Clinical, Laboratory and Epidemiologic Characterization of Individuals and Families at High Risk of Hematologic Cancer

Background:

Persons may be prone to develop hematologic or lymphoproliferative cancer for a variety of reasons including: inherited predisposition of benign, premalignant, or malignant conditions; environmental exposures shared by family members; previous tumors or preneoplastic conditions; immune deficiency; or stochastic processes

Investigations of individuals and families at high risk of cancer often lead to etiologic clues that may be important in the sporadic counterparts of these cancers in the general population

Identification of etiologically important genetic factors could inform chemoprevention trials, screening programs, and treatment of hematologic and lymphoproliferative cancers

Objectives:

To evaluate and define the clinical spectrum and natural history of disease in syndromes predisposing to hematologic cancer

To evaluate potential precursor states of malignancy in families at risk

To quantify the risks of specific tumors in family members and define syndromic constellations

To identify, map, characterize, clone, and determine function of tumor susceptibility genes

To validate and test associations of biomarkers with risk

To identify genetic determinants, environmental factors, and gene-environmental interactions conferring cancer risk in individuals and families

To identify differences and similarities between the familial and sporadic condition

To educate and counsel study participants about their risk of hematologic malignancy including prevention recommendations and early detection activities when known

To develop syndrome-specific educational materials for medical professionals and high-risk family members

Eligibility:

On referral, persons >= 11 months will be included only because of personal history, and persons >/=18 years can also be included because of personal or family history of the parameters listed below:

• a medical history of hematologic/lymphoproliferative malignancy of an unusual type, pattern, or number or
• there are known or suspected factor(s) predisposing to hematologic malignancy, either genetic or congenital factors, environmental exposure, or unusual demographic features

• For familial neoplasms, two or more living affected cases among family members are generally required

Design:

This is a prospective study. Families are studied long-term using a cohort approach.

The study design and evaluation vary by the specific type of familial neoplasm being studied

The overall approach to eligible families includes defining affection status, characterization of disease, localization of genetic loci, identification of genes, evaluation of phenotype/genotype correlations, estimation of risk of the disease associated with carrier

status and identification of other risk factors that modify penetrance (genetic, environmental, and host factors)

• INCLUSION CRITERIA:

On referral, persons >= 11 months will be included only because of personal history, and persons >=18 years can also be included because of personal or family history of the parameters listed below:

• A medical history of hematologic/ lymphoproliferative malignancy of an unusual type, pattern, or number or
• Known or suspected factor(s) predisposing to hematologic malignancy, either genetic and/or congenital factors (birth defects, metabolic phenotype, chromosomal anomalies or Mendelian traits associated with tumors), environmental exposure (medications, occupation, radiation, diet, infectious agents, etc.), or unusual demographic features (very young age of onset, multiple tumors, etc.)

Personal and family medical history must be verified through questionnaires, interviews, and review of pathology slides and medical records. For familial neoplasms, two or more living affected cases among family members are generally required, although in selected instances exceptions may be made, e.g., for WM, one case plus a living 1st degree relative with an autoimmune condition will qualify a family for further investigations.

Disease-specific considerations. Familial aggregation of any hematologic cancer(s) is eligible for study. Disease-specific procedures are outlined in appendices:

• Chronic lymphocytic leukemia (CLL)
• Waldenstrom macroglobulinemia (WM)
• Non-Hodgkin lymphoma (NHL)
• Hodgkin lymphoma (HL)
• Mixed/miscellaneous hematologic and lymphoproliferative diseases

Ability of subject or Legally Authorized Representative (LAR) to understand, and the willingness to sign, a written informed consent document.

Exclusion criteria

• Referred individuals for whom reported diagnoses cannot be verified;
• Referred individuals who decline informed consent.