Purpose: Telomere length plays an important role in the maintenance of chromosomal stability and in tumorigenesis. We hypothesized that telomere length in peripheral WBC DNA obtained from healthy individuals would be a predictor of future risk of developing non-Hodgkin lymphoma. Experimental Design: Using a new assay to measure relative telomere length, monochrome multiplex quantitative PCR, which strongly correlates with telomere length measured by Southern blot (Spearman r = 0.91, P < 0.0001) and has high precision (coefficient of variation = 7%), we compared telomere length in peripheral WBC DNA in 107 incident male non-Hodgkin lymphoma cases and 107 matched controls within the prospective Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study cohort. Results: Median (10th, 90th percentile) telomere length was 1.10 (0.79, 1.43) in cases and 1.02 (0.78, 1.26) in controls (P = 0.0017, Wilcoxon sign test). There was a strong dose-response relationship between quartiles of telomere length and risk of nonHodgkin lymphoma overall [odds ratios (95% confidence intervals) by quartile: 1.0; 1.1 (0.4-2.7); 1.8 (0.7-4.9); and 3.6 (1.4-8.9); P trend = 0.003], and this association was similar across the most common non-Hodgkin lymphoma subtypes present in this study. Conclusion: These results suggest that longer telomere length may be a potential predictor for future risk of non-Hodgkin lymphoma. (Clin Cancer Res 2009;15(23):7429-33) Telomeres are complexes of tandem repeats of the sequence TTAGGG that cap chromosomes. They are essential for protecting chromosomal integrity (1), and shorten after every cell division. Short telomere length can cause genomic instability, which is associated with the initiation and progression of human cancers (2). At the same time, many incipient tumors can terminate their own growth by shortening their telomeres sufficiently to trigger replicative senescence or apoptosis (3). However, if sufficient numbers of mutations that promote growth and block cell senescence and apoptotic pathways accumulate in a cell before its telomeres shorten enough to trigger senescence or apoptosis and protect it from cancer, then unlimited proliferation may ensue. It follows that in some cell types, under some circumstances, long telomeres may actually increase the risk of cancer, by allowing more time and more cell divisions during which the cell can accumulate oncogenic mutations.Most epidemiologic studies have reported that relatively shorter telomere length measured in peripheral WBC and in some instances buccal cells is associated with increased risk of cancer (4-10). In contrast, some recent reports have suggested that longer telomere length may be associated with increased risk of certain tumors, such as breast cancer and melanoma (11,12). Most studies have used a case-control design (4-8), with several more recent reports using a prospective cohort design (9-11).Given that peripheral WBC contain lymphocyte subsets that derive from lymphocytic stem cells and immunologically active tissue, we...