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African Burkitt Lymphoma: Age-Specific Risk and Correlations with Malaria Biomarkers

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  • Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland; Shirati Health, Education, and Development Foundation, Shirati, Tanzania; Department of Surgery, St. Mary's Hospital, Lacor, Gulu, Uganda; Kampala Cancer Registry, Makerere College of Health Sciences, Kampala, Uganda; Shirati Hospital, Shirati, North Mara, Tanzania; Emeritus Prof. Noguchi Memorial Institute, Accra, Ghana; Department of Child Health, Korle Bu University Teaching Hospital, Accra, Ghana; Shirati Hospital, Shirati, North Mara, Tanzania/Interchurch Medical Assistance, New Windsor, Maryland; Department of Epidemiology Research, Staten Serum Institute, Copenhagen, Denmark

African Burkitt lymphoma is an aggressive B-cell, non-Hodgkin lymphoma linked to Plasmodium falciparum malaria. Malaria biomarkers related to onset of African Burkitt lymphoma are unknown. We correlated age-specific patterns of 2,602 cases of African Burkitt lymphoma (60% male, mean ± SD age = 7.1 ± 2.9 years) from Uganda, Ghana, and Tanzania with malaria biomarkers published from these countries. Age-specific patterns of this disease and mean multiplicity of P. falciparum malaria parasites, defined as the average number of distinct genotypes per positive blood sample based on the merozoite surface protein-2 assessed by polymerase chain reaction, were correlated and both peaked between 5 and 9 years. This pattern, which was strong and consistent across regions, contrasted parasite prevalence, which peaked at 2 years and decreased slightly, and geometric mean parasite density, which peaked between 2 and 3 years and decreased sharply. Our findings suggest that concurrent infection with multiple malaria genotypes may be related to onset of African Burkitt lymphoma.

Author Notes

*Address correspondence to Benjamin Emmanuel, Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, Executive Plaza South, Room 7080, Rockville, MD 20852-7248. E-mail: emmanuelb@mail.nih.gov

Financial support: The study was supported by the Intramural Research Program of the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services (grants HHSN26120090068P, HHSN261200555004C, N02-CP-31003, and N01-CO-12400).

Authors' addresses: Benjamin Emmanuel, Kishor Bhatia, and Sam M. Mbulaiteye, Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, E-mails: emmanuelb@mail.nih.gov, bhatiak@mail.nih.gov, and mbulaits@mail.nih.gov. Esther Kawira, Shirati Health, Education, and Development Foundation, Shirati, Tanzania, E-mail: elkawira@gmail.com. Martin D. Ogwang, Department of Surgery, St. Mary's Hospital, Lacor, Gulu, Uganda, E-mail: ogwang.martin@lacorhospital.org. Henry Wabinga, Kampala Cancer Registry, Department of Pathology, Makerere University, Kampala, Uganda, E-mail: hwabinga@med.mak.ac.ug. Josiah Magatti and Glen Brubaker, Interchurch Medical Assistance, New Windsor, MD, E-mails: jomagati2000@yahoo.com and grb176@comcast.net. Francis Nkrumah, Noguchi Memorial Institute, University of Ghana, Legon, Legon, Ghana, E-mail: fnkrumah@noguchi.mimcom.org. Janet Neequaye, Department of Child Health, Korle Bu University Teaching Hospital, Korle-Bu, Accra, Ghana, E-mail: janet.neequaye@yahoo.com. Robert J. Biggar, Department of Epidemiology Research, Staten Serum Institute, Copenhagen S, Denmark, E-mail: rjbiggar@gmail.com.

Reprint requests: Sam M. Mbulaiteye, 6120 Executive Boulevard, Executive Plaza South, Room 7080, Rockville, MD 20852-7248, E-mail: mbulaits@mail.nih.gov.

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