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Epidemiology of Burkitt Lymphoma in East-African Children and Minors (EMBLEM)

Sam Mbulaiteye

6 Collaborator(s)

Funding source

National Cancer Institute (NIH)
Burkitt lymphoma is an aggressive monoclonal B-cell malignancy is sporadic worldwide, but is 100-fold more common in equatorial Africa, particularly among children. Epstein-Barr virus (EBV) and malaria are epidemiologically linked to endemic BL in epidemiologic studies, but questions remain about role of EBV variants and the evidence for association with malaria is weak. EBV is ubiquitous, yet only a few children develop BL, possibly because only a few EBV variants are pathogenically relevant. The association of BL with malaria is based on ecologic and non-comparative studies. Two case-control studies have reported significant association of high anti-malarial antibodies with BL (OR=5) among children in Uganda and in Malawi, but selection is bias and reverse causality bias were limitations. Two studies conducted in the 60s & 70s to test association of carriage of malaria-resistance gene with BL, reported a significant or marginal inverse association. These pioneering studies were small and looked at one polymorphism in the sickle cell gene. Improvements in technologies to characterize genetic variation allow the EBV and malaria hypotheses to be examined with greater power by looking at genetic variation across multiple genes. The Epidemiology of Burkitt lymphoma in East African children and minors is a case-control study of 1500 BL cases and 3000 age-, sex- and residence-frequency matched controls we are proposing to conduct in East Africa. The study will enroll cases at four hospitals in four regions in East Africa, where malaria transmission is holoendemic and year round. The controls will be enrolled from general population based attendees at Health Center II units where the cases originated. The primary study objectives are: 1) to test the hypothesis that genetic resistance to malaria associated with a lower risk of BL, and 2) to use genome-wide association methods to discover genetic variation that may be associated with decreased or increased risk of BL.

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