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Newswise BIRMINGHAM, Ala. In 2001, Christine Skibola, Ph.D., now a professor of epidemiology at the University of Alabama at Birmingham School of Public Health, joined forces with a small group seeking a large goal discovery of genetic and environmental links to the white blood cell tumors that collectively are called lymphomas.

This has now resulted in the largest epidemiology and genetic studies of non-Hodgkin lymphoma (NHL) ever conducted. Thus far, these studies have culminated into four genetics papers published in Nature Genetics, American Journal of Human Genetics and Nature Communications, and an entire monograph in the Journal of the National Cancer Institute Monographs comprising 13 papers on environmental and medical risk factors found to be associated with various lymphoma subtypes. More papers are on the way.

This sort of research is huge in scale. The hundreds of investigators involved did risk factor analysis and genome-wide association studies on more than 17,400 NHL cases and 23,000 matched controls from North America, Europe and Australia. Two recent Skibola papers, for example, included 140 different authors at 82 different universities, institutes or hospitals that were located in 16 U.S. states and 18 foreign countries.

This is what it takes now to get the large power to detect true associations in most cases, Skibola said.

Those results finding links to personal and family histories, or associations with individual genetic markers set the path for future research and future possible treatments.

Consider the stark difference in risk profiles discovered by Skibola and others for two of the most common types of NHL diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL).

On the one hand, when researchers looked at risk factors related to medical history, lifestyle, family history and occupation, the DLBCL patients had numerous significant risks. These included being obese as a young adult, having a history of any one of a number of autoimmune diseases and a family history of a blood cancer. Other factors, such as allergic conditions, a history of alcohol consumption or a previous blood transfusion for men, and hormone replacement therapy or oral contraceptive use for women, gave some protection from DLBCL. In contrast, only a few, modest epidemiology risk factors were found for FL.

On the other hand, when researchers looked at risk factors associated with genetic changes, the tables were reversed: FL had a number of profound genetic risk factors and DLBCL had much less.

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UAB Researcher Has Key Role in Massive Non-Hodgkin Lymphoma Study