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{{Non-Hodgkin lymphoma}}
{{Non-Hodgkin lymphoma}}


{{CMG}}; {{AE}} {{AS}}
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==Overview==
==Overview==
The known risk factors in the development of Hodgkin's lymphoma are weakened immune system, [[autoimmune disorders]], certain infections and previous cancer treatment. Other possible risk factors include family history of Non-Hodgkin lymphoma, exposure to [[pesticides]], exposure to [[trichloroethylene]], [[diet]], [[obesity]], hair dyes, and occupational exposures.
The known risk factors in the development of non-Hodgkin lymphoma are weakened immune system, [[autoimmune disorders]], certain infections, and previous cancer treatment. Other possible risk factors include positive family history of non-Hodgkin lymphoma, exposure to [[pesticides]], exposure to [[trichloroethylene]], [[diet]], [[obesity]], hair dyes, and occupational exposures.
==Risk Factors==
==Risk Factors==
The known risk factors in the development of Hodgkin's lymphoma are weakened immune system, [[autoimmune disorders]], certain infections and previous cancer treatment. Other possible risk factors include family history of Non-Hodgkin lymphoma, exposure to [[pesticides]], exposure to [[trichloroethylene]], [[diet]], [[obesity]], hair dyes, and occupational exposures.<ref name=CCS>{{cite web | title = Canadian Cancer Society Risk factors for non-Hodgkin lymphoma| url =http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/risks/?region=ab}}</ref>
The known risk factors in the development of non-Hodgkin lymphoma are:<ref name="pmid22967995">{{cite journal |vauthors=Kane EV, Bernstein L, Bracci PM, Cerhan JR, Costas L, Dal Maso L, Holly EA, La Vecchia C, Matsuo K, Sanjose S, Spinelli JJ, Wang SS, Zhang Y, Zheng T, Roman E, Kricker A |title=Postmenopausal hormone therapy and non-Hodgkin lymphoma: a pooled analysis of InterLymph case-control studies |journal=Ann. Oncol. |volume=24 |issue=2 |pages=433–41 |date=February 2013 |pmid=22967995 |pmc=3551484 |doi=10.1093/annonc/mds340 |url=}}</ref><ref name="pmid25174033">{{cite journal |vauthors=Skibola CF, Slager SL, Berndt SI, Lightfoot T, Sampson JN, Morton LM, Weisenburger DD |title=Medical history, lifestyle, family history, and occupational risk factors for adult acute lymphocytic leukemia: the InterLymph Non-Hodgkin Lymphoma Subtypes Project |journal=J. Natl. Cancer Inst. Monographs |volume=2014 |issue=48 |pages=125–9 |date=August 2014 |pmid=25174033 |pmc=4155464 |doi=10.1093/jncimonographs/lgu009 |url=}}</ref><ref name="pmid25174026">{{cite journal |vauthors=Bracci PM, Benavente Y, Turner JJ, Paltiel O, Slager SL, Vajdic CM, Norman AD, Cerhan JR, Chiu BC, Becker N, Cocco P, Dogan A, Nieters A, Holly EA, Kane EV, Smedby KE, Maynadié M, Spinelli JJ, Roman E, Glimelius B, Wang SS, Sampson JN, Morton LM, de Sanjosé S |title=Medical history, lifestyle, family history, and occupational risk factors for marginal zone lymphoma: the InterLymph Non-Hodgkin Lymphoma Subtypes Project |journal=J. Natl. Cancer Inst. Monographs |volume=2014 |issue=48 |pages=52–65 |date=August 2014 |pmid=25174026 |pmc=4207869 |doi=10.1093/jncimonographs/lgu011 |url=}}</ref><ref name="pmid25174034">{{cite journal |vauthors=Morton LM, Slager SL, Cerhan JR, Wang SS, Vajdic CM, Skibola CF, Bracci PM, de Sanjosé S, Smedby KE, Chiu BC, Zhang Y, Mbulaiteye SM, Monnereau A, Turner JJ, Clavel J, Adami HO, Chang ET, Glimelius B, Hjalgrim H, Melbye M, Crosignani P, di Lollo S, Miligi L, Nanni O, Ramazzotti V, Rodella S, Costantini AS, Stagnaro E, Tumino R, Vindigni C, Vineis P, Becker N, Benavente Y, Boffetta P, Brennan P, Cocco P, Foretova L, Maynadié M, Nieters A, Staines A, Colt JS, Cozen W, Davis S, de Roos AJ, Hartge P, Rothman N, Severson RK, Holly EA, Call TG, Feldman AL, Habermann TM, Liebow M, Blair A, Cantor KP, Kane EV, Lightfoot T, Roman E, Smith A, Brooks-Wilson A, Connors JM, Gascoyne RD, Spinelli JJ, Armstrong BK, Kricker A, Holford TR, Lan Q, Zheng T, Orsi L, Dal Maso L, Franceschi S, La Vecchia C, Negri E, Serraino D, Bernstein L, Levine A, Friedberg JW, Kelly JL, Berndt SI, Birmann BM, Clarke CA, Flowers CR, Foran JM, Kadin ME, Paltiel O, Weisenburger DD, Linet MS, Sampson JN |title=Etiologic heterogeneity among non-Hodgkin lymphoma subtypes: the InterLymph Non-Hodgkin Lymphoma Subtypes Project |journal=J. Natl. Cancer Inst. Monographs |volume=2014 |issue=48 |pages=130–44 |date=August 2014 |pmid=25174034 |pmc=4155467 |doi=10.1093/jncimonographs/lgu013 |url=}}</ref><ref name="pmid25174023">{{cite journal |vauthors=Cerhan JR, Kricker A, Paltiel O, Flowers CR, Wang SS, Monnereau A, Blair A, Dal Maso L, Kane EV, Nieters A, Foran JM, Miligi L, Clavel J, Bernstein L, Rothman N, Slager SL, Sampson JN, Morton LM, Skibola CF |title=Medical history, lifestyle, family history, and occupational risk factors for diffuse large B-cell lymphoma: the InterLymph Non-Hodgkin Lymphoma Subtypes Project |journal=J. Natl. Cancer Inst. Monographs |volume=2014 |issue=48 |pages=15–25 |date=August 2014 |pmid=25174023 |pmc=4155465 |doi=10.1093/jncimonographs/lgu010 |url=}}</ref><ref name="pmid25864967">{{cite journal |vauthors=Chihara D, Nastoupil LJ, Williams JN, Lee P, Koff JL, Flowers CR |title=New insights into the epidemiology of non-Hodgkin lymphoma and implications for therapy |journal=Expert Rev Anticancer Ther |volume=15 |issue=5 |pages=531–44 |date=May 2015 |pmid=25864967 |pmc=4698971 |doi=10.1586/14737140.2015.1023712 |url=}}</ref>


{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Risk factors for Non-hodgkin lymphoma'''
|+ '''Risk factors for non-Hodgkin lymphoma'''
! style="background: #4479BA; color:#FFF;" | Known risk factors
! style="background: #4479BA; color:#FFF;" | Known risk factors
! style="background: #4479BA; color:#FFF;" | Possible risk factors
! style="background: #4479BA; color:#FFF;" | '''Factors that Decrease risk'''
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" | Weakened immune system
| style="padding: 5px 5px; background: #F5F5F5;" | Age (above 60 years)
| style="padding: 5px 5px; background: #F5F5F5;" | Family history of Non-Hodgkin lymphoma
| style="padding: 5px 5px; background: #F5F5F5;" | [[Alcohol]] consumption
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" | Autoimmune disorders
| style="padding: 5px 5px; background: #F5F5F5;" | Ethnicity (Caucasians more than African and Asian Americans)
| style="padding: 5px 5px; background: #F5F5F5;" | Exposure to pesticides
| style="padding: 5px 5px; background: #F5F5F5;" | [[Atopy|Atopic disease]]
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" | Certain infections
| style="padding: 5px 5px; background: #F5F5F5;" | Positive family history of first degree relative with non-Hodgkin lymphoma
| style="padding: 5px 5px; background: #F5F5F5;" | Exposure to trichloroethylene
| style="padding: 5px 5px; background: #F5F5F5;" | [[Hormone replacement therapy|Hormone therapy]] use after ≥ 50 years of age
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" | Previous cancer treatment
| style="padding: 5px 5px; background: #F5F5F5;" | Weakened immune system ( genetic diseases like [[ataxia telangiectasia]] or infection like HIV)
| style="padding: 5px 5px; background: #F5F5F5;" | Diet
| style="padding: 5px 5px; background: #F5F5F5;" | High sun exposure
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" | B-cell activating [[autoimmune disorders]]
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" | Obesity
|-  
|-  
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |[[Radioactive contamination|Radiation exposure]]
| style="padding: 5px 5px; background: #F5F5F5;" | Hair dyes  
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Infections ( [[Human Immunodeficiency Virus (HIV)|HIV]], [[Hepatitis C|Hep C]], [[Human T-lymphotropic virus|HTLV-1]], [[Epstein Barr virus|EBV]], [[Kaposi's sarcoma-associated herpesvirus|HHV-8]], [[Helicobacter pylori]], [[Chlamydophila psittaci|Chlamydophila psitt]]<nowiki/>aci, [[Campylobacter jejuni]]),
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Previous cancer treatment
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Exposure to chemicals and drugs ([[pesticides]], [[methotrexate]],tumor necrosis factor (TNF) inhibitors, [[trichloroethylene]])
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Smoking|Cigarette smoking]] for ≥ 40 years
| style="padding: 5px 5px; background: #F5F5F5;" |  
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Body mass index|BMI]] ≥30 kg/m2
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Occupational exposures (hairdresser, farmer)
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #F5F5F5;" |[[Diet (nutrition)|Diet]]
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Hair dyes
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |[[Breast implants]]
| style="padding: 5px 5px; background: #F5F5F5;" | Occupational exposures
| style="padding: 5px 5px; background: #F5F5F5;" |  
|-
|-
|}
|}
===Known risk factors===
:*  
====Weakened immune system====
* Congenital immune system damage
:* Inherited immunodeficiency disorders are very rare, but acquired ones are a little more common
::* Inherited disorders
:::* [[Ataxia-telangiectasia]] (AT)
:::* [[Wiskott-Aldrich syndrome]]
:::* [[Severe combined immunodeficiency]] (SCID)
:::* X-linked lymphoproliferative disorder
* Acquired immune system damage
:* Acquired disorders
::* [[Common variable immunodeficiency]] (CVID)
::* [[HIV]] and [[AIDS]]
:* Immunosuppressant drugs for
::* [[Organ transplant]] (such as a kidney, heart or liver transplant)
::* [[Rheumatoid arthritis]]
::* [[Inflammatory bowel disease]]
::* [[Systemic lupus erythematosus]] (SLE)
 
====Autoimmune disorders====
* [[Sjogren’s syndrome]]
:* Linked with marginal cell lymphoma
:* Linked with [[diffuse large B-cell lymphoma]]
 
* [[Rheumatoid arthritis]]
:* Linked with diffuse large B-cell lymphoma
 
:* Linked with [[lymphoplasmacytic lymphoma]]
 
* [[Systemic lupus erythematosus]] (SLE)
:* Linked with diffuse large B-cell lymphoma
 
* [[Celiac disease]] 
:* Linked with a higher risk for [[enteropathy-associated T-cell lymphoma]] (EATL)
 
* Hashimotos thyroiditis
:* Linked with a higher risk of developing primary thyroid lymphoma
 
 
 
Certain infections
 
[[Viral]] infection and [[Bacterial]] infection
Epstein-Barr virus (EBV)
Causes infectious mononucleosis
Occur most commonly in Africa
Linked to Burkitt lymphoma 
 
Linked to lymphomas in people with a weakened immune system
 
Human T-cell leukemia/lymphoma virus, type 1 (HTLV-1) increases the risk of developing adult T-cell lymphoma and leukemia. It is most common in southern Japan and the Caribbean.
 
Helicobacter pylori (H. pylori) is a type of bacteria that causes stomach ulcers and inflammation of the stomach lining (called gastritis). It is linked with gastric lymphomas, particularly a type of lymphoma that occurs in the stomach called mucosa-associated lymphoid-tissue (MALT) lymphoma. H. pylori also increases the risk of stomach cancer.
 
Kaposi sarcoma herpes virus (KSHV) is also called Human herpesvirus 8 (HHV-8). It is linked with primary effusion lymphoma, body cavity lymphomas and AIDS-related lymphomas.
 
Hepatitis C virus (HCV) and hepatitis B virus (HBV) are 2 of a group of viruses that can cause inflammation of the liver (called hepatitis). People with HCV or HBV infection have a higher risk of developing some types of NHL.
 
Campylobacter jejuni (C. jejuni) is a type of bacteria that can cause gastrointestinal (GI) infections. It is linked with a type of lymphoma called mucosa-associated lymphoid-tissue (MALT) lymphoma.
 
Back to top
 
Previous cancer treatment
 
People who have received chemotherapy, with or without radiation therapy, for another type of cancer have a higher risk of developing NHL. This is especially true for people who were treated for Hodgkin lymphoma. But the benefit of being treated for cancer usually far outweighs the risk of developing a second cancer.
 
The risk of developing NHL is greatest in the first 5 years after treatment. But people who have been treated for cancer have a higher risk of developing NHL for the rest of their lives.
 
Back to top
 
Possible risk factors
 
The following factors have been linked with NHL, but there is not enough evidence to show they are known risk factors. Further study is needed to clarify the role of these factors for NHL.
 
Family history of NHL
 
NHL is not generally considered to be familial, which means occurring in families more often than would be expected by chance. But some studies show a higher risk of NHL in people with a first-degree relative (a parent, brother, sister or child) who has been diagnosed with lymphoma. Further studies are needed to determine the risk of developing NHL when a first-degree relative has had the disease.
 
Exposure to pesticides
 
Pesticides include a large number of different chemicals, some of which may be related to NHL risk. Some studies suggest that exposure to certain pesticides, such as Agent Orange, may be linked with a higher risk of developing NHL. The evidence has not been consistent, so further research is needed to help clarify the possible link between pesticides and cancer, and to identify which ones may increase the risk of NHL.
 
Exposure to trichloroethylene
 
Trichloroethylene (TCE) is a solvent used mostly to remove grease from metal. Some studies suggest that exposure to TCE may increase the risk of developing NHL.
 
Diet
 
The link between NHL and diet is very complex. Researchers are trying to find out if diet may increase the risk for NHL. Some studies suggest that diets high in meat, dairy products and saturated fat may increase the risk of developing NHL. Other studies show that diets low in vegetables increase the risk of NHL.
 
Obesity
 
Some studies suggest that being obese may increase the risk of developing NHL, particularly large B-cell lymphoma.
 
Hair dyes
 
Studies have shown a higher risk of NHL in people who used hair dye before 1980. The chemical composition of hair dyes is different now than before 1980, and some of the harmful ingredients have been removed. The risk affects people who used permanent dyes with dark colours in particular. This risk may also be higher in hair dressers and barbers, who were exposed to the dye at work.
 
Occupational exposures
 
A number of studies suggest that people working in certain jobs have a higher risk of NHL. These occupations include farming, the rubber industry, wood and forestry, printing and welding. Researchers haven’t identified specific exposures to explain these risks. More research is needed.
 
Back to top
 
Unknown risk factors
 
It isn’t known whether or not exposure to ionizing radiation is linked with NHL. It may be that researchers can’t show a definite link or that studies have had different results. Further study is needed to see if ionizing radiation is a risk factor for NHL.
 
People who survived nuclear industry accidents or the atomic bombs used during World War II were exposed to large amounts of ionizing radiation. People who are treated with radiation therapy are exposed to smaller amounts of ionizing radiation. Medical imaging, such as x-rays, also uses very small doses of ionizing radiation.
 
Read more: http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/risks/?region=ab#ixzz3m0Z0sOfx
 
The following are some of the risk factors associated with this disease:
 
*Age/sex.  The likelihood of getting non-Hodgkin's lymphoma increases with age and is more common in men than in women.
*Weakened immune system ([[AIDS-related lymphoma]]).  Non-Hodgkin's lymphoma is more common among people with inherited immune deficiencies, [[autoimmune disease]]s, or HIV/[[AIDS]], and among people taking [[immunosuppressant]] drugs following [[organ transplant]]s. (see [[Post-transplant lymphoproliferative disorder]])
*Viruses.  Human T-lymphotropic virus type I ([[HTLV-1]]) and [[Epstein-Barr virus]] are two infectious agents that increase the chance of developing non-Hodgkin's lymphoma.
*Environment.  People who work extensively with or are otherwise exposed to certain chemicals, such as pesticides, solvents, or fertilizers, have a greater chance of developing non-Hodgkin's lymphoma.
People who are concerned about non-Hodgkin's lymphoma should talk with their doctor about the disease, the symptoms to watch for, and an appropriate schedule for checkups. The doctor's advice will be based on the person's age, medical history, and other factors.
 


==References==
==References==
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Latest revision as of 20:37, 21 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Preeti Singh, M.B.B.S.[2]

Overview

The known risk factors in the development of non-Hodgkin lymphoma are weakened immune system, autoimmune disorders, certain infections, and previous cancer treatment. Other possible risk factors include positive family history of non-Hodgkin lymphoma, exposure to pesticides, exposure to trichloroethylene, diet, obesity, hair dyes, and occupational exposures.

Risk Factors

The known risk factors in the development of non-Hodgkin lymphoma are:[1][2][3][4][5][6]

Risk factors for non-Hodgkin lymphoma
Known risk factors Factors that Decrease risk
Age (above 60 years) Alcohol consumption
Ethnicity (Caucasians more than African and Asian Americans) Atopic disease
Positive family history of first degree relative with non-Hodgkin lymphoma Hormone therapy use after ≥ 50 years of age
Weakened immune system ( genetic diseases like ataxia telangiectasia or infection like HIV) High sun exposure
B-cell activating autoimmune disorders
Radiation exposure
Infections ( HIV, Hep C, HTLV-1, EBV, HHV-8, Helicobacter pylori, Chlamydophila psittaci, Campylobacter jejuni),
Previous cancer treatment
Exposure to chemicals and drugs (pesticides, methotrexate,tumor necrosis factor (TNF) inhibitors, trichloroethylene)
Cigarette smoking for ≥ 40 years
BMI ≥30 kg/m2
Occupational exposures (hairdresser, farmer)
Diet
Hair dyes
Breast implants

References

  1. ↑ Kane EV, Bernstein L, Bracci PM, Cerhan JR, Costas L, Dal Maso L, Holly EA, La Vecchia C, Matsuo K, Sanjose S, Spinelli JJ, Wang SS, Zhang Y, Zheng T, Roman E, Kricker A (February 2013). "Postmenopausal hormone therapy and non-Hodgkin lymphoma: a pooled analysis of InterLymph case-control studies". Ann. Oncol. 24 (2): 433–41. doi:10.1093/annonc/mds340. PMC 3551484. PMID 22967995.
  2. ↑ Skibola CF, Slager SL, Berndt SI, Lightfoot T, Sampson JN, Morton LM, Weisenburger DD (August 2014). "Medical history, lifestyle, family history, and occupational risk factors for adult acute lymphocytic leukemia: the InterLymph Non-Hodgkin Lymphoma Subtypes Project". J. Natl. Cancer Inst. Monographs. 2014 (48): 125–9. doi:10.1093/jncimonographs/lgu009. PMC 4155464. PMID 25174033.
  3. ↑ Bracci PM, Benavente Y, Turner JJ, Paltiel O, Slager SL, Vajdic CM, Norman AD, Cerhan JR, Chiu BC, Becker N, Cocco P, Dogan A, Nieters A, Holly EA, Kane EV, Smedby KE, Maynadié M, Spinelli JJ, Roman E, Glimelius B, Wang SS, Sampson JN, Morton LM, de Sanjosé S (August 2014). "Medical history, lifestyle, family history, and occupational risk factors for marginal zone lymphoma: the InterLymph Non-Hodgkin Lymphoma Subtypes Project". J. Natl. Cancer Inst. Monographs. 2014 (48): 52–65. doi:10.1093/jncimonographs/lgu011. PMC 4207869. PMID 25174026.
  4. ↑ Morton LM, Slager SL, Cerhan JR, Wang SS, Vajdic CM, Skibola CF, Bracci PM, de Sanjosé S, Smedby KE, Chiu BC, Zhang Y, Mbulaiteye SM, Monnereau A, Turner JJ, Clavel J, Adami HO, Chang ET, Glimelius B, Hjalgrim H, Melbye M, Crosignani P, di Lollo S, Miligi L, Nanni O, Ramazzotti V, Rodella S, Costantini AS, Stagnaro E, Tumino R, Vindigni C, Vineis P, Becker N, Benavente Y, Boffetta P, Brennan P, Cocco P, Foretova L, Maynadié M, Nieters A, Staines A, Colt JS, Cozen W, Davis S, de Roos AJ, Hartge P, Rothman N, Severson RK, Holly EA, Call TG, Feldman AL, Habermann TM, Liebow M, Blair A, Cantor KP, Kane EV, Lightfoot T, Roman E, Smith A, Brooks-Wilson A, Connors JM, Gascoyne RD, Spinelli JJ, Armstrong BK, Kricker A, Holford TR, Lan Q, Zheng T, Orsi L, Dal Maso L, Franceschi S, La Vecchia C, Negri E, Serraino D, Bernstein L, Levine A, Friedberg JW, Kelly JL, Berndt SI, Birmann BM, Clarke CA, Flowers CR, Foran JM, Kadin ME, Paltiel O, Weisenburger DD, Linet MS, Sampson JN (August 2014). "Etiologic heterogeneity among non-Hodgkin lymphoma subtypes: the InterLymph Non-Hodgkin Lymphoma Subtypes Project". J. Natl. Cancer Inst. Monographs. 2014 (48): 130–44. doi:10.1093/jncimonographs/lgu013. PMC 4155467. PMID 25174034.
  5. ↑ Cerhan JR, Kricker A, Paltiel O, Flowers CR, Wang SS, Monnereau A, Blair A, Dal Maso L, Kane EV, Nieters A, Foran JM, Miligi L, Clavel J, Bernstein L, Rothman N, Slager SL, Sampson JN, Morton LM, Skibola CF (August 2014). "Medical history, lifestyle, family history, and occupational risk factors for diffuse large B-cell lymphoma: the InterLymph Non-Hodgkin Lymphoma Subtypes Project". J. Natl. Cancer Inst. Monographs. 2014 (48): 15–25. doi:10.1093/jncimonographs/lgu010. PMC 4155465. PMID 25174023.
  6. ↑ Chihara D, Nastoupil LJ, Williams JN, Lee P, Koff JL, Flowers CR (May 2015). "New insights into the epidemiology of non-Hodgkin lymphoma and implications for therapy". Expert Rev Anticancer Ther. 15 (5): 531–44. doi:10.1586/14737140.2015.1023712. PMC 4698971. PMID 25864967.

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