Association of Occupational Pesticide Exposure With Immunochemotherapy Response and Survival Among Patients With Diffuse Large B-Cell Lymphoma
| Autor: | Laurence Sanhes, Isabelle Baldi, Sylvain Lamure, Sara Burcheri, Alain Saad, Agathe Waultier, Franciane Paul, Guillaume Cartron, Philippe Quittet, Quam Aquereburu, C. Defez, Jean-Luc Labourey, Carole Exbrayat, Emmanuelle Tchernonog, Daniel Donadio, Ihssen Belhadj, Pascale Fabbro-Peray, Camille Carles, Eric Jourdan |
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| Přispěvatelé: | Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Département d'hématologie biologique[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-CHU Saint-Eloi, Epidémiologie, santé publique et développement, Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Montpellier (UM), Centre Hospitalier Saint Jean de Perpignan, BESPIM |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty [SDV]Life Sciences [q-bio] Disease-Free Survival 03 medical and health sciences 0302 clinical medicine Risk Factors Occupational Exposure Internal medicine Odds Ratio Humans Medicine Treatment Failure 030212 general & internal medicine Pesticides Risk factor Aged Proportional Hazards Models Retrospective Studies business.industry Proportional hazards model Confounding Hazard ratio Agriculture Retrospective cohort study General Medicine Odds ratio Middle Aged medicine.disease 3. Good health Lymphoma Occupational Diseases 030220 oncology & carcinogenesis Female Immunotherapy Lymphoma Large B-Cell Diffuse business Diffuse large B-cell lymphoma |
| Zdroj: | JAMA Network Open JAMA Network Open, American Medical Association, 2019, 2 (4), pp.e192093. ⟨10.1001/jamanetworkopen.2019.2093⟩ |
| ISSN: | 2574-3805 |
| Popis: | International audience; Importance: Professional use of pesticides is a risk factor for non-Hodgkin lymphoma. The main biological mechanisms of pesticides and chemotherapy are genotoxicity and reactive oxygen species generation. Cellular adaptation among patients exposed to low doses of genotoxic and oxidative compounds might hinder chemotherapy efficiency in patients with lymphoma. Objective: To examine the association of occupational exposure to pesticides with immunochemotherapy response and survival among patients treated for diffuse large B-cell lymphoma. Design, setting, and participants: This retrospective cohort study assessed patients treated from July 1, 2010, to May 31, 2015, for diffuse large B-cell lymphoma, with a 2-year follow-up. The study took place at 6 university and nonuniversity hospitals in Languedoc-Roussillon, France. A total of 404 patients with newly diagnosed diffuse large B-cell lymphoma treated with anthracycline-based immunochemotherapy were included before the study began. Occupational history was reconstructed for 244 patients and analyzed with the PESTIPOP French job-exposure matrix to determine likelihood of occupational exposure to pesticides. Analysis of the data was performed from July 15, 2017, to July 15, 2018. Main outcomes and measures: Treatment failure (ie, partial response, stable disease, disease progression, or interruption for toxic effects) rate, 2-year event-free survival, and overall survival between exposed and nonexposed patients after adjustment for confounding factors. Results: A total of 244 patients (mean [SD] age, 61.3 [15.2] years; 153 [62.7%] male) had complete occupational data. Of these patients, 67 (27.4%) had occupational exposure to pesticides, with 38 exposed through agricultural occupations. Occupational exposure was not associated with clinical and biological characteristics at diagnosis. Occupationally exposed patients had a significantly higher treatment failure rate (22.4% vs 11.3%; P = .03; adjusted odds ratio [AOR] for confounding factors, 3.0; 95% CI, 1.3-6.9); this difference was higher among patients with exposing agricultural occupations compared with other patients (29.0% vs 11.7%; AOR, 5.1; 95% CI, 2.0-12.8). Two-year event-free survival was 70% in the occupationally exposed group vs 82% in the unexposed group (adjusted hazard ratio [AHR] for confounding factors, 2.2; 95% CI, 1.3-3.9). Among patients with exposing agricultural occupations compared with other patients, the difference was more pronounced (2-year event-free survival, 56% vs 83%; AHR, 3.5; 95% CI, 1.9-6.5). Similarly, 2-year overall survival was lower in the group of patients with exposing agricultural occupations compared with other patients (81% vs 92%; AHR, 3.9; 95% CI, 1.5-10.0). Conclusions and relevance: This retrospective study showed that agricultural occupational exposure to pesticides was associated with treatment failure, event-free survival, and overall survival among patients with diffuse large B-cell lymphoma. |
| Databáze: | OpenAIRE |
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