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STUDY OF RISK FACTORS OF B-CELL NON-HODGKIN
LYMPHOMA (NHL) IN THE CALIFORNIA TEACHERS STUDY
by
Yani Lu
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(EPIDEMIOLOGY)
August 2009
Copyright 2009 Yani Lu
Object Description
| Title | Study of risk factors of B-cell non-Hodgkin lymphoma (NHL) in the California Teachers Study |
| Author | Lu, Yani |
| Author email | yanilucoh@gmail.com; yanilu@usc.edu |
| Degree | Doctor of Philosophy |
| Document type | Dissertation |
| Degree program | Preventive Medicine (Health Behavior) |
| School | Keck School of Medicine |
| Date defended/completed | 2009-06-10 |
| Date submitted | 2009 |
| Restricted until | Unrestricted |
| Date published | 2009-08-04 |
| Advisor (committee chair) | Bernstein, Leslie |
| Advisor (committee member) |
Mack, Wendy Deapen, Dennis Taylor, Clive |
| Abstract | The incidence of Non-Hodgkin lymphoma (NHL) has risen for several decades. However, few risk factors have been identified and most of the etiology of NHL has not been explained.; This dissertation presents the results for family history of hematopoietic malignancy, body size, physical activity, and exogenous hormone use on B-cell NHL risk among women aged 22 to 84 years old at cohort entry in the California Teachers Study. Multivariable adjusted relative risks (RR) and 95% confidence intervals (CI) were estimated by fitting Cox proportional hazards models. A history of hematopoietic malignancy in any first-degree relative was associated with increased B-cell NHL risk (RR=1.52, 95% CI=1.11-2.07). Risk patterns vary by type of hematopoietic malignancy and the gender of the relative. Height was positively associated with all B-cell NHL combined (P for trend=0.0002) and B-cell chronic lymphocytic leukemias/small lymphocytic lymphomas (CLL/SLL) subtype (P for trend=0.001). Weight and body mass index (BMI, kg/m2) at age 18 were predictors for B-cell NHL overall. Women who used oral contraceptives (OC) had lower risk of B-cell NHL than women who had never used OC (RR=0.82, 95%CI=0.66-1.03). Although the overall association between B-cell NHL and HT use was null (RR=1.05, 95%CI=0.82-1.34), current users of unopposed estrogen therapy (ET) had greater risk (RR=1.36, 95%CI=1.00-1.87) and current users of estrogen plus progestin therapy (EPT) had lower risk (RR=0.80, 95%CI=0.58-1.10) than women with no HT use. Furthermore, risk of B-cell NHL declined as duration of EPT use increased, whereas no duration of use effect was observed for ET use.; These findings indicate: 1) Family history of hematopoietic malignancy is positively associated with B-cell NHL risk and risk patterns vary by type of hematopoietic malignancy and the gender of the relative; 2) Greater height, which may reflect early life immune function, infectious exposures, nutrition, or growth hormone levels, may play a role in NHL etiology; body size at age 18 may be more relevant to NHL etiology than that in later life; 3) Unopposed estrogen use may increase the risk of B-cell NHL, but combinations of estrogen and progestin, as EPT or OC, may decrease risk. |
| Keyword | non-Hodgkin lymphoma; family history; body size; physical activity; oral contraceptive; menopausal hormonal therapy |
| Geographic subject (state) | California |
| Language | English |
| Part of collection | University of Southern California dissertations and theses |
| Publisher (of the original version) | University of Southern California |
| Place of publication (of the original version) | Los Angeles, California |
| Publisher (of the digital version) | University of Southern California. Libraries |
| Provenance | Electronically uploaded by the author |
| Type | texts |
| Legacy record ID | usctheses-m2467 |
| Rights | Lu, Yani |
| Repository name | Libraries, University of Southern California |
| Repository address | Los Angeles, California |
| Repository email | http://www.usc.edu/isd/libraries/services/ask_a_librarian/email/ |
| Filename | etd-Lu-3156 |
| Archival file | uscthesesreloadpub_Volume51/etd-Lu-3156.pdf |
Description
| Title | Page 1 |
| Full text | STUDY OF RISK FACTORS OF B-CELL NON-HODGKIN LYMPHOMA (NHL) IN THE CALIFORNIA TEACHERS STUDY by Yani Lu A Dissertation Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY (EPIDEMIOLOGY) August 2009 Copyright 2009 Yani Lu |
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