Vaccination History and Risk of Lymphoma and Its Major Subtypes

Geffen Kleinstern, Melissa C. Larson, Stephen M. Ansell, Carrie A. Thompson, Grzegorz S. Nowakowski, Timothy G. Call, Dennis P. Robinson, Matthew J. Maurer, Raphael Mwangi, Andrew L. Feldman, Neil E. Kay, Anne J. Novak, Thomas M. Habermann, Susan L. Slager, James R. Cerhan

Research output: Contribution to journalArticlepeer-review


Background: Vaccinations have been hypothesized to play a role in lymphoma etiology, but there are few studies, mixed results, and limited data on lymphoma subtypes. Herein, we investigate the association of vaccinations with risk of major lymphoma subtypes. Methods: We studied 2,461 lymphoma cases and 2,253 controls enrolled from 2002 to 2014. Participants self-reported history of vaccinations against hepatitis A, hepatitis B, yellow fever, and influenza. Polytomous logistic regression was used to estimate OR and 95% confidence intervals (CI), adjusting for potential confounders. Results: After multivariable adjustment, vaccination against influenza was inversely associated with lymphoma (OR ¼ 0.82; 95% CI, 0.66–1.02), which was stronger for last vaccination 1þ years before enrollment (OR ¼ 0.71; 95% CI, 0.56–0.91) and for >5 influenza vaccinations (OR ¼ 0.56; 95% CI, 0.46–0.68). Ever vaccination against hepatitis A (OR ¼ 0.81; 95% CI, 0.66–1.00) but not hepatitis B (OR ¼ 0.97; 95% CI, 0.81–1.18) was associated with lymphoma risk, although more recent vaccinations were inversely associated with lymphoma risk for both hepatitis A (<6 years before enrollment, OR ¼ 0.56; 95% CI, 0.40–0.77) and hepatitis B (<9 years before enrollment, OR ¼ 0.72; 95% CI, 0.55–0.93). Ever vaccination against yellow fever was inversely associated with risk (OR ¼ 0.73; 95% CI, 0.55–0.96), and this did not vary by time since last vaccination. Although there was no overall statistical evidence for heterogeneity of vaccination history by lymphoma subtype, the only statistically significant inverse associations were observed for influenza and yellow fever vaccinations with diffuse large B-cell and follicular lymphoma. Conclusions: Selected vaccinations were inversely associated with lymphoma risk, with time since last vaccination relevant for some of these vaccines. Impact: Vaccinations against hepatitis A, hepatitis B, yellow fever, and influenza are unlikely to increase lymphoma risk.

Original languageEnglish
Pages (from-to)461-470
Number of pages10
JournalCancer Epidemiology Biomarkers and Prevention
Issue number2
StatePublished - Feb 2022

Bibliographical note

Funding Information:
Research reported in this article was supported by the NCI of the NIH under award number R01 CA92153 and P50 CA97274 (to J.R. Cerhan).

Funding Information:
G.S. Nowakowski reports grants from BMS and Roche; grants, personal fees, and non-financial support from Morphosys; and personal fees from TG Therapeutics, Kite, Constellation, Ryvu, Kymera, and Kyropharm outside the submitted work. M.J. Maurer reports grants from National Cancer Institute during the conduct of the study as well as personal fees from Pfizer; grants and personal fees from Morphosys; grants from NanoString, Genentech, and BMS; and personal fees from Kite Pharma outside the submitted work. A.L. Feldman reports other support from Seattle Genetics and Zeno Pharmaceuticals outside the submitted work; in addition, A.L. Feldman has a patent 8,679,743 issued and a patent 9,677,137 issued. N.E. Kay reports grants from CA92153 and CA97274 during the conduct of the study as well as NEK Advisory Board for AbbVie, AstraZeneca, Behring, Cytomx Therapy, Dava Oncology, Janssen,

Publisher Copyright:
©2021 American Association for Cancer Research


  • Humans
  • Influenza Vaccines
  • Influenza, Human
  • Logistic Models
  • Lymphoma/epidemiology
  • Vaccination

ASJC Scopus subject areas

  • Oncology
  • Epidemiology


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