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Title: Etiologic heterogeneity among non-Hodgkin lymphoma subtypes: the InterLymph Non-Hodgkin Lymphoma Subtypes Project.
Authors: Morton LM,  Slager SL,  Cerhan JR,  Wang SS,  Vajdic CM,  Skibola CF,  Bracci PM,  de Sanjosé S,  Smedby KE,  Chiu BC,  Zhang Y,  Mbulaiteye SM,  Monnereau A,  Turner JJ,  Clavel J,  Adami HO,  Chang ET,  Glimelius B,  Hjalgrim H,  Melbye M,  Crosignani P,  di Lollo S,  Miligi L,  Nanni O,  Ramazzotti V,  Rodella S,  Costantini AS,  Stagnaro E,  Tumino R,  Vindigni C,  Vineis P,  Becker N,  Benavente Y,  Boffetta P,  Brennan P,  Cocco P,  Foretova L,  Maynadié M,  Nieters A,  Staines A,  Colt JS,  Cozen W,  Davis S,  de Roos AJ,  Hartge P,  Rothman N,  Severson RK,  Holly EA,  Call TG,  Feldman AL,  Habermann TM,  Liebow M,  Blair A,  Cantor KP,  Kane EV,  Lightfoot T,  Roman E,  Smith A,  Brooks-Wilson A,  Connors JM,  Gascoyne RD,  Spinelli JJ,  Armstrong BK,  Kricker A,  Holford TR,  Lan Q,  Zheng T,  Orsi L,  Dal Maso L,  Franceschi S,  La Vecchia C,  Negri E,  Serraino D,  Bernstein L,  Levine A,  Friedberg JW,  Kelly JL,  Berndt SI,  Birmann BM,  Clarke CA,  Flowers CR,  Foran JM,  Kadin ME,  Paltiel O,  Weisenburger DD,  Linet MS,  Sampson JN
Journal: J Natl Cancer Inst Monogr
Date: 2014 Aug
Branches: BB, EBP, MEB, IIB, OEEB, REB
PubMed ID: 25174034
PMC ID: PMC4155467
Abstract: BACKGROUND: Non-Hodgkin lymphoma (NHL) comprises biologically and clinically heterogeneous subtypes. Previously, study size has limited the ability to compare and contrast the risk factor profiles among these heterogeneous subtypes. METHODS: We pooled individual-level data from 17 471 NHL cases and 23 096 controls in 20 case-control studies from the International Lymphoma Epidemiology Consortium (InterLymph). We estimated the associations, measured as odds ratios, between each of 11 NHL subtypes and self-reported medical history, family history of hematologic malignancy, lifestyle factors, and occupation. We then assessed the heterogeneity of associations by evaluating the variability (Q value) of the estimated odds ratios for a given exposure among subtypes. Finally, we organized the subtypes into a hierarchical tree to identify groups that had similar risk factor profiles. Statistical significance of tree partitions was estimated by permutation-based P values (P NODE). RESULTS: Risks differed statistically significantly among NHL subtypes for medical history factors (autoimmune diseases, hepatitis C virus seropositivity, eczema, and blood transfusion), family history of leukemia and multiple myeloma, alcohol consumption, cigarette smoking, and certain occupations, whereas generally homogeneous risks among subtypes were observed for family history of NHL, recreational sun exposure, hay fever, allergy, and socioeconomic status. Overall, the greatest difference in risk factors occurred between T-cell and B-cell lymphomas (P NODE < 1.0×10(-4)), with increased risks generally restricted to T-cell lymphomas for eczema, T-cell-activating autoimmune diseases, family history of multiple myeloma, and occupation as a painter. We further observed substantial heterogeneity among B-cell lymphomas (P NODE < 1.0×10(-4)). Increased risks for B-cell-activating autoimmune disease and hepatitis C virus seropositivity and decreased risks for alcohol consumption and occupation as a teacher generally were restricted to marginal zone lymphoma, Burkitt/Burkitt-like lymphoma/leukemia, diffuse large B-cell lymphoma, and/or lymphoplasmacytic lymphoma/Waldenström macroglobulinemia. CONCLUSIONS: Using a novel approach to investigate etiologic heterogeneity among NHL subtypes, we identified risk factors that were common among subtypes as well as risk factors that appeared to be distinct among individual or a few subtypes, suggesting both subtype-specific and shared underlying mechanisms. Further research is needed to test putative mechanisms, investigate other risk factors (eg, other infections, environmental exposures, and diet), and evaluate potential joint effects with genetic susceptibility.