To explore the link between COVID-19 incidence, socio-economic covariates, and NHL incidence.
Ecological study design.
Sardinia, Italy.
We used official reports on the total cases of COVID-19 in ...2020, published data on NHL incidence, and socio-economic indicators by administrative unit, covering the whole regional population.
We used multivariable regression analysis to explore the association between the natural logarithm (ln) of the 2020 cumulative incidence of COVID-19 and the ln-transformed NHL incidence in 1974-2003, weighing by population size and adjusting by socioeconomic deprivation and other covariates.
The cumulative incidence of COVID-19 increased in relation to past incidence of NHL (p < 0.001), socioeconomic deprivation (p = 0.006), and proportion of elderly residents (p < 0.001) and decreased with urban residency (p = 0.001). Several sensitivity analyses confirmed the finding of an association between COVID-19 and NHL.
This ecological study found an ecological association between NHL and COVID-19. If further investigation would confirm our findings, shared susceptibility factors should be investigated among the plausible underlying mechanisms.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The causes of the peculiar time trend in the incidence of non-Hodgkin's lymphoma (NHL) in most parts of the world and of its geographic distribution are still unknown. We used the data base of ...1974-2003 incident cases of hematological malignancies to explore the time trend of NHL incidence in the region of Sardinia, Italy, and we used Bayesian methods to plot the probability of NHL incidence by residential unit on the regional map. In 1974-2003, 4109 NHL cases were diagnosed among resident adults in Sardinia, with an incidence rate of 13.38 x 10-5 (95% CI 12.97-13.80). NHL incidence showed an upward trend along the study period with an average annual percent change (APC) of 4.94 (95% CI -5.39-16.4), which did not vary by gender or by age-group. Cancer registry data, covering part of the region starting from 1993, suggest that the increasing trend did not persist in the subsequent years. Areas with the highest probability of an excess incidence tended to cluster in the north-eastern part of the region and in two major urban centers, with the low incidence areas located in the south, confirming previous observations. Prevalence of viral infections, environmental and occupational exposures, or socio-economic deprivation would not explain the peculiar geographic distribution we observed. These findings provide convincing arguments for extending the coverage of routine cancer registration over the whole Sardinian population, while prompting further research on the genetic and environmental determinants of NHL in the risk areas.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
A few reports have described increasing trends and spatial distribution of multiple myeloma (MM). We used a validated database including the 1606 cases of MM diagnosed in Sardinia in 1974-2003 to ...explore its time trend, and we applied Bayesian methods to plot MM probability by administrative unit on the regional map. Over the 30 years of observation, the MM standardized incidence rate (standard world population, all ages) was 2.17 × 10
(95% CI 2.01-2.34), 2.29 (95% CI 2.06-2.52) among men, and 2.06 (95% CI 1.83-2.28) among women. MM incidence increased by 3.3%/year in 1974-2003, in both males and females, particularly among the elderly and in the high incidence areas. Areas at risk tended to cluster in the north-eastern part of the region. A higher proportion of elderly in the resident population, but not socioeconomic factors, nor livestock farming, was associated with higher incidence rates. The steep upward time trend and the spatial clustering of MM suggest interactions between genetic and environmental determinants that might be more efficiently investigated in the areas at risk.
Background
The epidemiology of myeloid hematologic malignancies in Italy has been poorly investigated.
Methods
We used a validated database of 1974-2003 incident cases of hematologic malignancies ...among the resident population (all ages) of Sardinia, Italy, to describe the incidence of myeloid malignancies overall (N = 4389 cases) and by subtype. We investigated the time trend of acute myeloid leukemia (N = 1227 cases), chronic myeloid leukemia (N = 613 cases), and myelodysplastic syndrome (N = 1296 cases), and used Bayesian methods to explore their geographic spread, and Poisson regression analysis to estimate their association with environmental and socio-economic factors.
Results
The annual standardized (world population) incidence rate (IR) of myeloid malignancies over the study period was 6.5 per 100,000 (95% CI 6.2-6.7). Myelodysplastic syndromes were the most prevalent subgroup (IR = 1.7, 95% CI 1.5-1.8). Incidence of all myeloid malignancies combined increased sharply during the study period with an annual percent change (APC) of 10.06% (95% CI 9.51-10.61), 19.77% for myelodysplastic syndromes (95% CI 19.63-19.91), and 3.18% (95% CI 2.99-3.37) for acute myeloid leukemia. Chronic myeloid leukemia did not show an upward trend. Apart from sporadic excesses in small rural communities and the major urban area, there was no evidence of spatial clustering. The risk of myeloid malignancies increased with increasing prevalence of sheep breeding.
Conclusions
Our results might prompt further research on the local genetic and environmental determinants of myeloid hematologic malignancies.
ObjectivesTo explore the time trend and geographical distribution of childhood leukaemia incidence over the territory of the Italian region of Sardinia.SettingAll hospitals departments, diagnostic ...centres and social security agencies in Sardinia were regularly screened in 1974–2003 to identify, register and review the diagnoses of incident cases of haematological malignancies (HM).ParticipantsThe whole child population aged 0–14 resident in Sardinia.Primary and secondary outcome measuresIncidence and time trend of childhood HM and childhood acute lymphoblastic leukaemia (ALL) over the study period, and use of Bayesian methods to plot the probability of areas with excess incidence on the regional map.ResultsOverall, 675 HM cases, including 378 ALL cases, occurred among children aged 0–14 years resident in Sardinia in 1974–2003, with an incidence rate of 6.97×10-5 (95% CI 6.47 to 7.51) and 3.85×10-5 (95% CI 3.48 to 4.26), respectively. Incidence of HM and ALL showed an upward trend along the study period especially among females. Three communes out of the 356 existing in 1974, namely Ittiri, Villa San Pietro and Carbonia, stand out as areas with excess incidence of HM and ALL in particular and another, Carloforte, for ALL only.ConclusionsOur results might serve as convincing arguments for extending the coverage of routine cancer registration over the whole Sardinian population, while prompting further research on the genetic and environmental determinants in the areas at risk.
•In Sardinia, Italy, chronic lymphocytic leukemia (CLL) incidence increased 5.5%/year during 1974–2003.•CLL risk was elevated in five sparse communes and urban areas.•Risk increased with distance ...from hospitals and cork harvesting.
Several reports have described a worldwide increasing incidence of chronic lymphocytic leukemia (CLL) dating back seven to eight decades. Although genetic susceptibility would be an implausible explanation, the determinants of this upward trend and its spatial coordinates are poorly understood. We explored CLL incidence in Sardinia, Italy, using a validated database including the 1700 CLL cases diagnosed during 1974–2003. We applied Bayesian methods to map the CLL probability by administrative unit and Poisson regression analysis to investigate socioeconomic and environmental determinants adjusting by possible confounders. The standardized (Standard European population) incidence rate for the Sardinian population over the study period was 5.1 per 100,000 (95% confidence interval CI 4.9–5.3), increased annually by 5.8% (95% CI 5.7–6.0) consistently by sex and age, and was more noticeable in urban areas. Five administrative units exceeded the 95% posterior probability of an elevated CLL incidence: these were rural areas spread over the regional territory, not suggestive of spatial clustering. The Poisson regression analysis showed that the risk was elevated in urban areas (RR = 1.11, 95% CI 1.05–1.17), among residents ≥ 30 km from the nearest hospital (RR = 1.09, 95% CI 1.06–1.12), and with the local prevalence of cork harvesting (RR = 1.62, 95% CI 1.12–2.34). Our results suggest that better access to health care facilities and improvements in diagnostic efficacy might have generated the observed upward trend in CLL incidence, along with contributing environmental factors.
From the Dept. of Hematology, Edouard Herriot Hospital, Lyon, France (XT); EORTC data Center, Brussels, Belgium (SS); Dept. of Hematology, Hôtel-Dieu Hospital, Paris, France (BR); Dept. of ...Hematology, Catholic University, Rome, Italy (GL); Dept. of Hematology, A.Businco Hospital, Cagliari, Italy (GB); Dept. of Hematoo-Oncology, CHU Sart-Tilman, Liège, Belgium (GF); Dept. of Hematology, Klinikum Grosshadern Ludwig-Maximilians, Munich, Germany (UJ); Dept. of Hematology, Erasme University Hospital, Brussels, Belgium (WF); Dept. of Hematology, Universita Degli Study "La Sapienza", Rome, Italy (GM); GIMEMA Data Center, Universita Degli Study "La Sapienza", Rome, Italy (MV); Dept. of Hematology, University Medical Center Nijmegen, Nijmegen, The Netherlands (TdW); Dept. of Hematology, University Tor Vergata, Rome, Italy(SA).
Correspondence:, Xavier Thomas, M.D., Ph.D., Department, of Hematology, Edouard Herriot Hospital, 69437 Lyon cedex 03, France., E-mail: xavier.thomas{at}chu-lyon.fr
Background and Objectives: The optimal post-remission treatment for elderly patients with acute myeloid leukemia (AML) is presently unknown. Recent studies have reported the feasibility of autologous peripheral blood stem cell transplantation (PBSCT) in this population. We evaluate the outcome of this post-remission approach after complete remission (CR) and consolidation in elderly patients included in the EORTC – GIMEMA AML – 13 trial.
Design and Methods: PBSCT after induction and consolidation chemotherapy was evaluated in patients aged 61 to 70 years old with a WHO performance status 0–1. The induction therapy was mitoxantrone, etoposide and cytarabine (MICE) with or without granulocyte colony-stimulating factor (G-CSF) during and/or after chemotherapy. The consolidation therapy consisted of non-infusional or infusional idarubicin, etposide and cytarabine (mini-ICE).
Results: Sixty-one patients were scheduled for stem cell harvest by leukapheresis after s.c. recombinant human G-CSF administration initiated after hematopoietic recovery from consolidation. Stem cells were effectively harvested from 54 patients. A median of two aphereses (range, 1–5) were performed, resulting in a median collection of 11.7 x 10 8 nucleated cells/kg (range, 2.4–99.8) containing 40.2 x 10 4 CFU-GM/kg (range, 0–786.8), and 5 x 10 6 CD34 + cells/kg (range, 0.1–99.8). For the whole group of 61 patients, the median disease-free survival (DFS) was 1.0 years and the 3-year DFS rate was 21%, while the median overall survival (OS) was 1.4 years and the 3-year OS rate was 32%. A total of 26 patients could not be autografed due to inadequate/no harvest (21 patients), early relapse (3 patients), or treatment refusal (2 patients). Autologous transplantation was performed in 35 patients following conditioning with the BAVC regimen. The median time for granulocyte recovery >0.5 x 10 9 /L was 24 days and for platelets >20 x 10 9 /L was 23 days following transplantation. After a median follow-up of 5.0 years from transplantation, the median DFS and OS were 1.1 and 1.6 years, respectively, and the 3-year rates were 28% and 39%, respectively. Eight autografted patients were still in continuous complete remission, 22 patients had relapsed and five had died in CR.
Interpretation and Conclusions: Intensification of remission treatment including autologous PBSCT was feasible in about half of harvested patients aged 61 to 70 years old, and did not improve the general outcome. This shows the limitations of autologous PBSCT and other intensive treatment modalities in elderly AML patients.
Key words: acute myeloid leukemia, elderly, autologous stem cell transplantation.
Using a database of 1974-2003 incident cases of haematological malignancies, we explored the time trend, geographic spread and socio-economic and environmental correlates of ALL incidence in ...Sardinia, Italy, by sex and age. The age- and sex-standardized (World population) ALL incidence rate was 2.0 per 100,000 (95% CI 1.8 – 2.1) and showed variable trend patterns by sex and age. In the total population, ALL incidence showed an annual per cent change of -1.4% (95% CI 0.59 - 3.34) over the study period, with a knot separating a downward slope in 1974-1996 from an increase in 1996-2003. ALL incidence replicated such pattern in women but not men, whose incidence did not vary over the study period (APC = -2.57%, 95% CI -5.45 - 0.26). Among women, the spatial analysis suggested a clustering of ALL in the southwestern part of the region, whilst only a commune had a high posterior probability of a high ALL incidence among men. Three unrelated communes showed a high posterior probability of ALL at age ≤ 24; only the most populated urban centre showed excess cases at age ≥ 25 years. There was no correlation between the geographic spread of ALL at ages ≤ 24 and ≥ 25 years (p = 0.082). Urban residence was a risk factor for the younger age group. Residences near industrial settlements and in the most populated urban centre were risk factors for subjects aged ≥ 25 years. Our findings suggest age-related differences in ALL aetiology.
•In Sardinia, Italy, time trends in ALL incidence differed by age and sex.•The ALL risk at age ≤ 24 was elevated in 3 sparse communes.•At age ≥ 25 years, only the major urban area showed a high risk of ALL.•The geographic spread of ALL at age ≤ 24 and ≥ 25 years were unrelated.•ALL risk at age ≥ 25 increased in proximity of industrial settlements.
: The epidemiological investigation of Hodgkin's lymphoma (HL) among the genetically peculiar population of the Italian island of Sardinia might provide interesting etiological clues.
: We used the ...database of 1974–2003 incident cases of hematological malignancies in Sardinia and Bayesian methods to explore the time trend and geographic spread of HL incidence by sex, and age whether ≤44 or ≥45 years. We also tested its association with several socio-economic and environmental risk factors.
: The age- and sex-standardized (world population) incidence rate of HL was 2.6 per 100,000 (95% CI, 2.5–2.8). Over the study period, HL incidence increased linearly in both sexes and among those aged ≤44 years but not above that age. Cases clustered among young women in a central-western area covering four bordering administrative units (13 cases vs. 5.7 expected, P = 0.002). The posterior probability of excess HL cases aged ≤44 years was elevated only in a commune in the suburban area of the region's capital. Cases aged ≥45 years were uniformly spread over the region. Among the risk factors we explored, urban residence was associated with an elevated and goat farming with a decreased risk of HL occurrence. We did not observe a link with socio-economic deprivation, environmental exposures, or multiple sclerosis. The geographic spread of COVID-19 was also unrelated to past HL incidence.
: Our results prompt further in-depth investigation into the previously undetected cluster and the nature of the observed associations.
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