Affiliations of authors: A. Tavani, M. Soler, Istituto di Ricerche Farmacologiche "Mario Negri," Milan, Italy; C. La Vecchia, Istituto di Ricerche Farmacologiche "Mario Negri," Milan, and Istituto di Statistica Medica e Biometria, University of Milan; S. Franceschi, Centro di Riferimento Oncologico, Aviano, Italy.
Correspondence to: Alessandra Tavani, Istituto di Ricerche Farmacologiche "Mario Negri," Via Eritrea 62, 20157 Milan, Italy (e-mail: tavani{at}irfmn.mnegri.it).
A population-based case-control study of non-Hodgkin's lymphoma (NHL) from Los Angeles County (1), based on 378 HIV seronegative case subjects, found no association between history of blood transfusion and risk of NHL. The odds ratio (OR) was 1.15 for any transfusion and was similar for patients with one or more transfusions, for men and women, and when subjects given a transfusion 3 years or less before the admission diagnosis were excluded.
In view of the overall evidence, the issue is still open to discussion. A study based on a Swedish cohort of blood recipients (2) found a higher incidence of NHL than in the general population (standard morbidity ratio = 2.70), and the Iowa Women's Health Study (3) found a significantly increased relative risk (RR) of 1.66, based on 114 cases of NHL. Likewise, a Swedish case-control study (4) based on 280 case patients of NHL found an OR of 1.74. However, no association was observed in a case-control study nested in another Swedish cohort (5), based on 361 case patients with NHL (OR = 0.93), and a moderate, statistically nonsignificant increased risk was found in a British cohort of infants transfused at birth (RR = 2.16) (6). No association was observed between transfusions and risk of soft tissue sarcoma (STS) (2,4), and scanty information is available on the relation of transfusions with Hodgkin's disease.
We analyzed the relation between blood transfusion and risk of lymphoid neoplasms in a
case-control study carried out in the greater Milan area and Pordenone, northern Italy, between
1984 and 1998 (7). Case subjects were 385 patients with incident,
histologically confirmed NHL (222 men and 163 women, median age 57 years, range 18-79
years), 201 with Hodgkin's disease (119 men and 82 women, median age 43 years, range
14-77 years), and 217 with STS (113 men and 104 women, median age 53 years, range 16-79
years). Control subjects were 1297 individuals (788 men and 509 women, median age 54 years,
range 17-79 years) admitted to the same hospitals for a wide spectrum of acute nonneoplastic,
nonimmune-related conditions (24% traumas, 27% other orthopedic disorders,
28% acute surgical conditions, 21% miscellaneous illnesses). Trained interviewers
collected information in the hospital by use of a structured questionnaire that sought data on,
among other things, blood transfusions in the past (more than 3 months previously) or recently
(within 3 months before diagnosis). Twenty-six (7%) patients with NHL, 18 (9%)
patients with Hodgkin's disease, 30 (14%) patients with STS, and 131 (10%)
control subjects reported a blood transfusion more than 3 months earlier (Table 1). The multivariate ORs were 0.6 for NHL, 1.0 for Hodgkin's disease, and 1.3
for STS; none of the estimates was statistically significant. Separate analysis in men and women
showed no heterogeneity. With reference to transfusions within the last 3 months, there was a
strong association with the risk of NHL (OR = 4.1), and some moderate statistically
nonsignificant increased risk of Hodgkin's disease (OR = 1.7) and STS (OR
= 1.3).
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NOTES
Supported by contributions from the Italian Association for Cancer Research, Milan.
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