biomathematics Institute, IBILI, Faculty of Medicine , University of Coimbra , Coimbra, Portugal
- c Centre of Investigation on Environment, Genetics, and Oncobiology, Faculty of Medicine , University of Coimbra , Coimbra, Portugal
- f Institute of Nuclear Sciences Applied to Health , University of Coimbra , Coimbra, Portugal
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Shanafelt TD, Drake MT, Maurer MJ, Allmer C, Rabe KG, Slager SL, Weiner GJ, Call TG, Link BK, Zent CS, Kay NE, Hanson CA, Witzig TE, Cerhan JR. Vitamin D insufficiency and prognosis in chronic lymphocytic leukemia. Blood 2011; 117:1492-8. [PMID: 21048153 DOI: 10.1182/blood-2010-07-295683] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Vitamin D insufficiency is common globally and low levels are linked to higher cancer incidence. Although vitamin D insufficiency is related to inferior prognosis in some cancers, no data exist for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). We evaluated the relationship of 25(OH)D serum levels with time-to-treatment (TTT) and overall survival (OS) in newly diagnosed CLL patients participating in a prospective cohort study (discovery cohort) and a separate cohort of previously untreated patients participating in an observational study (confirmation cohort). Of 390 CLL patients in the discovery cohort, 119 (30.5%) were 25(OH)D insufficient. After a median follow-up of 3 years, TTT (hazard ratio[HR] = 1.66; P = .005) and OS (HR = 2.39; P = .01) were shorter for 25(OH)D-insufficient patients. In the validation cohort, 61 of 153 patients (39.9%) were 25(OH)D insufficient. After a median follow-up of 9.9 years, TTT (HR = 1.59; P = .05) and OS (HR 1.63; P = .06) were again shorter for 25(OH)D-insufficient patients. On pooled multivariable analysis of patients in both cohorts adjusting for age, sex, Rai stage, CD38 status, ZAP-70 status, immunoglobulin heavy chain variable (IGHV) gene mutation status, CD49d status, and cytogenetic abnormalities assessed by interphase fluorescent in situ hybridization testing, 25(OH)D insufficiency remained an independent predictor of TTT (HR = 1.47; P = .008), although the association with OS was not significant (HR = 1.47; P = .07). Vitamin D insufficiency is associated with inferior TTT and OS in CLL patients. Whether normalizing vitamin D levels in deficient CLL patients would improve outcome merits clinical testing.
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38
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Drake MT, Maurer MJ, Link BK, Habermann TM, Ansell SM, Micallef IN, Kelly JL, Macon WR, Nowakowski GS, Inwards DJ, Johnston PB, Singh RJ, Allmer C, Slager SL, Weiner GJ, Witzig TE, Cerhan JR. Vitamin D insufficiency and prognosis in non-Hodgkin's lymphoma. J Clin Oncol 2010; 28:4191-8. [PMID: 20713849 DOI: 10.1200/jco.2010.28.6674] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Vitamin D insufficiency is common in the United States, with low levels linked in some studies to higher cancer incidence, including non-Hodgkin's lymphoma (NHL). Recent data also suggest that vitamin D insufficiency is related to inferior prognosis in some cancers, although there are no data for NHL. PATIENTS AND METHODS We tested the hypothesis that circulating 25-hydroxyvitamin D [25(OH)D] levels are predictive of event-free survival (EFS) and overall survival (OS) in a prospective cohort of 983 newly diagnosed patients with NHL. 25(OH)D and 1,25-dihydroxyvitamin D [1,25(OH)(2)D] levels were measured by liquid chromatography-tandem mass spectrometry. RESULTS Mean age at diagnosis was 62 years (range, 19 to 94 years); 44% of patients had insufficient 25(OH)D levels (< 25 ng/mL) within 120 days of diagnosis. Median follow-up was 34.8 months; 404 events and 193 deaths (168 from lymphoma) occurred. After adjusting for known prognostic factors and treatment, 25(OH)D insufficient patients with diffuse large B-cell lymphoma (DLBCL) had inferior EFS (hazard ratio [HR], 1.41; 95% CI, 0.98 to 2.04) and OS (HR, 1.99; 95% CI, 1.27 to 3.13); 25(OH)D insufficient patients with T-cell lymphoma also had inferior EFS (HR, 1.94; 95% CI, 1.04 to 3.61) and OS (HR, 2.38; 95% CI, 1.04 to 5.41). There were no associations with EFS for the other NHL subtypes. Among patients with DLBCL and T-cell lymphoma, higher 1,25(OH)(2)D levels were associated with better EFS and OS, suggesting that any putative tumor 1-α-hydroxylase activity did not explain the 25(OH)D associations. CONCLUSION 25(OH)D insufficiency was associated with inferior EFS and OS in DLBCL and T-cell lymphoma. Whether normalizing vitamin D levels in these patients improves outcomes will require testing in future trials.
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Yang J, Ikezoe T, Nishioka C, Ni L, Koeffler HP, Yokoyama A. Inhibition of mTORC1 by RAD001 (everolimus) potentiates the effects of 1,25-dihydroxyvitamin D3 to induce growth arrest and differentiation of AML cells in vitro and in vivo. Exp Hematol 2010; 38:666-76. [DOI: 10.1016/j.exphem.2010.03.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2009] [Revised: 03/08/2010] [Accepted: 03/30/2010] [Indexed: 01/25/2023]
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Purdue MP, Freedman DM, Gapstur SM, Helzlsouer KJ, Laden F, Lim U, Maskarinec G, Rothman N, Shu XO, Stevens VL, Zeleniuch-Jacquotte A, Albanes D, Bertrand K, Weinstein SJ, Yu K, Irish L, Horst RL, Hoffman-Bolton J, Giovannucci EL, Kolonel LN, Snyder K, Willett W, Arslan AA, Hayes RB, Zheng W, Xiang YB, Hartge P. Circulating 25-hydroxyvitamin D and risk of non-hodgkin lymphoma: Cohort Consortium Vitamin D Pooling Project of Rarer Cancers. Am J Epidemiol 2010; 172:58-69. [PMID: 20562184 PMCID: PMC2892540 DOI: 10.1093/aje/kwq117] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 04/12/2010] [Indexed: 12/12/2022] Open
Abstract
Case-control studies generally suggesting an inverse association between sun exposure and non-Hodgkin lymphoma (NHL) have led to speculation that vitamin D may protect against lymphomagenesis. To examine this hypothesis, the authors conducted a pooled investigation of circulating 25-hydroxyvitamin D (25(OH)D) and subsequent NHL risk within 10 cohorts participating in the Cohort Consortium Vitamin D Pooling Project of Rarer Cancers. The authors analyzed measurements from 1,353 cases and 1,778 controls using conditional logistic regression and other methods to estimate the association of 25(OH)D with NHL. No clear evidence of association between categories of 25(OH)D concentration and NHL was observed overall (P(trend) = 0.68) or by sex (men, P(trend) = 0.50; women, P(trend) = 0.16). Findings for other measures (continuous log(25(OH)D), categories of 25(OH)D using sex-/cohort-/season-specific quartiles as cutpoints, categories of season-adjusted residuals of predicted 25(OH)D using quartiles as cutpoints) were generally null, although some measures of increasing 25(OH)D were suggestive of an increased risk for women. Results from stratified analyses and investigations of histologic subtypes of NHL were also null. These findings do not support the hypothesis that elevated circulating 25(OH)D concentration is associated with a reduced risk of NHL. Future research investigating the biologic basis for the sunlight-NHL association should consider alternative mechanisms, such as immunologic effects.
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Affiliation(s)
- Mark P. Purdue
- Correspondence to Dr. Mark P. Purdue, National Cancer Institute, 6120 Executive Boulevard, EPS 8114, Rockville, MD 20852 (e-mail: )
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41
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Kelly JL, Friedberg JW, Calvi LM, van Wijngaarden E, Fisher SG. A case-control study of ultraviolet radiation exposure, vitamin D, and lymphoma risk in adults. Cancer Causes Control 2010; 21:1265-75. [PMID: 20373010 DOI: 10.1007/s10552-010-9554-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 03/23/2010] [Indexed: 12/31/2022]
Abstract
Recent research suggests that ultraviolet radiation exposure (UVRE), our major source of vitamin D, is associated with reduced lymphoma risk. Animal and human studies support an association between vitamin D (vitD) insufficiency and increased risk of some malignancies. We conducted a clinic-based case-control study (140 lymphoma cases, 139 controls; 2002-2005, Rochester, NY) to evaluate UVRE and vitD insufficiency in relation to lymphoma risk. Subjects completed a survey and provided a blood sample. We used multivariable logistic regression to estimate lymphoma risk in relation to past (5-10 years prior) UVRE and current vitD insufficiency (determined by serum 25(OH)D). Possible differences in effect by lymphoma subtype were explored, but statistical power was limited. We confirmed the previously reported decrease in lymphoma risk with past UVRE, specifically sunbathing (>once/week versus never); adjusted odds ratio (OR(adj)), = 0.28, 95% confidence interval (CI): 0.10-0.79. Current vitD insufficiency was not associated with lymphoma risk (OR(adj) = 0.89, 95% CI: 0.47-1.72). However, current sunbathing frequency was correlated with measured serum 25(OH)D values. Therefore, while our data do not support an association with current vitD status, development of accurate methods for past vitD assessment to further investigate its role in the association between past UVRE and lymphoma risk is warranted.
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Abstract
Animal and human studies support a protective effect of vitamin D sufficiency related to malignancy by uncovering paracrine and autocrine effects of extra-renal 25-hydroxyvitamin D (25(OH)D) activation including regulation of cell cycle proliferation, apoptosis induction, and increased cell differentiation signaling. Recent epidemiologic studies demonstrate a reduction in non-Hodgkin lymphoma (NHL) risk with increased sunlight exposure. As sunlight is a major vitamin D source, it has been suggested that vitamin D status may mediate this observed association. This review provides a comprehensive discussion of the current epidemiologic evidence with regard to the investigation of an association between vitamin D status and NHL risk.
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Affiliation(s)
- Jennifer L Kelly
- Department of Community and Preventive Medicine, University of Rochester, Rochester, NY 14642, USA.
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43
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Chang ET, Clarke CA, Glaser SL. Making sense of seasonal fluctuations in lymphoma diagnosis. Leuk Lymphoma 2009; 48:223-4. [PMID: 17325879 DOI: 10.1080/10428190601158662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ellen T Chang
- Northern California Cancer Center, Fremont, CA 94538, USA.
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44
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Boffetta P, van der Hel O, Kricker A, Nieters A, de Sanjosé S, Maynadié M, Cocco PL, Staines A, Becker N, Font R, Mannetje A', Goumas C, Brennan P. Exposure to ultraviolet radiation and risk of malignant lymphoma and multiple myeloma--a multicentre European case-control study. Int J Epidemiol 2008; 37:1080-94. [PMID: 18511490 DOI: 10.1093/ije/dyn092] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Three recent studies have reported a decreased risk of non-Hodgkin lymphoma (NHL) for high ultraviolet (UV) radiation exposure. METHODS We conducted a multicentre case-control study during 1998-2004 in France, Germany, Ireland, Italy and Spain, comprising 1518 cases of NHL, 268 cases of Hodgkin lymphoma, 242 cases of multiple myeloma and 2124 population or hospital controls. We collected information on sensitivity to sun and personal exposure to UV radiation in childhood and adulthood via interview, and assessed occupational exposure to UV radiation from the occupational history. RESULTS The risk of Hodgkin and NHL was increased for increasing skin sensitivity to the sun [odds ratio (OR) for no suntan vs very brown 2.35, 95% CI 0.94-5.87 and 1.39, 95% CI 1.03-1.87, respectively]. The risk of diffuse large B-cell lymphoma was reduced for increasing adult personal (OR for highest vs lowest quartile of exposure in free days 0.62, 95% CI 0.44-0.87) and for occupational exposure to UV radiation (OR for highest vs lowest exposure tertile 0.63, 95% CI 0.37-1.04). The risk of multiple myeloma was increased for personal exposure to UV radiation during adulthood (OR for highest vs lowest quartile of exposure in free days 1.49, 95% CI 0.88-2.50). A protective effect was observed for use of sun lamps for diffuse large B-cell lymphoma (OR for 25+ times vs never 0.63, 95% CI 0.38-1.03). CONCLUSIONS The hypothesis of a protective effect of UV radiation on lymphoma is supported by our results. The underlying mechanisms might differ from those operating in skin carcinogenesis. The increased risk of multiple myeloma is worth replication.
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Affiliation(s)
- Paolo Boffetta
- International Agency for Research on Cancer, Lyon, France.
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45
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Abstract
1,25-Dihydroxyvitamin D(3) (1,25(OH)(2)D(3)) can modulate immune responses, but whether it directly affects B cell function is unknown. Patients with systemic lupus erythematosus, especially those with antinuclear Abs and increased disease activity, had decreased 1,25(OH)(2)D(3) levels, suggesting that vitamin D might play a role in regulating autoantibody production. To address this, we examined the effects of 1,25(OH)(2)D(3) on B cell responses and found that it inhibited the ongoing proliferation of activated B cells and induced their apoptosis, whereas initial cell division was unimpeded. The generation of plasma cells and postswitch memory B cells was significantly inhibited by 1,25(OH)(2)D(3), although the up-regulation of genetic programs involved in B cell differentiation was only modestly affected. B cells expressed mRNAs for proteins involved in vitamin D activity, including 1 alpha-hydroxylase, 24-hydroxylase, and the vitamin D receptor, each of which was regulated by 1,25(OH)(2)D(3) and/or activation. Importantly, 1,25(OH)(2)D(3) up-regulated the expression of p27, but not of p18 and p21, which may be important in regulating the proliferation of activated B cells and their subsequent differentiation. These results indicate that 1,25(OH)(2)D(3) may play an important role in the maintenance of B cell homeostasis and that the correction of vitamin D deficiency may be useful in the treatment of B cell-mediated autoimmune disorders.
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Affiliation(s)
- Sheng Chen
- Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892, USA
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46
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Purdue MP, Hartge P, Davis S, Cerhan JR, Colt JS, Cozen W, Severson RK, Li Y, Chanock SJ, Rothman N, Wang SS. Sun exposure, vitamin D receptor gene polymorphisms and risk of non-Hodgkin lymphoma. Cancer Causes Control 2007; 18:989-99. [PMID: 17653830 DOI: 10.1007/s10552-007-9039-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Accepted: 07/04/2007] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Recent findings suggest that ultraviolet (UV) radiation exposure may reduce risk of developing non-Hodgkin lymphoma (NHL), but the biologic basis for this relationship remains unclear. We analyzed data from our US population-based case-control study of NHL to investigate whether our previously reported inverse association with sun exposure was dependent upon variants in the vitamin D receptor gene (IVS10 + 283G > A (BsmI), Ex11 + 32T > C (TaqI)), and genes linked to UV-induced immune modulation (IL4, IL10, IL12A, IL12B, TNF). METHODS UV exposure data was collected from an in-person interview with 551 cases and 462 controls. We calculated odds ratios (OR) and 95% confidence intervals (CI) for sun exposure measures for joint variant-exposure effects. RESULTS The association with NHL risk for time in the midday sun within the last decade was dependent upon Ex11 + 32 T > C genotype. Compared to TT carriers who reported < 7 h/week of sun exposure, CC subjects with < 7 h/week of sun exposure had an increased risk of NHL (OR = 1.9, 95% CI 0.8-4.4, P(interaction) = 0.16), while the relative risks for other CC carriers approached unity with increasing level of sun exposure. This pattern of effects was especially apparent for follicular lymphoma (for CC genotype and < 7 h/week of exposure: OR 6.3, 95% CI 1.9-22, P(interaction) = 0.004), and was consistently observed across measures of reported sun exposure for different periods of life. As IVS10 + 283G > A is correlated with Ex11 + 32T > C in our population (r (2) = 0.95), results were equivalent for those with the IVS10 + 283 AA genotype. No evidence of interaction with cytokine gene variants was observed. CONCLUSIONS Our results suggest that the inverse association between UV exposure and NHL risk may be mediated by the vitamin D pathway. Further investigation of this finding in other studies is warranted.
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Affiliation(s)
- Mark P Purdue
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd, EPS 8009, Rockville, MD 20892, USA.
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47
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Abstract
It was initially hypothesized that sun exposure might cause non-Hodgkin lymphoma (NHL) on the following grounds: its incidence was increasing in parallel with that of cutaneous melanoma; its risk was increased in those with a history of melanoma or other skin cancer; sun exposure causes immune suppression; and immunosuppression for other reasons is associated with an increased risk of NHL. The association of NHL with prior skin cancer has been found consistently in subsequent studies, but results of ecological analyses have only partially supported this hypothesis. Contrary to it, three recent studies of NHL in individuals found that risk decreased, generally by 25% to 40%, across categories of increasing total or recreational, but not occupational, sun exposure. One study, thus far reported only in abstract, showed the opposite. Production of vitamin D from sun exposure offers a plausible mechanism for protection against NHL by sun exposure. A recent study has found a reduced risk of NHL in people with a high dietary intake of vitamin D. Results of additional studies in individuals and a planned original-data meta-analysis of case-control studies should help to resolve the present conflicting results on sun exposure and NHL.
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Affiliation(s)
- Bruce K Armstrong
- Sydney Cancer Centre, Royal Prince Alfred Hospital, Missenden Road, Camperdown 2050, Sydney, New South Wales, Australia.
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48
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Kricker A, Armstrong BK, Hughes AM, Goumas C, Smedby KE, Zheng T, Spinelli JJ, De Sanjosé S, Hartge P, Melbye M, Willett EV, Becker N, Chiu BCH, Cerhan JR, Maynadié M, Staines A, Cocco P, Boffeta P. Personal sun exposure and risk of non Hodgkin lymphoma: A pooled analysis from the Interlymph Consortium. Int J Cancer 2007; 122:144-54. [PMID: 17708556 DOI: 10.1002/ijc.23003] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In 2004-2007 4 independent case-control studies reported evidence that sun exposure might protect against NHL; a fifth, in women only, found increased risks of NHL associated with a range of sun exposure measurements. These 5 studies are the first to examine the association between personal sun exposure and NHL. We report here on the relationship between sun exposure and NHL in a pooled analysis of 10 studies participating in the International Lymphoma Epidemiology Consortium (InterLymph), including the 5 published studies. Ten case-control studies covering 8,243 cases and 9,697 controls in the USA, Europe and Australia contributed original data for participants of European origin to the pooled analysis. Four kinds of measures of self-reported personal sun exposure were assessed at interview. A two-stage estimation method was used in which study-specific odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for potential confounders including smoking and alcohol use, were obtained from unconditional logistic regression models and combined in random-effects models to obtain the pooled estimates. Risk of NHL fell significantly with the composite measure of increasing recreational sun exposure, pooled OR = 0.76 (95% CI 0.63-0.91) for the highest exposure category (p for trend 0.01). A downtrend in risk with increasing total sun exposure was not statistically significant. The protective effect of recreational sun exposure was statistically significant at 18-40 years of age and in the 10 years before diagnosis, and for B cell, but not T cell, lymphomas. Increased recreational sun exposure may protect against NHL.
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Affiliation(s)
- Anne Kricker
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
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Weihkopf T, Becker N, Nieters A, Mester B, Deeg E, Elsner G, Blettner M, Seidler A. Sun exposure and malignant lymphoma: A population-based case–control study in Germany. Int J Cancer 2007; 120:2445-51. [PMID: 17311289 DOI: 10.1002/ijc.22492] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Although some causes for malignant lymphoma are known their etiology is not well understood so far. We analyze the relationship between sun exposure and malignant lymphoma in a multicenter, population-based case-control study. Patients with malignant lymphoma (n = 710, 18-80 years) were prospectively recruited in 6 study regions in Germany. For each case, a gender, region and age-matched control was drawn from population-registers. In personal interviews, lifetime holidays spent in sunny climate, outdoor leisure activities and sunbed or sunlamp use were recorded. On basis of job task-specific supplementary questionnaires, an occupational physician assessed the cumulative working time outside. Odds ratios (OR) and 95%-confidence-intervals (CI) were calculated using conditional logistic regression analysis, adjusted for smoking and alcohol consumption. To increase statistical power, patients with specific lymphoma subentities were additionally compared with the entire control group using unconditional logistic regression. We observed a reduced overall lymphoma risk among subjects having spent vacations at sunny climates or frequently used sunbeds or sunlamps. The analysis of lymphoma subentities revealed similar results with the exception of T-NHL and follicular lymphoma which were positively associated with outdoor leisure activities. While cumulative working time outside appeared unrelated to NHL overall and most subentities, it was negatively associated with follicular lymphoma and weakly positively to HL. This data suggest that exposure to natural and artificial ultraviolet radiation may reduce the OR for lymphoma in this study population.
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Affiliation(s)
- Thomas Weihkopf
- Institute of Medical Biostatistics, Epidemiology and Informatics, Johannes-Gutenberg University, Mainz, Germany.
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Polesel J, Talamini R, Montella M, Parpinel M, Dal Maso L, Crispo A, Crovatto M, Spina M, La Vecchia C, Franceschi S. Linoleic acid, vitamin D and other nutrient intakes in the risk of non-Hodgkin lymphoma: an Italian case-control study. Ann Oncol 2006; 17:713-8. [PMID: 16556850 DOI: 10.1093/annonc/mdl054] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dietary habits have been suggested as a factor related to the increase of non-Hodgkin lymphoma (NHL) incidence in western populations, but the role of individual nutrients is still unclear. PATIENTS AND METHODS A hospital-based case-control study was conducted in Italy, 1999-2002. CASES 190 incident, histologically-confirmed NHL cases aged 18-84 years. CONTROLS 484 subjects admitted to hospital for acute, non-neoplastic diseases unrelated to diet. Dietary habits were assessed by a validated food-frequency questionnaire; nutrient intakes were computed using the Italian food composition database. Odds ratios (ORs) and corresponding 95% confidence intervals (CI) for tertiles of intake of nutrient were computed using the energy-adjusted residual models. RESULTS Inverse association emerged for polyunsaturated fatty acids (OR=0.6; 95% CI: 0.4-0.9), linoleic acid (OR=0.6; 95% CI: 0.4-0.9), and vitamin D (OR=0.6; 95% CI: 0.4-0.9). The protective effect for linoleic acid (OR=0.3; 95% CI: 0.2-0.7) and vitamin D (OR=0.4; 95% CI: 0.2-0.9) was stronger in women; no differences emerged according to age. Linoleic acid was inversely related to follicular and diffuse large B-cell lymphoma; the protective effect of vitamin D emerged most clearly for follicular subtypes. CONCLUSIONS Our study suggests that a diet rich in polyunsaturated fatty acids and vitamin D is associated with a reduced risk of NHL.
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Affiliation(s)
- J Polesel
- Unità di Epidemiologia e Biostatistica, Centro di Riferimento Oncologico, Aviano, Italy.
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