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- Title
Association of Occupational Pesticide Exposure With Immunochemotherapy Response and Survival Among Patients With Diffuse Large B-Cell Lymphoma.
- Authors
Lamure, Sylvain; Carles, Camille; Aquereburu, Quam; Quittet, Philippe; Tchernonog, Emmanuelle; Paul, Franciane; Jourdan, Eric; Waultier, Agathe; Defez, Christine; Belhadj, Ihssen; Sanhes, Laurence; Burcheri, Sara; Donadio, Daniel; Exbrayat, Carole; Saad, Alain; Labourey, Jean-Luc; Baldi, Isabelle; Cartron, Guillaume; Fabbro-Peray, Pascale
- Abstract
This cohort study examines the association of occupational exposure to pesticides with immunochemotherapy response and survival in patients in France treated for diffuse large B-cell lymphoma (DLBCL). Key Points: Question: What is the prognosis of patients treated for diffuse large B-cell lymphoma (DLBCL) with a history of occupational exposure to pesticides? Findings: In this cohort study of 244 patients treated for DLBCL, 67 patients were exposed to pesticides, with 38 exposed through agricultural occupations. The treatment failure rate was significantly higher among exposed patients compared with nonexposed patients after adjusting for potential confounding factors; the association was stronger when patients with exposing agricultural occupations were compared with those with nonexposing occupations. Meaning: Professional exposure to pesticides may be an independent risk factor for treatment failure in DLBCL. 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.
- Subjects
FRANCE; ANTHRACYCLINES; ACADEMIC medical centers; AGRICULTURE; B cell lymphoma; CHI-squared test; COMPARATIVE studies; CONFIDENCE intervals; DOSE-response relationship in biochemistry; FISHER exact test; IMMUNOTHERAPY; LONGITUDINAL method; MEDICAL cooperation; MUTAGENICITY testing; PESTICIDES; RESEARCH; RESEARCH funding; SURVIVAL analysis (Biometry); T-test (Statistics); OCCUPATIONAL hazards; ENVIRONMENTAL exposure; TREATMENT effectiveness; PROPORTIONAL hazards models; RETROSPECTIVE studies; DISEASE progression; DATA analysis software; ODDS ratio; MANN Whitney U Test; EVALUATION; PROGNOSIS; THERAPEUTICS
- Publication
JAMA Network Open, 2019, Vol 2, Issue 4, pe192093
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2019.2093