Prediagnostic plasma concentrations of organochlorines and risk of B-cell non-Hodgkin lymphoma in envirogenomarkers: a nested case-control studyReportar como inadecuado

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Environmental Health

, 16:9

First Online: 16 February 2017Received: 01 October 2016Accepted: 07 February 2017DOI: 10.1186-s12940-017-0214-8

Cite this article as: Kelly, R.S., Kiviranta, H., Bergdahl, I.A. et al. Environ Health 2017 16: 9. doi:10.1186-s12940-017-0214-8


BackgroundEvidence suggests a largely environmental component to non-Hodgkin’s lymphoma NHL. Persistent organic pollutants POPs including polychlorinated biphenyls PCBs, DDE and HCB have been repeatedly implicated, but the literature is inconsistent and a causal relationship remains to be determined.

MethodsThe EnviroGenoMarkers study is nested within two prospective cohorts EPIC-Italy and the Northern Sweden Health and Disease Study. Six PCB congeners, DDE and HCB were measured in blood plasma samples provided at recruitment using gas-chromatography mass spectrometry. During 16 years follow-up 270 incident cases of B-cell NHL including 76 cases of multiple myeloma were diagnosed. Cases were matched to 270 healthy controls by centre, age, gender and date of blood collection. Cases were categorised into ordered quartiles of exposure for each POP based on the distribution of exposure in the control population. Logistic regression was applied to assess the association with risk, multivariate and stratified analyses were performed to identify confounders or effect modifiers.

ResultsThe exposures displayed a strong degree of correlation, particularly amongst those PCBs with similar degrees of chlorination. There was no significant difference p < 0.05 in median exposure levels between cases and controls for any of the investigated exposures. However under a multivariate model PCB138, PCB153, HCB and DDE displayed significant inverse trends Wald test p-value <0.05. Under stratified analyses these were determined to be driven by males and by the Diffuse Large B-Cell Lymphoma subtype. When considering those in the highest levels of exposure >90 percentile the association was null for all POPs

ConclusionWe report no evidence that a higher body burden of PCBs, DDE or HCB increased the risk of subsequent NHL diagnosis. Significantly inverse associations were noted for males with a number of the investigated POPs. We hypothesize these unexpected relationships may relate to the subtype composition of our population, effect modification by BMI or other unmeasured confounding. This study provides no additional support for the previously observed role of PCBs, DDE and HCB as risk factors for NHL.

KeywordsNon Hodgkin lymphoma Polychlorinated biphenyls DDE HCB Organochlorines EnviroGenoMarkers AbbreviationsBDE-472,2-,4,4-Tetrabromodiphenyl ether

BMIBody mass index

CLL-SLLChronic lymphocytic leukemia- small lymphocytic lymphoma



DLBCLDiffuse large B-cell lymphoma

EPICEuropean Prospective Investigation into Cancer

FLFollicular lymphoma

GCGas chromatography



LOQLimit of quantification

MMMultiple myeloma

MSMass spectrometry

NHLNon-Hodgkin lymphoma

NSHDSNorthern Sweden Health and Disease Study

PCBPolychlorinated biphenyl

POPPersistent organic pollutant

SEERSurveillance, epidemiology, and end results program

Electronic supplementary materialThe online version of this article doi:10.1186-s12940-017-0214-8 contains supplementary material, which is available to authorized users.

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Autor: Rachel S. Kelly - Hannu Kiviranta - Ingvar A. Bergdahl - Domenico Palli - Ann-Sofie Johansson - Maria Botsivali - Paolo V


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