Non-Hodgkin Lymphoma in the Middle East Is Characterized by Low Incidence Rates With Advancing Age

Abstract

PURPOSE In the Middle East, incidence rate ratios (IRRs) of non-Hodgkin lymphoma (NHL) to Hodgkin lymphoma (HL) are more than 50% lower than the United States. MATERIALS AND METHODS Age-specific incidence rates (ASIRs), age-adjusted incidence rates (AAIRs), and IRRs of NHL:HL were compared using the cancer registries of Iraq, Jordan, Saudi Arabia, and US SEER. RESULTS The NHL AAIR (95% CI) per 100,000 population was 4.4 (4.1 to 4.7) for Iraq, 5.4 (4.6 to 6.2) for Jordan, 4.7 (4.4 to 5.1) for Saudi Arabia, and 13.2 (13.0 to 13.4) for the United States. The HL AAIR was 1.8 (1.6 to 2.0) for Iraq, 1.8 (1.4 to 2.2) for Jordan, 2.1 (1.9 to 2.2) for Saudi Arabia, and 2.3 (2.2 to 2.4) for the United States, with respective NHL:HL IRR of 2.4 (2.2 to 2.7), 3.0 (2.4 to 3.8), 2.2 (2.0 to 2.5), and 5.7 (5.5 to 6.0). NHL ASIRs for the Middle East and the United States were similar until 30 to 39 years of age. Thereafter, ASIR of NHL peaked at 20 to 33 per 100,000 at age 70 years in the Middle East regions, all much lower than the US age 70 years rate of greater than 100 per 100,000. Diffuse large B-cell lymphoma (DLBCL) represented 52% of NHL in Sulaimaniyah Province of Iraq and 51% of NHL in Saudi Arabia. Both regions had AAIR for DLBCL less than 42% of DLBCL in US SEER. Pediatric Epstein-Barr virus–related Burkitt’s lymphoma at 8% was the second most frequent NHL in Sulaimaniyah but made little contribution to overall NHL rates. CONCLUSION The incidence of HL was slightly lower than in the United States, but it was the markedly lower rates of adult NHL with advancing age, including the predominant DLBCL, that accounted for the low NHL:HL IRR in these Middle Eastern countries.

Response to Rituximab in Non-Hodgkin Lymphoma Patients at National Oncology Center, Aden, Yemen, 2017-2020: Retrospective Cohort Study

“…Diffuse large B cell lymphoma was the most frequent subtype of NHL in our study; this result is similar to a study conducted in Hadramoot Yemen, Aseer Saudia Arabia, and a previous study Middle East region [14,18,23]. This is due to DLBCL being the most common form of lymphoma that represents about 30% of NHL [24].…”

Cytomegalovirus infection may be oncoprotective against neoplasms of B-lymphocyte lineage: single-institution experience and survey of global evidence

“…[ 36 ] Middle East ¶ (Iraq, Jordan, S. Arabia) 90 9.12 < 0.05 Yaqo et al . [ 57 ] Sub-Saharan Africa ~ 92 7.2 < 0.05 Tomoka et al . [ 81 ] Hong Kong > 90 11.49 < 0.05 Bassig et al .…”

Epstein-Barr virus and Burkitt’s lymphoma. Associations in Iraqi Kurdistan and twenty-two countries assessed in the International Incidence of Childhood Cancer

“…While pediatric BL has a generally uniform histologic and clinical appearance, BL in adults can present challenges that may not be adequately addressed in current Middle East pathology practices. The WHO classification of lymphoid neoplasms was introduced into the region around 2010, and the complexity of the classification can be difficult for a general pathologist anywhere [ 9 ]. BL is defined as a high proliferation rate mature B-cell lymphoma with an isolated MYC translocation [ 2 , 5 ].…”

“…We believe this BL is a sporadic disease, with EBV being the only identifiable promoting factor. Most of the Middle East, including Iraq, has been malaria-free since the late 1990s, and non-Hodgkin lymphomas associated with other infections such as human herpes virus-8, Helicobacter pylori, and hepatitis B and C are uncommon [ 9 , 51 ].…”

“…In a previous publication, we analyzed rates of lymphoma in Iraqi Kurdistan over the years 2010-2014 and suggested that our BL might be four times as frequent as it is in children of similar age in the United States (US) [ 9 ]. BL in the Middle East may have elements of an endemic disease; nevertheless, no coexisting infection or promoting factor other than EBV has ever been identified [ 8 – 10 ].…”