TY - JOUR
T1 - Risk of lymphoid malignancies increased after Puumala virus infection in Finland, 2009-2019
T2 - A retrospective register-based cohort study
AU - Kääriäinen, Sohvi
AU - Ollgren, Jukka
AU - Dub, Timothee
AU - Laine, Outi
AU - Sinisalo, Marjatta
AU - Hepojoki, Jussi
AU - Strandin, Tomas
AU - Kekäläinen, Eliisa
AU - Sane, Jussi
AU - Lyytikäinen, Outi
N1 - Funding Information:
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The names and personal ID numbers were used only in the linkage of the NIDR and the FCR to identify the study population. They were not used in data analysis or when reporting the results. The permission to use register data from the NIDR and the FCR was given in the internal process within the Finnish Institute for Health and Welfare (decision number: THL/2253/6.02.00/2021). Ethical approval was not required for this register-based study. Sohvi Kääriäinen, Jukka Ollgren, Timothee Dub, Outi Laine, Marjatta Sinisalo, Jussi Sane and Outi Lyytikäinen contributed to the conception and design of the study. Sohvi Kääriäinen, Jukka Ollgren and Outi Lyytikäinen did the analyses and graphics. Sohvi Kääriäinen drafted the first version of the manuscript, and together with Jussi Hepojoki, Tomas Strandin, Eliisa Kekäläinen and Outi Lyytikäinen drafted the revisions. All authors contributed to the interpretation of the data and the critical revision of the manuscript.
Publisher Copyright:
© 2023 The Author(s)
PY - 2023/6
Y1 - 2023/6
N2 - Objectives: The Puumala virus (PUUV) is a hantavirus that causes hemorrhagic fever with renal syndrome. Studies showing an increased risk of lymphoid malignancies after hantavirus infection, together with the observation that PUUV infects B cells, motivated us to study the risk of lymphoid malignancies after PUUV infection. Methods: We linked data from the Finnish Cancer Registry and National Infectious Diseases Register for 2009-2019. We used a time-dependent Cox regression model to evaluate the hazard of the lymphoid malignancies grouped according to the HAEMACARE classification. Results: We identified 68 cases of lymphoid malignancies after PUUV infection among 16,075 PUUV-infected individuals during 61,114,826 person-years of observation. A total of 10 cases occurred within 3-<12 months and 38 within 1-<5 years after PUUV infection, and the risk of lymphoid malignancies increased with hazard ratios (HRs) of 2.0 (95% confidence interval [CI], 1.1-3.7) and 1.6 (95% CI, 1.2-2.3), respectively. The group of mature B cell neoplasms showed an increased risk 3-<12 months and 1-<5 years after PUUV infection, HR 2.2 (95% CI, 1.2-4.3) and HR 1.8 (95% CI, 1.3-2.5), respectively. Conclusion: PUUV infection is associated with lymphoid malignancies in the Finnish population, supporting the earlier studies. Further research is required to understand the pathophysiological mechanisms behind this association.
AB - Objectives: The Puumala virus (PUUV) is a hantavirus that causes hemorrhagic fever with renal syndrome. Studies showing an increased risk of lymphoid malignancies after hantavirus infection, together with the observation that PUUV infects B cells, motivated us to study the risk of lymphoid malignancies after PUUV infection. Methods: We linked data from the Finnish Cancer Registry and National Infectious Diseases Register for 2009-2019. We used a time-dependent Cox regression model to evaluate the hazard of the lymphoid malignancies grouped according to the HAEMACARE classification. Results: We identified 68 cases of lymphoid malignancies after PUUV infection among 16,075 PUUV-infected individuals during 61,114,826 person-years of observation. A total of 10 cases occurred within 3-<12 months and 38 within 1-<5 years after PUUV infection, and the risk of lymphoid malignancies increased with hazard ratios (HRs) of 2.0 (95% confidence interval [CI], 1.1-3.7) and 1.6 (95% CI, 1.2-2.3), respectively. The group of mature B cell neoplasms showed an increased risk 3-<12 months and 1-<5 years after PUUV infection, HR 2.2 (95% CI, 1.2-4.3) and HR 1.8 (95% CI, 1.3-2.5), respectively. Conclusion: PUUV infection is associated with lymphoid malignancies in the Finnish population, supporting the earlier studies. Further research is required to understand the pathophysiological mechanisms behind this association.
KW - Cox regression
KW - Hantavirus
KW - Hematologic malignancy
KW - Hemorrhagic fever with renal syndrome
KW - Lymphoma
U2 - 10.1016/j.ijid.2023.03.026
DO - 10.1016/j.ijid.2023.03.026
M3 - Article
C2 - 36948450
AN - SCOPUS:85151882336
SN - 1201-9712
VL - 131
SP - 1
EP - 6
JO - INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
JF - INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
ER -
