Serologic markers of viral infection and risk of non-Hodgkin lymphoma: A pooled study of three prospective cohorts in China and Singapore

Bryan A. Bassig, Martina Willhauck-Fleckenstein, Xiao Ou Shu, Woon Puay Koh, Yu Tang Gao, Mark P. Purdue, Yong Bing Xiang, Jennifer Adams-Haduch, Renwei Wang, Nicole Brenner, Tim Waterboer, Angelika Michel, Bu Tian Ji, H. Dean Hosgood, Charles S. Rabkin, Gong Yang, Jason Y.Y. Wong, Jinming Zhang, Wei Hu, Wei Jie SeowWong Ho Chow, Michael Pawlita, Wei Zheng, Jian Min Yuan, Qing Lan, Nathaniel Rothman

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Incidence rates of non-Hodgkin lymphoma (NHL) and distributions of certain viruses differ between East Asian and Western populations. There are limited data on associations between serologic markers of multiple viral infections in pre-diagnostic blood and NHL risk in East Asians. We conducted a nested case-control study of 214 NHL cases and 214 matched controls from three population-based prospective cohorts in Shanghai and Singapore. Antibodies against antigens from herpesviruses, Hepatitis B (HBV) and C (HCV) virus and polyomaviruses were measured in plasma or serum using fluorescent bead-based multiplex assays. Conditional logistic regression was used to evaluate associations between antibody levels and NHL risk. An increased risk of NHL was observed for higher compared to lower EA-D (Odds Ratio (OR) = 2.04, 95% Confidence Interval (CI) = 1.10-3.81; ptrend = 0.005) and ZEBRA (OR = 2.17, 95% CI = 0.96-4.89; ptrend = 0.008) Epstein-Barr Virus (EBV) antibodies, as well as for antibody seropositivity against the IE1A human herpesvirus-6 (HHV-6) antigen (OR = 1.85, 95% CI = 1.04-3.29). An increased NHL risk was also observed for higher compared to lower antibodies against the HBV-HBc and HBe antigens. An increased risk of NHL in relation to EBV and HBV infection in East Asians is consistent with findings in several studies of Western populations, suggesting similar viral risk factors for NHL in these diverse populations with distinct patterns of NHL. The association between HHV-6 antibodies and NHL has not previously been reported in a prospective study in this population and will require replication.

Original languageEnglish (US)
Pages (from-to)570-579
Number of pages10
JournalInternational Journal of Cancer
Issue number3
StatePublished - Aug 1 2018


  • Epstein-Barr virus
  • hepatitis
  • multiplex serology
  • non-Hodgkin lymphoma
  • viral antibodies

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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