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Lymphoma

Lymphoma and multiple myeloma in cohorts of persons exposed to ionising radiation at a young age

Leukemia volume 35, pages 2906–2916 (2021)Cite this article

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Abstract

There is limited evidence that non-leukaemic lymphoid malignancies are radiogenic. As radiation-related cancer risks are generally higher after childhood exposure, we analysed pooled lymphoid neoplasm data in nine cohorts first exposed to external radiation aged <21 years using active bone marrow (ABM) and, where available, lymphoid system doses, and harmonised outcome classification. Relative and absolute risk models were fitted. Years of entry spanned 1916–1981. At the end of follow-up (mean 42.1 years) there were 593 lymphoma (422 non-Hodgkin (NHL), 107 Hodgkin (HL), 64 uncertain subtype), 66 chronic lymphocytic leukaemia (CLL) and 122 multiple myeloma (MM) deaths and incident cases among 143,136 persons, with mean ABM dose 0.14 Gy (range 0–5.95 Gy) and mean age at first exposure 6.93 years. Excess relative risk (ERR) was not significantly increased for lymphoma (ERR/Gy = −0.001; 95% CI: −0.255, 0.279), HL (ERR/Gy = −0.113; 95% CI: −0.669, 0.709), NHL + CLL (ERR/Gy = 0.099; 95% CI: −0.149, 0.433), NHL (ERR/Gy = 0.068; 95% CI: −0.253, 0.421), CLL (ERR/Gy = 0.320; 95% CI: −0.678, 1.712), or MM (ERR/Gy = 0.149; 95% CI: −0.513, 1.063) (all p-trend > 0.4). In six cohorts with estimates of lymphatic tissue dose, borderline significant increased risks (p-trend = 0.02–0.07) were observed for NHL + CLL, NHL, and CLL. Further pooled epidemiological studies are needed with longer follow-up, central outcome review by expert hematopathologists, and assessment of radiation doses to lymphoid tissues.

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The data is available from the principal author upon request.

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Change history

  • 26 October 2021

    The name tagging of author Amy Berrington de Gonzalez was updated.

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Acknowledgements

This work was supported by the Intramural Research Program of the National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics. The Radiation Effects Research Foundation (RERF), Hiroshima and Nagasaki, Japan is a public interest foundation funded by the Japanese Ministry of Health, Labour and Welfare (MHLW) and the US Department of Energy (DOE). The research was also funded in part through DOE award DE-HS0000031 to the National Academy of Sciences. Dr. Zablotska’s work was supported by National Cancer Institute of the National Institutes of Health under awards R03CA188614 and R01CA197422. This publication was supported by RERF Research Protocol A1-16. The views of the authors do not necessarily reflect those of the two governments.

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Author notes

  1. These authors contributed equally: Mark P. Little, Richard Wakeford

  2. Deceased: Marie Lundell

  3. These authors jointly supervised this work: Benjamin French, Martha S. Linet, Amy Berrington de Gonzalez

Authors and Affiliations

  1. Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA

    Mark P. Little, David Borrego, Keith T. Griffin, Choonsik Lee, Michele M. Doody, Martha S. Linet & Amy Berrington de Gonzalez

  2. Centre for Occupational and Environmental Health, Institute of Population Health, The University of Manchester, Manchester, UK

    Richard Wakeford

  3. Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, CA, USA

    Lydia B. Zablotska

  4. Equipe d’Epidémiologie des radiations, Unité 1018 INSERM, Bâtiment B2M, Institut Gustave Roussy, Villejuif Cedex, France

    Rodrigue S. Allodji & Florent de Vathaire

  5. Radiation Effects Research Foundation, Hiroshima City, Japan

    Alina V. Brenner

  6. Information Management Services, Silver Spring, MD, USA

    Jeremy S. Miller & David Campbell

  7. Israel Ministry of Health, Jerusalem, Israel

    Siegal Sadetzki

  8. Cancer & Radiation Epidemiology Unit, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel-Hashomer, Israel & Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel

    Siegal Sadetzki

  9. Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden

    Erik Holmberg

  10. Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden

    Marie Lundell

  11. University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    Michael Jacob Adams

  12. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    Benjamin French

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Correspondence to Mark P. Little.

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RW receives a consultancy fee as a member of the Technical Working Party of the Compensation Scheme for Radiation-linked Diseases (http://www.csrld.org.uk). No other authors report conflicts of interest.

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The study cohort has been declared exempt by the National Cancer Institute Special Studies Institution Review Board, because using pre-existing approved data. Obtaining informed consent from all study subjects was therefore not necessary.

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Little, M.P., Wakeford, R., Zablotska, L.B. et al. Lymphoma and multiple myeloma in cohorts of persons exposed to ionising radiation at a young age. Leukemia 35, 2906–2916 (2021). https://doi.org/10.1038/s41375-021-01284-4

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