NYC vitreoretinal lymphoma cases linked to Chernobyl disaster

By Liz Meszaros, MDLinx
Published January 17, 2018

Key Takeaways

In New York City, a cluster of cases of vitreoretinal lymphoma (VRL)—a rare and unusual diagnosis—may be linked to patient proximity to the 1986 Chernobyl nuclear disaster, according to researchers from the University at Albany State University of New York, who published their findings in Leukemia & Lymphoma.

Over a 4-year period, 10 patients in New York City were diagnosed with ultra-rare VRL at four ophthalmology and oncology practices. The disease is an unusual presentation of primary central nervous system lymphoma, which is also very rare: only about 25% of patients with primary central nervous system lymphoma develop VRL.

Clinicians became curious, and contacted a renowned genetic epidemiologist and cancer researcher, Roxana Moslehi, PhD, associate professor, University of Albany School of Public Health, with a request to clarify the epidemiology of VRL and consider potential causes and risk factors in these patients.

"As soon as I was contacted by Dr. Sanford Kempin at Mount Sinai Beth Israel Comprehensive Cancer Center, I was immediately interested in helping because the cause of VRL to date is unknown," said Dr. Moslehi. "Any clues pointing to risk factors or causes we could learn from studying these 10 cases could be valuable in understanding the biologic mechanisms that lead to this type of cancer, and possibly to other forms of lymphoma as well. Determining the risk and causative factors is instrumental in disease prevention," she added.

Researchers confirmed that the 10 cases in New York City were a “cluster,” defined as an unusually high incidence of a disease occurring in close proximity in both time and location. They looked at patient characteristics including age at diagnosis, racial and ethnic backgrounds, past and prior residences, clinical disease characteristics, comorbid conditions, and family history.

Six of the 10 patients had one thing in common: they had all lived close to the Chernobyl nuclear power plant near Pripyat, Ukraine, in the Soviet Union, at the time of the infamous radioactive accident on April 26, 1986. Four lived in the Ukraine, one in Poland, and one in Moldova.

The Chernobyl accident is considered the world’s worst nuclear accident, and resulted in 31 direct deaths and an estimated (until 2011) 15 indirect deaths. The long-term effects of radiation exposure, however, are unknown.

Median time to VRL diagnosis in these patients was 26 years. The six patients living near the power plant had no other unique medical conditions compared with the remaining four who had not been in close proximity. Seven of the 10 subjects did have one more thing in common: they were of Ashkenazi Jewish ancestry.

Dr. Moslehi and colleagues also calculated VRL rates in 13 areas, from 1992-2014, using data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, which represents overall US cancer rates, and the New York State Cancer Registry Database.

Upon their epidemiologic analysis, the researchers found that from 1992-2014, only 20 people were diagnosed with VRL in 13 SEER areas. The estimated number of expected cases for the entire state of New York was three in 4 years.

"Though our results do not definitively confirm that exposure to nuclear radiation is a cause of VRL, our findings warrant further research on the role of radiation alone and/or in combination with genetic factors and gene-environment interactions," concluded Dr. Moslehi.

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