The impact of Agent Orange exposure on prognosis and management in patients with chronic lymphocytic leukemia: a National Veteran Affairs Tumor Registry Study

Mescher, Craig; Gilbertson, David T.; Randall, Nicole; Tarchand, Gobind; Tomaska, Julie; Kreuziger, Lisa Baumann; Morrison, Vicki A.

doi:10.1080/10428194.2017.1375109

Cited by 7 publications

(3 citation statements)

References 17 publications

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“…46 The data suggest that Agent Orange exposure is associated with a younger age at CLL diagnosis but does not lead to poor prognosis or worsened overall survival. 47 Whether radiation exposure can promote CLL development is not fully understood. Initially the lack of CLL cases in Japan after the bombing of Hiroshima and Nagasaki, and the absence of CLL in short-term follow-up of people exposed to radiation for benign conditions, suggested that radiation does not cause CLL.…”

Section: Environmental Risksmentioning

confidence: 99%

Clinical Risks for Chronic Lymphocytic Leukemia

Brown

2024

Journal of the National Comprehensive Cancer Network

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Our understanding of risk factors for the development of chronic lymphocytic leukemia (CLL) is still incomplete and includes genetic and environmental factors. CLL is one of the most familial of all cancers, yet common high-penetrance risk alleles have not been identified. Genome-wide association studies have identified many common variants with low relative risks, whereas exome-wide rare variant analysis has implicated ATM in CLL causation. Environmental factors have also been challenging to identify given the limited understanding of the relevant time period of exposure relative to diagnosis, and the inability to quantify past exposures. Agent Orange and glyphosate herbicides have perhaps the most data to support their role. CLL is preceded by a precursor condition called monoclonal B-cell lymphocytosis (MBL), which could therefore be considered a risk factor, but which itself is likely caused by the same risk factors that ultimately give rise to CLL. Although virtually all people with CLL have a preceding MBL phase, most people with MBL will not develop CLL.

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Section: Environmental Risksmentioning

confidence: 99%

Clinical Risks for Chronic Lymphocytic Leukemia

Brown

2024

Journal of the National Comprehensive Cancer Network

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“…Exposure to pesticides, specifically deltamethrin (Leon et al 2019), and herbicides (Alavanja et al 2014;Coggon et al 2015) has been associated with the development of CLL; the most convincing is Agent Orange used during the Vietnam War (Baumann Kreuziger et al 2014;Mescher et al 2018). Radon exposure has shown a similar relationship (Schwartz and Klug 2016).…”

Section: Environmental Considerationsmentioning

confidence: 99%

Chronic Lymphocytic Leukemia

Chiorazzi

Chen

Kanti

2020

Cold Spring Harb Perspect Med

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“…Studies have assessed the link between AO and MGUS as well as AO to various leukemias, such as chronic lymphocytic leukemia. 8,9 Other studies have shown the relationship between AO exposure and worse outcomes in persons with MM. 10 To date, only a single abstract from a US Department of Veterans Affairs (VA) medical center has investigated the relationships between AO exposure and MGUS, MM, and the rate of transformation.…”

Section: Introductionmentioning

confidence: 99%

Agent Orange Exposure, Transformation From MGUS to Multiple Myeloma, and Outcomes in Veterans

Dodlapati¹

2022

Federal Practitioner

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Background: Multiple myeloma (MM) accounts for 1% to 2% of all cancers. Exposure to the pesticide Agent Orange (AO) has been established as a potential risk factor for the development of monoclonal gammopathy of undetermined significance (MGUS) and, subsequently, MM in Vietnam War veterans. Methods: This study explored variation in survival related to AO exposure, transformation from MGUS to MM, and covariates. Vietnam War veterans with MM or MGUS were identified in Veterans Health Administration (VHA) health records data. Cox proportional hazards models analyzed survival as a function of AO, race, ethnicity, body mass index, nicotine dependence, alcohol use disorder, Charlson Comorbidity Index, and treatment. Autologous hematopoietic cell transplantation for MM was defined by procedure codes. Results: In the VHA 16,366 patients were identified: 11,112 patients diagnosed with MGUS and 7261 with MM during fiscal years 2010 to 2015 were identified; 12% (n = 2007) had both diagnoses. No statistically significant difference in the rate of transformation from MGUS to MM in the AO exposed and AO not exposed groups was found. In survival models, AO exposure was associated with slightly lower mortality. Alcohol use disorder, nicotine dependence, older age, and greater comorbidity burden increased mortality risk. Black race, female sex, obesity/overweight, and hematopoietic cell transplantation for patients with MM were protective factors. AO exposure was associated with decreased mortality for both MM/MGUS groups. Transformation increased mortality risk for patients with MGUS and decreased mortality risk for patients with MM. Conclusions: Because AO exposure is a nonmodifiable risk factor, focus should be placed on modifiable risk factors (eg, nicotine dependence, alcohol and drug use disorders, underlying comorbid conditions) as these were associated with worse outcomes. Future studies should examine the correlation of AO exposure, cytogenetics, and clinical outcomes in these veterans to best identify their disease course and optimize their care in the latter part of their life.

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The impact of Agent Orange exposure on prognosis and management in patients with chronic lymphocytic leukemia: a National Veteran Affairs Tumor Registry Study

Cited by 7 publications

References 17 publications

Clinical Risks for Chronic Lymphocytic Leukemia

Clinical Risks for Chronic Lymphocytic Leukemia

Chronic Lymphocytic Leukemia

Agent Orange Exposure, Transformation From MGUS to Multiple Myeloma, and Outcomes in Veterans

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