Sylvain Lamure, MD, Hematologist, Principal InvestigatorPascale Fabbro-Peray, MD, PhD , Epidemiologist, Senior InvestigatorUniversity of Montpellier, France

Occupational Exposure to Pesticides: Poor Prognosis for Diffuse Large B-Cell Lymphoma Patients interview with:
Sylvain Lamure, MD, Hematologist, Principal Investigator

Pascale Fabbro-Peray, MD, PhD , Epidemiologist, Senior Investigator
University of Montpellier, France What is the background for this study?

Response: Occupational exposure to pesticides is a well-documented associated factor for non-Hodgkin lymphoma. The main biological mechanisms of both pesticides and chemotherapy are genotoxicity and reactive oxygen species generation. Cellular adaptation among patients exposed to low doses of genotoxic and oxidative compounds might hinder chemotherapy efficiency in lymphoma patients. T

hus, we have investigated the association of occupational exposure with response to immunochemotherapy and survival in the subgroup of diffuse large B cell lymphoma, whose treatment is standardized. What are the main findings?

Response: We observed that occupationally-exposed patients had significantly higher treatment failure rate compared to non occupationally-exposed patients, after adjusting for prognosis factors; this difference was higher among patients with exposing agricultural occupations compared to other patients.

Similarly, two-year event-free survival was lower in the occupationally-exposed patients compared to non occupationally-exposed patients and this difference was more prononced in patients with exposing agricultural occupation compared to others. Two-year overall survival was lower in patients with exposing agricultural occupations compared to other patients but this association was not shown in occupationally-exposed patients compared to non occupationally-exposed patients. What should readers take away from your report? 

Response:  This study suggests, for the first time, poorer prognosis for DLBCL patients exposed to pesticides, concerning both the response to treatment, 2-years Event-Free Survival and Overall Survival. What recommendations do you have for future research as a result of this work?

Response: It would be important to confirm these results in further prospective studies. In addition, there are several potential biological mechanisms explaining our results deserving further investigation. The characterization of specific pesticides is another point of current investigation. Is there anything else you would like to add? 

Response: In this retrospective study, an independent epidemiological team performed computational analysis using Job-Exposure Matrix, blinded for all patient informations, reducing the risk of information bias on exposure. The authors have no conflict of interest and the study was funded by a hospital grant.


Lamure S, Carles C, Aquereburu Q, et al. Association of Occupational Pesticide Exposure With Immunochemotherapy Response and Survival Among Patients With Diffuse Large B-Cell Lymphoma. JAMA Netw Open. 2019;2(4):e192093. doi:10.1001/jamanetworkopen.2019.2093

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Last Updated on April 23, 2019 by Marie Benz MD FAAD