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Int J Cancer. 2019 May 11. doi: 10.1002/ijc.32393. [Epub ahead of print]

Childhood infectious diseases and risk of non-Hodgkin's lymphoma according to the WHO classification: A reanalysis of the Italian multicenter case-control study.

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Epidemiology and Biostatistics Unit, Scientific Directorate, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Unit of Occupational and Environmental Epidemiology, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy.
ISDE, Associazione Medici per l'Ambiente, Arezzo, Italy.
Azienda Sanitaria Locale di Novara, Novara, Italy.
Biostatistics and Clinical Trials Unit, IRCCS IRST, Meldola, Italy.
Epidemiology and Cancer Registry Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
Healthcare Development and Evaluation Unit, Agency for Health and Social Care, Bologna, Italy.
Cancer Registry and Histopathology Department, Azienda Sanitaria Provinciale, Ragusa, Italy.
Pathology Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
MRC/PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
Clinical Epidemiology, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy.


Since 1960, incidence of non-Hodgkin's lymphoma (NHL) has been increasing in most industrialized countries, but causes of this trend remain unclear. A role of the decreased exposure to infectious agents during childhood has been proposed. Our study evaluates the association between common childhood infectious diseases and the risk of NHL and its major subtypes by a reanalysis of the Italian multicenter case-control study. After exclusion of next-of-kin interviews, 1,193 cases, diagnosed between 1990 and 1993, and 1,708 population-based controls were included in the analyses. OR estimates were obtained by logistic regression, adjusting for gender, age, residence area, education, smoking habit and exposure to radiations, pesticides and aromatic hydrocarbons. Among B-cell lymphomas (n = 1,102) an inverse association was observed for rubella (OR = 0.80, 95% CI: 0.65-0.99), pertussis (OR = 0.74, 95% CI: 0.62-0.88) and any infection (OR = 0.75, 95% CI: 0.61-0.93). A negative trend by number of infections was observed, which was more evident among mature B-cell lymphoma (OR = 0.66 for three infections or more, 95% CI: 0.48-0.90). Our results indicate a potential protective role of common childhood infections in the etiology of B-cell NHL.


NHL subtypes; case-control study; childhood infections


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