Highlights of This Issue

Highly active antiretroviral therapy (HAART) has extended the life expectancy of HIV/AIDS patients, but it remains unclear whether HIV infection affects the survival of lymphoma patients in the HAART era. Han and colleagues compared survival of lymphoma patients treated with HAART therapy. Among 179,520 lymphoma patients, HIV infection was significantly associated with inferior overall survival for patients with each lymphoma subtype, indicating that HIV/AIDS continues to be independently associated with increased risk of death among lymphoma patients in the HAART era in the United States.

Adolescents and young adults (15 to 39 years old) with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) experience inferior survival when compared with children. Wolfson and colleagues examined the impact of care at NCI-designated Comprehensive Cancer Centers (CCC) or Children's Oncology Group sites (COG) on survival disparities. The authors report that adolescent and young adult ALL or AML patients at non-CCC/COG sites experienced inferior outcomes. Barriers to accessing specialized CCC/COG care include public insurance/uninsured, and African American and Hispanic race/ethnicity.

Type II diabetes is associated with breast cancer risk in epidemiologic studies, and pregnancy also modifies breast cancer risk. Powe and colleagues hypothesized that women with a history of gestational diabetes mellitus (GDM) would have greater invasive breast cancer risk than parous women without a history of diabetes. The authors conducted a prospective analysis among parous women in the Nurses' Health Study II. Among 86,972 women studied, 5,188 women reported a history of GDM and 2,377 developed invasive breast cancer. Among this large cohort of U.S. women, a history of GDM was not associated with an elevated risk of subsequent invasive breast cancer.

The neutrophil-to-lymphocyte ratio (NLR) is a cytological marker of both inflammation and poor outcomes in cancer patients. DNA methylation is a key element of the epigenetic program defining different leukocyte subtypes, and may provide an alternative to cytology in assessing leukocyte profiles. Koestler and colleagues created a bioinformatic tool to estimate NLR using DNA methylation and assessed its diagnostic and prognostic performance in human populations. The authors developed a DNA methylation-derived NLR (mdNLR) index based on normal isolated leukocyte methylation libraries and established cell-mixture deconvolution algorithms. Across cancer studies, mdNLR scores were either elevated in cases relative to controls, or associated with increased hazard of death, indicating our current understanding of mature leukocyte methylomes is sufficient to apply epigenetically based analyses of NLR in clinical and epidemiologic studies of cancer risk and survival.