On the aetiology of Hodgkin lymphoma.

摘要: The thesis is based on seven publications in English and a review of the literature. studies were carried out to contribute understanding Hodgkin lymphoma epidemiology through descriptions its occurrence association with Epstein-Barr virus (EBV) infection presenting as infectious mononucleosis. investigations supported by Danish Cancer Society, Swedish Research Foundation, Nordic Union, Lundbeck Plan Danmark, National Lily Benthine Lund's Aase og Ejnar Danielsen's Grosserer L. F. Foght's Leukaemia Reseach Fund, Kay Kendall U.S. Institutes Health. work was period 1999-2010 during my employment at Department Epidemiology Statens Serum Institut. employed study designs included population-based incidence surveys countries Singapore, register-based cohort characterise pattern cancer patients mononucleosis their first degree relatives, case-control between taking tumour EBV-status into consideration, case-series analysis assess HLA class I alleles EBV-positive EBV-negative lymphomas. Analyses data demonstrated that had increased markedly younger adults 1978-97, whereas it decreased among older adults. In combination, these developments led an accentuation adult peak, which has been hallmark Western hemisphere for more than half century. opposing trends are consistent prevailing hypothesis aetiological heterogeneity lymphomas different age groups. contrast industrialised countries, absence peak characteristic developing Asian populations. A survey Singapore 1968-2002 revealed increasing rates emergence appearance conjunction socio-economic transition towards world lifestyle compatible suspicion associated correlates socioeconomic affluence childhood, such delayed exposure childhood agents. EBV can be malignant cells subset speculated virus' presence may distinguish aetiologically separate entities. This possibility explored five characterising lymphoma. studies, not accompanied risk general, but specifically time since because typical adolescent most prominent Supplementing provided little support notion observed explained confounding or biases. stratified status indicated after confined harbour cells. genetic analyses pointed HLA-A*01 HLA-A*02 alleles, respectively. two abrogated effect. immunological model according level circulating infected lymphocyte regulated cytotoxic T-cell responses critical determinant disease risk. Overall, favour causally development circumstances under ubiquitous leads must future should include gene-environment interactions. Meanwhile, aetiology remains elusive. Possible clinical implications also considered assessed.