Buckley JD, Buckley CM, Ruccione K, Sather HN, Waskerwitz MJ, Woods WG, Robison LL, For The Children's Cancer GroupEpidemiological characteristics of childhood acute lymphocytic leukemia. Analysis by immunophenotype. Leukemia 8: 856-864
Department of Preventive Medicine, University of Southern California, Los Angeles. Leukemia
(Impact Factor: 10.43).
While a number of epidemiological studies of childhood acute lymphocytic leukemia (ALL) have been conducted, separate analysis of risk factors for ALL subtypes has generally not been possible. We report the results of an analysis of data obtained from parents of children with ALL (and a control group of children without cancer), linked to a clinical database. Cases were classified into four ALL subtypes, and odds ratios (OR) were determined for each subtype for a broad range of factors. Numerous significant associations were found, some across all subtypes and others that were subtype-specific. Factors with elevated and/or significant ORs included: (i) for common ALL (n = 286): Down syndrome; family history (FH) of bone/joint diseases; postnatal jaundice; birthweight; MMR vaccination; exposure to gases and insecticides; and parental occupational exposure to insecticides. (ii) for pre-B ALL (n = 38): FH of gastrointestinal, hematological or bone/joint diseases, or allergy; cat ownership; exposure to solvents, fumes, petroleum products, cleaning agents and farm animals; and parental exposure to farm animals, fumes and solvents; (iii) for T-cell ALL (n = 158): FH of gastrointestinal disorders, maternal age, male gender, and parental occupational exposure to metals; (iv) for null-cell ALL (n = 65): FH of congenital heart disorders; measles; and parental occupational exposure to fumes, metals or solvents. This analysis should be considered as a hypothesis-generating process for future case-control interview studies.
Available from: Philip C. Nasca
- "Since then, however, most studies of maternal age and the risk of leukaemia in the offspring have been negative or have shown weak, nonsignificant elevated risk with older maternal age (Salonen and Saxen, 1975; Kneale and Stewart, 1976; Shaw et al, 1984; Steensel-Moll et al, 1985; McKinney et al, 1987, 1999; Shu et al, 1988, 1994, 1999; Zack et al, 1991; Cnattingius et al, 1995; Petridou et al, 1997; Roman et al, 1997; Ross et al, 1997; Westergaard et al, 1997; Dockerty et al, 1999; Thompson et al, 2001; Murray et al, 2002; Okcu et al, 2002; Jourdan-Da Silva et al, 2004). A handful of studies have resulted in statistically significant increased risk ratios in the order of 1.5 – 2.0 for ALL or all leukaemias among children born to women older than age 35 years at delivery (Kaye et al, 1991; Buckley et al, 1994; Hemminki et al, 1999; Mogren et al, 1999; Dockerty et al, 2001; Reynolds et al, 2002; Shu et al, 2002; Jourdan-Da Silva et al, 2004). Little (1999) proposed that the lack of consistency between the early studies and those conducted later was due to the introduction of easily accessible contraception and abortion, which has introduced the possibility of confounding by socioeconomic status. "
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ABSTRACT: There is mounting evidence that childhood leukaemia is associated with high birth weight, but few studies have examined the relationship between leukaemia and other perinatal factors that influence birth weight, such as maternal weight or gestational weight gain. This case-cohort study included 916 acute lymphocytic leukaemia (ALL) and 154 acute myeloid leukaemia (AML) cases diagnosed prior to age 10 years between 1985 and 2001 and born in New York State excluding New York City between 1978 and 2001. Controls (n=9686) were selected from the birth cohorts for the same years. Moderate increased risk of both ALL and AML was associated with birth weight 3500 g or more. For ALL, however, there was evidence of effect modification with birth weight and maternal prepregnancy weight. High birth weight was associated with ALL only when the mother was not overweight while heavier maternal weight was associated with ALL only when the infant was not high birth weight. Increased pregnancy-related weight gain was associated with ALL. For AML, birth weight under 3000 g and higher prepregnancy weight were both associated with increased risk. These findings suggest childhood leukaemia may be related to factors influencing abnormal fetal growth patterns.
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- "Amongst them, Roman et al (1997) reported a significantly increased risk of leukaemia with non-specific viral infection (OR ¼ 6AE0; 95% CI: 1AE2–29AE7) and a nonsignificantly raised OR of 4AE0 for non-specific viral infection and subsequent childhood ALL. Another study looked at leukaemia subtype and the increased risk was particularly apparent for precursor B-cell ALL, with an OR of 1AE5 (P < 0AE05) for non-specific maternal infection (Buckley et al, 1994). Six other reported case–control studies looked at maternal infection and risk of childhood leukaemia (reviewed by Little, 1999). "
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ABSTRACT: There are three current hypotheses concerning infectious mechanisms in the aetiology of childhood leukaemia: exposure in utero or around the time of birth, delayed exposure beyond the first year of life to common infections and unusual population mixing. No specific virus has been definitively linked with childhood leukaemia and there is no evidence to date of viral genomic inclusions within leukaemic cells. The case-control and cohort studies have revealed equivocal results. Maternal infection during pregnancy has been linked with increased risk whilst breast feeding and day care attendance in the first year of life appear to be protective. There is inconclusive evidence from studies on early childhood infectious exposures, vaccination and social mixing. Some supportive evidence for an infectious aetiology is provided by the findings of space-time clustering and seasonal variation. Spatial clustering suggests that higher incidence is confined to specific areas with increased levels of population mixing, particularly in previously isolated populations. Ecological studies have also shown excess incidence with higher population mixing. The marked childhood peak in resource-rich countries and an increased incidence of the childhood peak in acute lymphoblastic leukaemia (ALL) (occurring at ages 2-6 years predominantly with precursor B-cell ALL) is supportive of the concept that reduced early infection may play a role. Genetically determined individual response to infection may be critical in the proliferation of preleukaemic clones as evidenced by the human leucocyte antigen class II polymorphic variant association with precursor B-cell and T-cell ALL.
Available from: kinderkrebsregister.de
- "We collected information on potential risk factors both by questionnaire and by a subsequent telephone interview. The questions were based on a structured questionnaire developed by the US Children's Cancer Group . Questionnaires were mailed by the physician responsible for the cancer treatment (cases) or by the study center at the GCCR (controls) and were to be returned to the study center. "
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ABSTRACT: Neuroblastoma is one of the childhood cancers included in two recent population-based case-control studies in West Germany. Altogether, 183 children under the age of 8 with neuroblastoma diagnosed in 1988-1994 and 1785 control children sampled from population registration files participated. Information on potential risk factors was obtained from the children's parents by a self-administered questionnaire and subsequent telephone interview. We observed positive associations with the use of oral contraceptives or other sex hormones during pregnancy (particularly with male offspring), a shorter gestational duration, lower birth weight, and maternal alcohol consumption during pregnancy. While the association with maternal use of oral contraceptives or sex hormones was strong for stages I/II (odds ratio 4.5, 95% confidence interval 1.2-16.5), the associations with shorter gestation duration (odds ratio 3.4, 95% confidence interval 1.7-6.7) as well as maternal alcohol consumption during pregnancy (>7 glasses/week odds ratio 5.2, 95% confidence interval 1.3-20.6) were observed only for the unfavourable advanced stages. It is notable that the associations in our study were either observed only for the advanced stages of disease or only for the less advanced stages, but not for both subgroups. This adds to evidence for the hypothesis that neuroblastoma consists of at least two distinct disease entities, which differ in clinical stage at the time of diagnosis.
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