The distribution of non-Hodgkin lymphoma (NHL) subtypes differs around the world but a systematic study of Latin America has not been done. Therefore, we evaluated the relative frequencies of NHL subtypes in Central and South America (CSA). Five expert hematopathologists classified consecutive cases of NHL from 5 CSA countries using the WHO classification and compared them to 400 cases from North America (NA). Among the 1028 CSA cases, the proportions of B-and T-cell NHL and the sex distribution were similar to NA. However, the median age of B-cell NHL in CSA (59 years) was significantly lower than in NA (66 years; P < .0001). The distribution of high-grade (52.9%) and low-grade (47.1%) mature B-cell NHL in CSA was also significantly different from NA (37.5% and 62.5%; P < .0001). Diffuse large B-cell lymphoma was more common in CSA (40%) than in NA (29.2%; P < .0001), whereas the frequency of follicular lymphoma was similar in Argentina (34.1%) and NA (33.8%), and higher than the rest of CSA (17%; P < .001). Extranodal NK/Tcell NHL was also more common in CSA (P < .0001). Our study provides new objective evidence that the distribution of NHL subtypes varies significantly by geographic region and should prompt epidemiologic studies to explain these differences. (Blood. 2012;120(24):4795-4801)
IntroductionNeoplasms of the lymphoid system are very diverse with different clinical presentations, morphologic appearances, and biologic behaviors. 1 Furthermore, the non-Hodgkin lymphoma (NHL) category includes numerous different subtypes. The incidence of NHL is increasing worldwide and, although this increase began to slow in the 1990s, significant variations in temporal trends have been noted for individual NHL subtypes. 2,3 Epidemiologic studies of risk factors for NHL have contributed significantly to our understanding of the pathogenesis of these neoplasms. [2][3][4][5] In numerous epidemiologic studies investigators also have analyzed the distribution of NHL subtypes in North America (NA), Europe, the Far East, and Middle East. 3,[6][7][8][9][10][11][12] These studies have shown substantial differences in the relative frequencies of NHL subtypes in different geographic regions. Furthermore, it has become clear that subtype-specific NHL frequency patterns in different geographic regions may be indicative of environmental or host risk factors in a particular region. [2][3][4]7 Moreover, comparison of the incidence rates and frequency patterns of specific NHL subtypes may provide critical clues to guide future epidemiologic studies. 3 Although studies of individual NHL subtypes have been conducted in several Central and South American (CSA) countries, [13][14][15][16] in only a few epidemiologic studies have authors examined the distribution of NHL subtypes in individual countries. [17][18][19] However, to our knowledge, a large-scale, wellorganized, systematic study of the distribution of NHL subtypes in CSA has not been undertaken. The aim of this study was to assess the clinical features and distribution of NHL su...