Outcomes from the National Database of Lymphoid Malignancies in US Veterans Using Data from the Veterans Health Administration
The proposed study will investigate the associations of environmental toxin exposure with clinical course and outcomes of lymphoid malignancies by querying the VA Informatics and Computing Infrastructure (VINCI), which houses electronic medical records.
Abstract: Environmental toxins, such as dioxins like Agent Orange (AO) and chemicals from burn pits, are important exposures to the military and civilian populations in theaters of conflict and have been related to development of lymphoid malignancies. Preclinical studies show that dioxin activation of the aryl hydrocarbon receptor (AHR, the dioxin receptor) pathway leads to the development of lymphoid malignancies because of inhibition of apoptosis through the cyclooyxygenase-2 pathway (COX2) and/or immune suppression. To understand underlying mechanisms, more information is needed on the associations of environmental exposures and the development and clinical course of lymphoid malignancies, including lymphomas, chronic lymphocytic leukemia (CLL), and multiple myeloma.
To investigate the associations of exposures with the clinical course and outcomes of lymphoid malignancies, we will query the VA Informatics and Computing Infrastructure (VINCI), which houses data from the medical records of Veterans nationally, for 72,451 lymphoid malignancy cases that we have identified. In Aim 1, we will use data from the VA VINCI database including the VA Corporate Data Warehouse (CDW) data domains, vital status file, and the national death index to abstract variables to create a National Database of Lymphoid Malignancies in US Veterans. In Aim 2, we will evaluate the association of exposures with the development and clinical course of different subsets of lymphoid malignancies, stratified by age and prognostic indices.