AIDS-related Burkitt lymphoma in the United States: what do age and CD4 lymphocyte patterns tell us about etiology and/or biology?
Trimodal or bimodal age-specific incidence rates for Burkitt lymphoma (BL) were observed in the United States general population, but the role of immunosuppression could not be excluded. Incidence rates, rate ratios, and 95% confidence intervals for BL and other non-Hodgkin lymphoma (NHL), by age and CD4 lymphocyte count categories, were estimated using Poisson regression models using data from the United States HIV/AIDS Cancer Match study (1980-2005). BL incidence was 22 cases per 100 000 person-years and 586 for non-BL NHL. Adjusted BL incidence rate ratio among males was 1.6× that among females and among non-Hispanic blacks, 0.4× that among non-Hispanic whites, but unrelated to HIV-transmission category. Non-BL NHL incidence increased from childhood to adulthood; in contrast, 2 age-specific incidence peaks during the pediatric and adult/geriatric years were observed for BL. Non-BL NHL incidence rose steadily with decreasing CD4 lymphocyte counts; in contrast, BL incidence was lowest among people with ≤ 50 CD4 lymphocytes/μL versus those with ≥ 250 CD4 lymphocytes/μL (incidence rate ratio 0.3 [95% confidence interval = 0.2-0.6]). The bimodal peaks for BL, in contrast to non-BL NHL, suggest effects of noncumulative risk factors at different ages. Underascertainment or biological reasons may account for BL deficit at low CD4 lymphocyte counts.
Guech-Ongey
Mercy
M
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA. guechome@mail.nih.gov
Simard
Edgar P
EP
Anderson
William F
WF
Engels
Eric A
EA
Bhatia
Kishor
K
Devesa
Susan S
SS
Mbulaiteye
Sam M
SM
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002051:Burkitt Lymphoma / Q000453:epidemiology* / Q000276:immunology* / Q000473:pathology; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016483:Lymphoma, AIDS-Related / Q000453:epidemiology* / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014481:United States / Q000453:epidemiology; D055815:Young Adult
IARC Sci Publ. 1985;(60):217-24
4065946
Nature. 1993 Mar 25;362(6418):355-8
8455722
Nat Rev Microbiol. 2005 Feb;3(2):182-7
15685227
AIDS. 2006 Aug 1;20(12):1645-54
16868446
Eur J Cancer. 1972 Jun;8(3):305-8
4677829
Semin Cancer Biol. 2009 Dec;19(6):347-50
19607918
AIDS. 2007 Nov 12;21(17):2265-70
18090274
Lancet. 1998 Jun 20;351(9119):1833-9
9652666
Stat Med. 1995 Mar 15-Apr 15;14(5-7):491-8
7792443
Am J Med. 2001 Dec 15;111(9):704-11
11747850
Curr Opin HIV AIDS. 2009 May;4(3):183-7
19532048
J Clin Oncol. 1993 Jun;11(6):1099-107
8099121
Ann Intern Med. 1969 Apr;70(4):817-32
4306129
J Biol Chem. 1999 Jun 25;274(26):18470-6
10373455
PLoS Med. 2009 Jul 7;6(7):e1000107
19582166
Proc Natl Acad Sci U S A. 1991 Nov 1;88(21):9838-42
1682922
J Natl Cancer Inst. 2007 Jun 20;99(12):962-72
17565153
Pediatr Blood Cancer. 2009 Sep;53(3):366-70
19434731
Int J Cancer. 2008 Dec 1;123(11):2658-63
18767045
Nature. 1972 May 5;237(5349):33-4
4113130
Oncologist. 2006 Apr;11(4):375-83
16614233
Cancer. 1957 Sep-Oct;10(5):1045-54
13472655
Int J Cancer. 2009 Apr 15;124(8):1745-55
19165855
Int J Cancer. 2009 Apr 1;124(7):1497-502
19089924
MMWR Morb Mortal Wkly Rep. 2006 Jun 2;55(21):589-92
16741494
Int J Cancer. 2010 Apr 1;126(7):1732-9
19810101
Immunity. 2007 Aug;27(2):190-202
17723214
MMWR Suppl. 1987 Dec 25;36(7):1S-20S
2826984
Prev Med. 1995 Jul;24(4):375-7
7479628
Blood. 1999 Jan 15;93(2):758
10215347
JAMA. 2001 Apr 4;285(13):1736-45
11277828
Proc Natl Acad Sci U S A. 1995 Jul 3;92(14):6577-81
7604036
Am J Epidemiol. 1995 Feb 15;141(4):300-4
7840107
Blood. 1999 Feb 1;93(3):1124
10025990
J Natl Cancer Inst. 1974 May;52(5):1397-401
4406651