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


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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Data availability

The data is available from the principal author upon request.

Code availability

All analysis code is available from the principal author upon request.


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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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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 ( 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 (2021).

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