Aspirin and Other Nonsteroidal Anti-Inflammatory Drugs and Risk of Non-Hodgkin Lymphoma

Abstract

Few large prospective studies have examined associations between nonsteroidal anti-inflammatory drug (NSAID) use and non-Hodgkin lymphoma (NHL). We examined the association between NSAID use and NHL incidence among 149,570 participants in the Cancer Prevention Study-II Nutrition cohort. Aspirin and nonaspirin NSAID use were reported at enrollment in 1992 and updated on periodic follow-up questionnaires. During follow-up through 2007, 1,709 incident NHLs were identified. Time-dependent hazard ratios were calculated using extended Cox regression. Compared to no use, current use of 60þ NSAID pills/month (aspirin and nonaspirin NSAIDs combined) was associated with slightly higher NHL incidence (hazard ratio [HR] ¼ 1.26, 95% confidence interval [CI], 1.04-1.53), but no association with frequency of use was observed when NSAID exposure was lagged by approximately 2 years (HR ¼ 1.08, 95% CI, 0.88-1.32). Long duration regular use (current use of 30þ pills/month for 5 years) was not associated with NHL incidence (HR ¼ 1.09, 95% CI, 0.91-1.33). In subtype analyses, current use of 60þ NSAID pills/month was associated with follicular lymphoma incidence (HR ¼ 1.87, 95% CI, 1.08-3.24). This association persisted when NSAID exposure was lagged (HR ¼ 1.76, 95% CI, 1.04-2.98) and was similar for aspirin and nonaspirin NSAIDs. The association of current, but not lagged, NSAID use with risk of all NHL could be attributable to use of NSAIDs to relieve symptoms of undiagnosed NHL. However, the association with follicular lymphoma persisted in analyses where NSAID use was lagged and should be investigated further. These findings are particularly important for aspirin as the risks and benefits of prophylactic daily use are weighed. Cancer Epidemiol Biomarkers Prev; 22(3);

Regular Aspirin Use and Risk of Multiple Myeloma: A Prospective Analysis in the Health Professionals Follow-up Study and Nurses' Health Study

“…In the VITAL cohort, regular use of baby aspirin during the ten years prior to study enrollment was inversely associated with risk of plasma cell disorders (P-trend=0.02); “high” users of baby aspirin (i.e., ≥4 days/week for ≥4 years) had a marginally significant 60% lower risk of plasma cell disorders compared to non-users (23). In contrast, Teras and colleagues (24) did not observe an association of regular aspirin quantity or duration with MM risk in the CPS-II cohort in an analysis of comparable sample size to the present study. Differences in the computation of CPS-II participants’ usual aspirin quantity from self-reported baby v. adult strength tablets, and in the choice of exposure lag, may partially explain the discrepant findings.…”

“…An etiologic association of aspirin use with MM is also plausible and has been examined to date in four studies: one hospital-based (117 cases, 483 matched controls) (21) and one population-based case-control study (179 cases, 691 frequency-matched controls) (22), and two prospective studies: the Vitamins and Lifestyle (VITAL) cohort (6–8 years follow-up, 66 cases of plasma cell disorders, cohort N=64,839) (23) and the American Cancer Society (ACS) Cancer Prevention Study (CPS)-II Nutrition cohort (15 years follow-up, 310 cases, cohort N=184,188) (24). Neither case-control study reported an association of aspirin use with MM; duration of regular use was not associated with MM risk in the hospital-based study (21) and was not reported in the population-based study (22).…”

“…The VITAL study reported a significant inverse association of regular use of 81 mg aspirin with risk of plasma cell disorders (P-trend=0.02) but no association of plasma cell disorder risk with use of regular strength aspirin (23). In the CPS-II study, neither quantity nor duration of aspirin use was associated with MM (24). We undertook the present prospective study in the Nurses’ Health Study and Health Professionals Follow-up Study cohorts to further examine the association of regular aspirin use with risk of MM, taking advantage of biennially updated, detailed information on aspirin use and relevant covariables.…”

IFN-γ and TNF-α Synergistically Induce Mesenchymal Stem Cell Impairment and Tumorigenesis via NFκB Signaling

“…On the one hand, although aspirin was shown to be associated with higher BMD at multiple skeletal sites in a cohort study of men and women [58], Bauer et al [59] only observed a modest beneficial effect on BMD in another cohort study of postmenopausal women. On the other hand, although daily aspirin has been proved to decrease the risk of adenocarcinoma metastasis in a randomized controlled trial [17], a recent study indicated that regular administration of aspirin and other nonsteroidal anti‐inflammatory drugs was associated with a slightly higher incidence of follicular lymphoma incidence [60]. Thus, the daily use of aspirin or nonsteroidal anti‐inflammatory drugs and the risk of cancer in human should be investigated carefully using large cohorts of patients.…”

Use of non‐steroidal anti‐inflammatory drugs and risk of non‐Hodgkin lymphoma: a systematic review and meta‐analysis

“…Animal and laboratory studies indicate that NSAIDs induce apoptosis of hematological tumour cells via this mechanism [6]. However, epidemiological studies have thus far produced conflicting results, with some studies suggesting increased risk of NHLs amongst NSAIDs users [7][8][9][10][11] and others finding no association [12][13][14][15][16][17], or even a decreased risk [18][19][20][21]. Bernatsky and colleagues conducted a meta-analysis of studies published before 2007 and found that, overall, NSAID use was not associated with the risk of NHLs [22].…”