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Pagliaro L, Chen SJ, Herranz D, Mecucci C, Harrison CJ, Mullighan CG, Zhang M, Chen Z, Boissel N, Winter SS, Roti G. Acute lymphoblastic leukaemia. Nat Rev Dis Primers 2024; 10:41. [PMID: 38871740 DOI: 10.1038/s41572-024-00525-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 06/15/2024]
Abstract
Acute lymphoblastic leukaemia (ALL) is a haematological malignancy characterized by the uncontrolled proliferation of immature lymphoid cells. Over past decades, significant progress has been made in understanding the biology of ALL, resulting in remarkable improvements in its diagnosis, treatment and monitoring. Since the advent of chemotherapy, ALL has been the platform to test for innovative approaches applicable to cancer in general. For example, the advent of omics medicine has led to a deeper understanding of the molecular and genetic features that underpin ALL. Innovations in genomic profiling techniques have identified specific genetic alterations and mutations that drive ALL, inspiring new therapies. Targeted agents, such as tyrosine kinase inhibitors and immunotherapies, have shown promising results in subgroups of patients while minimizing adverse effects. Furthermore, the development of chimeric antigen receptor T cell therapy represents a breakthrough in ALL treatment, resulting in remarkable responses and potential long-term remissions. Advances are not limited to treatment modalities alone. Measurable residual disease monitoring and ex vivo drug response profiling screening have provided earlier detection of disease relapse and identification of exceptional responders, enabling clinicians to adjust treatment strategies for individual patients. Decades of supportive and prophylactic care have improved the management of treatment-related complications, enhancing the quality of life for patients with ALL.
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Affiliation(s)
- Luca Pagliaro
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Translational Hematology and Chemogenomics (THEC), University of Parma, Parma, Italy
- Hematology and BMT Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Sai-Juan Chen
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Daniel Herranz
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Cristina Mecucci
- Department of Medicine, Hematology and Clinical Immunology, University of Perugia, Perugia, Italy
| | - Christine J Harrison
- Leukaemia Research Cytogenetics Group, Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Charles G Mullighan
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ming Zhang
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Zhu Chen
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Nicolas Boissel
- Hôpital Saint-Louis, APHP, Institut de Recherche Saint-Louis, Université Paris Cité, Paris, France
| | - Stuart S Winter
- Children's Minnesota Cancer and Blood Disorders Program, Minneapolis, MN, USA
| | - Giovanni Roti
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
- Translational Hematology and Chemogenomics (THEC), University of Parma, Parma, Italy.
- Hematology and BMT Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
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McCormick BJ, Imran H. Spontaneous Remission of Acute Lymphoblastic Leukemia Following Candida tropicalis Fungemia. Cureus 2024; 16:e62435. [PMID: 39011219 PMCID: PMC11249080 DOI: 10.7759/cureus.62435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2024] [Indexed: 07/17/2024] Open
Abstract
Spontaneous remission (SR) in acute lymphoblastic leukemia (ALL) is a poorly understood phenomenon that has been sporadically reported in medical literature for over a century, and the molecular and immunologic mechanisms of remission pose interesting clinical questions. Furthermore, the often-transient nature of these remissions poses a challenge to physicians in formulating an approach to treatment. We report on a rare case of Candida tropicalis sepsis in a three-year-old female with high-risk ALL who received less than two months of treatment prior to sepsis and subsequent SR.
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Affiliation(s)
| | - Hamayun Imran
- Pediatric Hematology/Oncology, University of South Alabama, Mobile, USA
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de Carvalho VM, Chung-Filho AA, Braga FHP, Chagas-Neto P, Soares-Lima SC, Pombo-de-Oliveira MS. Interaction between birth characteristics and CRHR1, MC2R, NR3C1, GLCCI1 variants in the childhood lymphoblastic leukemia risk. Front Oncol 2024; 13:1274131. [PMID: 38348123 PMCID: PMC10859751 DOI: 10.3389/fonc.2023.1274131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/31/2023] [Indexed: 02/15/2024] Open
Abstract
Background The incidence rate of childhood acute lymphoblastic leukemia (ALL) differs worldwide, and the interplay between hemostasis actors and the maladaptive responses to environmental exposures has been explored. It has been proposed that endogenous cortisol, induced by different triggers, would eliminate pre-leukemic clones originated in utero. Herein, we tested if the interaction between CRHR1rs242941 C>A, MC2Rrs1893219 A>G, NR3C1rs41423247 G>C, and GLCCI1rs37972 C>T (players in glucocorticoid secretion) and birth characteristics would be associated with ALL risk. Methods Children aged <10 years were enrolled within the EMiLI project (period: 2012 to 2020). The study had three steps: (1) observational analysis of birth characteristics (n = 533 cases and 1,603 controls); (2) genotyping to identify single-nucleotide variants (n = 756 cases and 431 controls); and (3) case-only to test gene-environment interactions (n = 402 cases). Genetic syndromes were exclusion criteria. The controls were healthy children. The distribution of the variables was assessed through Pearson's chi-square test. Logistic regression (LR) tests were run fitted and adjusted for selected covariate models to estimate the association risk. Formal interaction analysis was also performed. Genotyping was tested by qPCR with TaqMan probes (NR3C1) or by high-resolution melting (MC2R and GLCCI1). Hardy-Weinberg equilibrium (HWE) was accessed by the chi-square test. The genotype-risk association was tested in co-dominant, dominant, and recessive models. The gene-environment interaction odds ratio (iOR) was assessed in case-only. Results Low birthweight, C-section, and low maternal schooling were associated with increased risk for ALL, adjOR 2.11, 95% CI, 1.02-4.33; adjOR 1.59, 95% CI, 1.16-2.17; and adjOR 3.78, 95% CI, 2.47-5.83, respectively, in a multiple logistic regression model. MC2R rs1893219 A>G was negatively associated with ALL (AG: OR = 0.68; 95% CI = 0.50-0.94 and GG: OR = 0.60; 95% CI = 0.42-0.85), while for GLCCI1 rs37972 C>T, TT was positively associated with ALL (OR = 1.91; 95% CI = 1.21-3.00). The combination of genotypes for MC2R (AA) and GLCCI1 (TT) increased ALL risk (OR = 2.61; 95% CI = 1.16-5.87). In a multiplicative interaction, MC2R rs1893219 A>G was associated with children whose mothers had less than 9 years of schooling (iOR = 1.99; 95% CI = 1.11-1.55). Conclusion Our study has demonstrated a significant association between MC2R rs1893219 A>G (reduced risk) and GLCCI1 rs37972 C>T variants (increased risk) and childhood ALL susceptibility. Based on this evidence, genes controlling the HPA axis activity may play a role in leukemogenesis, and further investigation is needed to substantiate our findings.
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Affiliation(s)
- Vitoria Müller de Carvalho
- Research Center, Molecular Carcinogenesis Program, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Alython Araujo Chung-Filho
- Research Center, Molecular Carcinogenesis Program, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Flávio Henrique Paraguassu Braga
- National Placental and Umbilical Cord Blood Bank, Instituto Nacional de Câncer (INCA), Ministério da Saúde (MS), Rio de Janeiro, Brazil
| | - Paulo Chagas-Neto
- Research Center, Molecular Carcinogenesis Program, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Sheila Coelho Soares-Lima
- Research Center, Molecular Carcinogenesis Program, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Maria S. Pombo-de-Oliveira
- Research Center, Molecular Carcinogenesis Program, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
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Khanolkar A, Liu G, Simpson Schneider BM. Defining the Basal and Immunomodulatory Mediator-Induced Phosphoprotein Signature in Pediatric B Cell Acute Lymphoblastic Leukemia (B-ALL) Diagnostic Samples. Int J Mol Sci 2023; 24:13937. [PMID: 37762241 PMCID: PMC10531382 DOI: 10.3390/ijms241813937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
It is theorized that dysregulated immune responses to infectious insults contribute to the development of pediatric B-ALL. In this context, our understanding of the immunomodulatory-mediator-induced signaling responses of leukemic blasts in pediatric B-ALL diagnostic samples is rather limited. Hence, in this study, we defined the signaling landscape of leukemic blasts, as well as normal mature B cells and T cells residing in diagnostic samples from 63 pediatric B-ALL patients. These samples were interrogated with a range of immunomodulatory-mediators within 24 h of collection, and phosflow analyses of downstream proximal signaling nodes were performed. Our data reveal evidence of basal hyperphosphorylation across a broad swath of these signaling nodes in leukemic blasts in contrast to normal mature B cells and T cells in the same sample. We also detected similarities in the phosphoprotein signature between blasts and mature B cells in response to IFNγ and IL-2 treatment, but significant divergence in the phosphoprotein signature was observed between blasts and mature B cells in response to IL-4, IL-7, IL-10, IL-21 and CD40 ligand treatment. Our results demonstrate the existence of both symmetry and asymmetry in the phosphoprotein signature between leukemic and non-leukemic cells in pediatric B-ALL diagnostic samples.
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Affiliation(s)
- Aaruni Khanolkar
- Department of Pathology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
- Department of Pathology, Northwestern University, Chicago, IL 60611, USA
| | - Guorong Liu
- Department of Pathology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
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Pombo-de-Oliveira MS, Petridou ET, Karalexi MA, Junqueira MER, Braga FHP, Bouzas LF, Murra GRC, Lopes LF, Ntzani E, Greaves M. The Interplay of Cesarean-Section Delivery and First-Birth Order as Risk Factors in Acute Lymphoblastic Leukemia. Cancer Epidemiol Biomarkers Prev 2023; 32:371-379. [PMID: 36525650 DOI: 10.1158/1055-9965.epi-22-0664] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/24/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Childhood B-cell precursor acute lymphoblastic leukemia (BCP-ALL) has been associated with early-life exposures, including birth by cesarean section (C-section), and a deficit of social exposure (first child). These exposures as proxies for microbiome acquisition in infancy are essential to prime the immune system and restrain later dysregulated immune responses that can trigger ALL in susceptible individuals. We tested risk factors pertaining to immune stimulation that may impact BCP-ALL development. METHODS Cases comprised 1,126 children (0-12 years) with ALL (BCP-ALL: 78.5%) from the EMiLI study group in Brazil (2002-2020). Age- and sex-matched controls (n = 2,252) were randomly selected from healthy children whose mothers participated in the National Placental and Umbilical Cord Blood Bank donation. Multiple logistic regression was run fitted and adjusted for selected covariates models. RESULTS C-section delivery was associated with increased risk for ALL [odds ratio (OR) ALL: 1.10; 95% confidence intervals (CI), 1.04-1.15; ORBCP-ALL: 1.09; 95% CI, 1.03-1.14], as well as being the firstborn child. Interaction analysis showed a significant effect of first birth on the observed C-section associations (P < 0.0001). Indeed, high-risk children, namely, firstborn children delivered via C-section were at increased risk for ALL (OR: 2.33; 95% CI, 2.40-4.84) compared with non-first, vaginally born children. An increased risk was found for firstborn children delivered by C-section and non-breastfed with ALL (ORALL: 2.32; 95% CI, 1.27-4.24; ORBCP-ALL: 2.37; 95% CI, 1.18-4.76). CONCLUSIONS Our observations are in accord with the prediction that exposures determining microbiome composition and adrenal pathway in infancy contribute to the risk of BCP-ALL. IMPACT These findings encourage the exploration of potential preventive interventions. See related commentary by Wiemels and Gallant, p. 292.
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Affiliation(s)
| | - Eleni Th Petridou
- Hellenic Society for Social Pediatrics and Health Promotion, Athens, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria A Karalexi
- Hellenic Society for Social Pediatrics and Health Promotion, Athens, Greece
| | | | | | - Luis Fernando Bouzas
- National Placental and Umbilical Cord Blood Bank, INCA, MS, Rio de Janeiro, Brazil
| | | | - Luiz Fernando Lopes
- Children's Cancer Hospital, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Evangelia Ntzani
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island
| | - Mel Greaves
- Center for Evolution and Cancer, Institute of Cancer Research, Sutton, United Kingdom
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Yang Y, Yu C, Fu R, Xia S, Ni H, He Y, Zhu K, Sun Q. Association of cesarean section with risk of childhood leukemia: A meta-analysis from an observational study. Hematol Oncol 2023; 41:182-191. [PMID: 36000274 DOI: 10.1002/hon.3070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/15/2022] [Accepted: 08/20/2022] [Indexed: 02/03/2023]
Abstract
Recent studies suggest that children born via cesarean section (CS) are predisposed to immune-mediated diseases later in life. The association between CS and childhood leukemia was investigated in this meta-analysis of observational studies. Two researchers independently searched PubMed, Web of Science, Embase, and Cochrane Library for literature on the association between CS and childhood leukemia before February 2022. And pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated to determine the link between CS and childhood leukemia. The preliminary search resulted in 1321 articles and 16 articles were finally included after screening. The primary outcome was the risk of leukemia in children born via CS versus those born vaginally. The results revealed that having a CS was associated with an increased risk of childhood leukemia compared to having vaginal section (VS) (OR = 1.07, 95% CI: 1.02-1.13, p = 0.01), especially for acute lymphoblastic leukemia (ALL) (OR = 1.09, 95% CI: 1.03-1.16, p = 0.004). Children delivered via elective CS had a higher risk of ALL (OR = 1.18, 95% CI: 1.07-1.31, p = 0.001), but emergency CS did not. It is worth noting that neither emergency CS nor elective CS were found to be associated with acute myeloid leukemia. Compared to VS, CS increased the risk of leukemia in children, with elective CS significantly increasing ALL risk.
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Affiliation(s)
- Yingzhu Yang
- Department of Gynecology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
| | - Chiyuan Yu
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Rongrong Fu
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Shishan Xia
- Department of Medicine, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
| | - Haixiang Ni
- Department of Endocrinology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yujing He
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Keying Zhu
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qian Sun
- Department of Obstetrics and Gynecology, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China
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Cohen WR, Robson MS, Bedrick AD. Disquiet concerning cesarean birth. J Perinat Med 2022:jpm-2022-0343. [PMID: 36376060 DOI: 10.1515/jpm-2022-0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022]
Abstract
Cesarean birth has increased substantially in many parts of the world over recent decades and concerns have been raised about the propriety of this change in obstetric practice. Sometimes, a cesarean is necessary to preserve fetal and maternal health. But in balancing the risks of surgical intervention the implicit assumption has been that cesarean birth is an equivalent alternative to vaginal birth from the standpoint of the immediate and long-term health of the fetus and neonate. Increasingly, we realize this is not necessarily so. Delivery mode per se may influence short-term and abiding problems with homeostasis in offspring, quite independent of the indications for the delivery and other potentially confounding factors. The probability of developing various disorders, including respiratory compromise, obesity, immune dysfunction, and neurobehavioral disorders has been shown in some studies to be higher among individuals born by cesarean. Moreover, many of these adverse effects are not confined to the neonatal period and may develop over many years. Although the associations between delivery mode and long-term health are persuasive, their pathogenesis and causality remain uncertain. Full exploration and a clear understanding of these relationships is of great importance to the health of offspring.
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Affiliation(s)
- Wayne R Cohen
- Departments of Obstetrics and Gynecology, University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - Alan D Bedrick
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, AZ, USA
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Flores-Lujano J, Duarte-Rodríguez DA, Jiménez-Hernández E, Martín-Trejo JA, Allende-López A, Peñaloza-González JG, Pérez-Saldivar ML, Medina-Sanson A, Torres-Nava JR, Solís-Labastida KA, Flores-Villegas LV, Espinosa-Elizondo RM, Amador-Sánchez R, Velázquez-Aviña MM, Merino-Pasaye LE, Núñez-Villegas NN, González-Ávila AI, del Campo-Martínez MDLÁ, Alvarado-Ibarra M, Bekker-Méndez VC, Cárdenas-Cardos R, Jiménez-Morales S, Rivera-Luna R, Rosas-Vargas H, López-Santiago NC, Rangel-López A, Hidalgo-Miranda A, Vega E, Mata-Rocha M, Sepúlveda-Robles OA, Arellano-Galindo J, Núñez-Enríquez JC, Mejía-Aranguré JM. Persistently high incidence rates of childhood acute leukemias from 2010 to 2017 in Mexico City: A population study from the MIGICCL. Front Public Health 2022; 10:918921. [PMID: 36187646 PMCID: PMC9518605 DOI: 10.3389/fpubh.2022.918921] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/09/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction Over the years, the Hispanic population living in the United States has consistently shown high incidence rates of childhood acute leukemias (AL). Similarly, high AL incidence was previously observed in Mexico City (MC). Here, we estimated the AL incidence rates among children under 15 years of age in MC during the period 2010-2017. Methods The Mexican Interinstitutional Group for the Identification of the Causes of Childhood Leukemia conducted a study gathering clinical and epidemiological information regarding children newly diagnosed with AL at public health institutions of MC. Crude age incidence rates (cAIR) were obtained. Age-standardized incidence rates worldwide (ASIRw) and by municipalities (ASIRm) were calculated by the direct and indirect methods, respectively. These were reported per million population <15 years of age; stratified by age group, sex, AL subtypes, immunophenotype and gene rearrangements. Results A total of 903 AL cases were registered. The ASIRw was 63.3 (cases per million) for AL, 53.1 for acute lymphoblastic leukemia (ALL), and 9.4 for acute myeloblastic leukemia. The highest cAIR for AL was observed in the age group between 1 and 4 years (male: 102.34 and female: 82.73). By immunophenotype, the ASIRw was 47.3 for B-cell and 3.7 for T-cell. The incidence did not show any significant trends during the study period. The ASIRm for ALL were 68.6, 66.6 and 62.8 at Iztacalco, Venustiano Carranza and Benito Juárez, respectively, whereas, other municipalities exhibited null values mainly for AML. Conclusion The ASIRw for childhood AL in MC is among the highest reported worldwide. We observed spatial heterogeneity of rates by municipalities. The elevated AL incidence observed in Mexican children may be explained by a combination of genetic background and exposure to environmental risk factors.
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Affiliation(s)
- Janet Flores-Lujano
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Pediatría “Dr. Silvestre Frenk Freund, ” Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - David Aldebarán Duarte-Rodríguez
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Pediatría “Dr. Silvestre Frenk Freund, ” Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Elva Jiménez-Hernández
- Servicio de Hematología Pediátrica, Centro Médico Nacional “La Raza, ” Hospital General “Gaudencio González Garza, ” Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico,Servicio de Oncología, Hospital Pediátrico de Moctezuma, Secretaría de Salud de la Ciudad de México (SSCDMX), Mexico City, Mexico
| | - Jorge Alfonso Martín-Trejo
- Servicio de Hematología Pediátrica, Unidad Médica de Alta Especialidad, Hospital de Pediatría “Dr. Silvestre Frenk Freund, ” Centro Médico Nacional “Siglo XXI, ” Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Aldo Allende-López
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Pediatría “Dr. Silvestre Frenk Freund, ” Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | | | - María Luisa Pérez-Saldivar
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Pediatría “Dr. Silvestre Frenk Freund, ” Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Aurora Medina-Sanson
- Departamento de HematoOncología, Hospital Infantil de México Federico Gómez, Secretaría de Salud (SS), Mexico City, Mexico
| | - José Refugio Torres-Nava
- Servicio de Oncología, Hospital Pediátrico de Moctezuma, Secretaría de Salud de la Ciudad de México (SSCDMX), Mexico City, Mexico
| | - Karina Anastacia Solís-Labastida
- Servicio de Hematología Pediátrica, Unidad Médica de Alta Especialidad, Hospital de Pediatría “Dr. Silvestre Frenk Freund, ” Centro Médico Nacional “Siglo XXI, ” Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Luz Victoria Flores-Villegas
- Servicio de Hematología Pediátrica, Centro Médico Nacional “20 de Noviembre, ” Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | | | - Raquel Amador-Sánchez
- Servicio de Hematología Pediátrica, Hospital General Regional 1 “Dr. Carlos McGregor Sánchez Navarro, ” Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | | | - Laura Elizabeth Merino-Pasaye
- Servicio de Hematología Pediátrica, Centro Médico Nacional “20 de Noviembre, ” Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Nora Nancy Núñez-Villegas
- Servicio de Hematología Pediátrica, Centro Médico Nacional “La Raza, ” Hospital General “Gaudencio González Garza, ” Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Ana Itamar González-Ávila
- Servicio de Hematología Pediátrica, Hospital General Regional 1 “Dr. Carlos McGregor Sánchez Navarro, ” Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - María de los Ángeles del Campo-Martínez
- Servicio de Hematología Pediátrica, Centro Médico Nacional “La Raza, ” Hospital General “Gaudencio González Garza, ” Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Martha Alvarado-Ibarra
- Servicio de Hematología Pediátrica, Centro Médico Nacional “20 de Noviembre, ” Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Vilma Carolina Bekker-Méndez
- Hospital de Infectología “Dr. Daniel Méndez Hernández, ” “La Raza, ” Instituto Mexicano del Seguro Social (IMSS), Unidad de Investigación Médica en Inmunología e Infectología, Mexico City, Mexico
| | - Rocío Cárdenas-Cardos
- Servicio de Oncología Pediátrica, Instituto Nacional de Pediatría, Secretaría de Salud (SS), Mexico City, Mexico
| | - Silvia Jiménez-Morales
- Laboratorio de Genómica del Cáncer, Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | - Roberto Rivera-Luna
- Servicio de Oncología Pediátrica, Instituto Nacional de Pediatría, Secretaría de Salud (SS), Mexico City, Mexico
| | - Haydee Rosas-Vargas
- Unidad de Investigación Médica en Genética Humana, Unidad Médica de Alta Especialidad, Hospital de Pediatría “Dr. Silvestre Frenk Freund, ” Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Norma C. López-Santiago
- Servicio de Hematología Pediátrica, Instituto Nacional de Pediatría, Secretaría de Salud (SS), Mexico City, Mexico
| | - Angélica Rangel-López
- Coordinación de Investigación en Salud, Unidad Habilitada de Apoyo al Predictamen, Centro Médico Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Alfredo Hidalgo-Miranda
- Laboratorio de Genómica del Cáncer, Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | - Elizabeth Vega
- Instituto de Ciencias de la Atmósfera y Cambio Climático, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Minerva Mata-Rocha
- Unidad de Investigación Médica en Genética Humana, Unidad Médica de Alta Especialidad, Hospital de Pediatría “Dr. Silvestre Frenk Freund, ” Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Omar Alejandro Sepúlveda-Robles
- Unidad de Investigación Médica en Genética Humana, Unidad Médica de Alta Especialidad, Hospital de Pediatría “Dr. Silvestre Frenk Freund, ” Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - José Arellano-Galindo
- Unidad de Investigación en Enfermedades Infecciosas, Laboratorio de Virología Clínica y Experimental, Hospital Infantil de México Federico Gómez, Secretaría de Salud (SS), Mexico City, Mexico
| | - Juan Carlos Núñez-Enríquez
- Unidad de Investigación Médica en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Pediatría “Dr. Silvestre Frenk Freund, ” Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico,Juan Carlos Núñez-Enríquez
| | - Juan Manuel Mejía-Aranguré
- Laboratorio de Genómica del Cáncer, Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico,Unidad de Investigación Médica en Genética Humana, Unidad Médica de Alta Especialidad, Hospital de Pediatría “Dr. Silvestre Frenk Freund, ” Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico,Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico,*Correspondence: Juan Manuel Mejía-Aranguré
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9
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Dwyer KE, Wang R, Cozen W, Cartmel B, Wiemels JL, Morimoto LM, Metayer C, Ma X. Mode of Delivery, Birth Characteristics, and Early-Onset Non-Hodgkin Lymphoma in a Population-Based Case-Control Study. Cancer Epidemiol Biomarkers Prev 2021; 30:2286-2293. [PMID: 34548330 DOI: 10.1158/1055-9965.epi-21-0535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/09/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The etiology of non-Hodgkin lymphoma (NHL) in children and in adolescents and young adults (AYA) is not well understood. METHODS We evaluated potential associations between mode of delivery, birth characteristics, and NHL risk in a population-based case-control study, which included 3,064 cases of NHL [490 with Burkitt lymphoma, 981 with diffuse large B-cell lymphoma (DLBCL), and 978 with T-cell NHL) diagnosed at the age of 0 to 37 years in California during 1988 to 2015 and 153,200 controls frequency matched on year of birth. Odds ratios (OR) and 95% confidence intervals (CI) were estimated from an unconditional multivariable logistic regression model that included year of birth and birth characteristics. RESULTS Individuals born via cesarean section had a decreased risk of pediatric Burkitt lymphoma (age 0-14 years; OR = 0.71, 95% CI: 0.51-0.99) and pediatric T-cell NHL (OR = 0.73, 95% CI: 0.55-0.97) compared with those born vaginally. Having a birth order of second (OR = 0.73, 95% CI: 0.57-0.93) or third or higher (OR = 0.76, 95% CI: 0.58-0.99) was associated with a lower risk of pediatric T-cell NHL compared with first-borns. AYA (age 15-37 years) with a heavier birthweight had an elevated risk of DLBCL (OR for each kg = 1.16, 95% CI: 1.00-1.35). Associations between other birth characteristics, including plurality, maternal age, maternal education, and NHL risk, also exhibited variations across subgroups based on age of diagnosis and histologic subtype. CONCLUSIONS These findings support a role of mode of delivery and birth characteristics in the etiology of early-onset NHL. IMPACT This study underscores the etiologic heterogeneity of early-onset NHL.
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Affiliation(s)
- Kayla E Dwyer
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Rong Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Wendy Cozen
- Division of Hematology/Oncology, Department of Medicine, School of Medicine, University of California, Irvine, California
| | - Brenda Cartmel
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Joseph L Wiemels
- Center for Genetic Epidemiology, USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Libby M Morimoto
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California
| | - Catherine Metayer
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California
| | - Xiaomei Ma
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.
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10
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Genetic and Epigenetic Characterization of a Discordant KMT2A/AFF1-Rearranged Infant Monozygotic Twin Pair. Int J Mol Sci 2021; 22:ijms22189740. [PMID: 34575904 PMCID: PMC8466096 DOI: 10.3390/ijms22189740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 11/26/2022] Open
Abstract
The KMT2A/AFF1 rearrangement is associated with an unfavorable prognosis in infant acute lymphocytic leukemia (ALL). Discordant ALL in monozygotic twins is uncommon and represents an attractive resource to evaluate intrauterine environment–genetic interplay in ALL. Mutational and epigenetic profiles were characterized for a discordant KMT2A/AFF1-rearranged infant monozygotic twin pair and their parents, and they were compared to three independent KMT2A/AFF1-positive ALL infants, in which the DNA methylation and gene expression profiles were investigated. A de novo Q61H NRAS mutation was detected in the affected twin at diagnosis and backtracked in both twins at birth. The KMT2A/AFF1 rearrangement was absent at birth in both twins. Genetic analyses conducted at birth gave more insights into the timing of the mutation hit. We identified correlations between DNA methylation and gene expression changes for 32 genes in the three independent affected versus remitted patients. The strongest correlations were observed for the RAB32, PDK4, CXCL3, RANBP17, and MACROD2 genes. This epigenetic signature could be a putative target for the development of novel epigenetic-based therapies and could help in explaining the molecular mechanisms characterizing ALL infants with KMT2A/AFF1 fusions.
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11
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Mejia-Arangure JM, McNally RJQ, Pombo-de-Oliveira MS. Editorial: Prevention in Acute Leukemias in Children. Front Public Health 2021; 9:700739. [PMID: 34434914 PMCID: PMC8381149 DOI: 10.3389/fpubh.2021.700739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/23/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Juan M Mejia-Arangure
- Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Mexico & Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
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12
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Transient Pancytopenia Subsequently Diagnosed With Acute Leukemia: A Report of 4 Cases of Acute Lymphoblastic Leukemia and Acute Myeloid Leukemia. J Pediatr Hematol Oncol 2021; 43:e715-e717. [PMID: 32852394 DOI: 10.1097/mph.0000000000001922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
A transient pancytopenic phase has been described in pediatric leukemia. The characteristic complete recovery of peripheral counts can obscure a clinician's suspicion for malignancy and may impact subsequent follow-up care. The authors describe 4 pediatric patients that had transient pancytopenia with an initial abnormal marrow finding. These patients were subsequently diagnosed with acute leukemia within 5 months of presentation. Awareness of this phenomenon by the provider and education of families may help with the appropriate and timely diagnosis of subsequent leukemia.
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13
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Towards prevention of childhood ALL by early-life immune training. Blood 2021; 138:1412-1428. [PMID: 34010407 PMCID: PMC8532195 DOI: 10.1182/blood.2020009895] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/21/2021] [Indexed: 11/21/2022] Open
Abstract
B-cell precursor acute lymphoblastic leukemia (BCP-ALL) is the most common form of childhood cancer. Chemotherapy is associated with life-long health sequelae and fails in ∼20% of cases. Thus, prevention of leukemia would be preferable to treatment. Childhood leukemia frequently starts before birth, during fetal hematopoiesis. A first genetic hit (eg, the ETV6-RUNX1 gene fusion) leads to the expansion of preleukemic B-cell clones, which are detectable in healthy newborn cord blood (up to 5%). These preleukemic clones give rise to clinically overt leukemia in only ∼0.2% of carriers. Experimental evidence suggests that a major driver of conversion from the preleukemic to the leukemic state is exposure to immune challenges. Novel insights have shed light on immune host responses and how they shape the complex interplay between (1) inherited or acquired genetic predispositions, (2) exposure to infection, and (3) abnormal cytokine release from immunologically untrained cells. Here, we integrate the recently emerging concept of “trained immunity” into existing models of childhood BCP-ALL and suggest future avenues toward leukemia prevention.
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14
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Etiology of Acute Leukemia: A Review. Cancers (Basel) 2021; 13:cancers13092256. [PMID: 34066700 PMCID: PMC8125807 DOI: 10.3390/cancers13092256] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/30/2021] [Accepted: 05/05/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Acute leukemias are some of the most common cancers affecting all age groups. Despite a significant improvement made in the treatment of acute leukemias, their cause remains unknown. A number of genetic and environmental factors for the development of acute leukemias have been proposed, but none have been proven. Undoubtedly, genetics have a major role in the development of these diseases. The effects of a variety of environmental factors, occupations and hobbies have been explored. A recent “two-hit” theory” for the development of acute lymphoblastic leukemia has been proposed. This combines genetic factors and exposure to infections for the development of this disease. Several genetic factors are suggested. Most recently, for the infection portion, exposure to a virus containing Aspergillus Flavus has been proposed. This review summarizes what is currently known about the factors that are proposed for the development of acute leukemias. Abstract Acute leukemias constitute some of the most common malignant disorders. Despite significant progress made in the treatment of these disorders, their etiology remains unknown. A large and diverse group of genetic and environmental variables have been proposed. The role of a variety of factors, including pre-existing and acquired genetic mutations, exposure to radiation and various chemicals during preconception, pregnancy and throughout life, have been explored. The effects of inherited genetic variations and disorders, pre-existing diseases, infectious agents, hobbies, occupations, prior treatments, and a host of other factors have been proposed, but none is universally applicable to all cases. Variation in the incidence and prognosis based on the age, sex, race, type of the disease, geographic area of residence and other factors are intriguing but remain unexplained. Advances in genomic profiling, including genome-wide gene expression, DNA copy number and single nucleotide polymorphism (SNP) genotype, may shed some light on the role of genetics in these disparities. Separate two-hit hypotheses for the development of acute myeloblastic and lymphoblastic leukemia have been proposed. The latter combines genetics and infection factors resulting in leukemogenesis. A number of pre- and post-natal environmental conditions and exposure to infections, including a mycovirus infected Aspergillus flavus, have been suggested. The exact nature, timing, sequence of the events and mechanisms resulting in the occurrence of leukemia requires further investigations. This review summarizes some of the above factors in acute lymphoblastic and myeloblastic leukemias and the direction for future research on the etiology of these disorders.
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15
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Schmiegelow K. Have COVID-19 affected ALL epidemiology? Acta Paediatr 2021; 110:387-388. [PMID: 33215748 PMCID: PMC7753803 DOI: 10.1111/apa.15631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Kjeld Schmiegelow
- Paediatrics and Paediatric Oncology Dept of Paediatrics and Adolescent Medicine Rigshospitalet University Hospital Copenhagen Copenhagen Denmark
- Institute of Clinical Medicine Faculty of Medicine, University of Copenhagen Copenhagen Denmark
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16
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Cesarean section and risk of childhood leukemia: a systematic review and meta-analysis. World J Pediatr 2020; 16:471-479. [PMID: 32048234 DOI: 10.1007/s12519-020-00338-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 01/13/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND A large number of studies pointed that being delivered by cesarean section (CS) would affect the health outcomes of offspring, however, whether CS would affect the risk of childhood leukemia remained uncertain. This study conducted a meta-analysis to quantitatively evaluate whether being delivered by CS would influence the onset of childhood leukemia. METHODS PubMed, Embase and Web of Science databases were searched from 3rd June, 1950 to 13th October, 2019 to identify the literature, which examined the relationship between CS and childhood leukemia. This study used Newcastle-Ottawa Scale to assess the quality of literature. Subgroup analyses were conducted on region, mode of delivery, design of the study and number of confounders adjusted. Egger's test and Begg's test were performed to evaluate possible publication bias. RESULTS The pooled odds ratio (OR) estimates illustrated that children delivered by CS had a higher risk of developing leukemia [OR 1.10, 95% confidence interval (CI) 1.04-1.17, P = 0.002] and lymphoblastic leukemia (OR 1.12, 95% CI 1.03-1.23, P = 0.009), while a significant association for myeloid leukemia was not observed (OR 1.05, 95% CI 0.92-1.20, P = 0.451). Results of subgroup analyses indicated that elective CS would increase the risk of childhood lymphoblastic leukemia (OR 1.16, 95% CI 1.06-1.27, P = 0.002). However, a statistical relationship between emergency CS and lymphoblastic leukemia was not observed (OR 1.07, 95% CI 0.93-1.23, P = 0.364). CONCLUSIONS CS would increase the risk of childhood lymphoblastic leukemia. It is worth noting that subgroup analyses shows that elective CS rather than emergency CS increases the risk of lymphoblastic leukemia in offspring.
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17
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Martig DS, Williamson CM, Xu X, Sukov WR, Greipp PT, Hoppman NL, Baughn LB, Ketterling RP, Peterson JF. Siblings with ETV6/RUNX1-positive B-lymphoblastic leukemia: A single site experience and review of the literature. Ann Diagn Pathol 2020; 48:151588. [PMID: 32836179 DOI: 10.1016/j.anndiagpath.2020.151588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 11/19/2022]
Abstract
Siblings diagnosed with B-lymphoblastic leukemia (B-ALL) that share the same driver abnormality have been rarely described in the literature. Herein, we report three pairs of siblings (one non-identical pair, one maternal half-sibling pair, and one identical pair) all diagnosed with ETV6/RUNX1-positive B-ALL. Considering that ETV6/RUNX1 fusion is thought to represent a prenatal event and necessitates additional genomic alterations to result in leukemia, siblings of patient's with known ETV6/RUNX1-positive B-ALL may be at increased risk of ETV6/RUNX1-positive B-ALL due to common exposures (environmental or infectious) or shared germline polymorphisms.
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Affiliation(s)
- Daniel S Martig
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Cynthia M Williamson
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Xinjie Xu
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - William R Sukov
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Patricia T Greipp
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Nicole L Hoppman
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Linda B Baughn
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Rhett P Ketterling
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America; Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Jess F Peterson
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America.
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18
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Bispo JAB, Pinheiro PS, Kobetz EK. Epidemiology and Etiology of Leukemia and Lymphoma. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a034819. [PMID: 31727680 DOI: 10.1101/cshperspect.a034819] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Available evidence suggests that the incidence of leukemia and lymphoma tends to be higher in highly developed regions of the world and among Whites in the United States. Temporal trends in incidence are dynamic and multifactorial; for instance, the incidence of non-Hodgkin's lymphoma increased around the turn of the century, in part because of the acquired immune deficiency syndrome (AIDS) epidemic. Most leukemias and lymphomas are sporadic and the specific etiology remains elusive. Still, research shows that these malignancies often develop in the context of genetic abnormalities, immunosuppression, and exposure to risk factors like ionizing radiation, carcinogenic chemicals, and oncogenic viruses. The prognosis varies by subtype, with poorer survival outcomes for acute leukemias among adults, and more favorable outcomes for Hodgkin's lymphoma. At a time when specific prevention efforts targeting these malignancies are nonexistent, there is a great need to ensure equitable access to diagnostic services and treatments worldwide.
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Affiliation(s)
- Jordan A Baeker Bispo
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida 33136, USA
| | - Paulo S Pinheiro
- Sylvester Comprehensive Cancer Center and Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida 33136, USA
| | - Erin K Kobetz
- Sylvester Comprehensive Cancer Center and Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida 33136, USA
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19
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Heck JE, Lee PC, Wu CK, Tsai HY, Ritz B, Arah OA, Li CY. Gestational risk factors and childhood cancers: A cohort study in Taiwan. Int J Cancer 2020; 147:1343-1353. [PMID: 32020595 DOI: 10.1002/ijc.32905] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/05/2019] [Accepted: 01/13/2020] [Indexed: 12/18/2022]
Abstract
Gestational risk factors such as birth weight, gestational age and parity have been repeatedly found to be related to pediatric cancers, but few reports have emerged from Asian countries. Here we report on demographic and gestational factors in a Taiwanese cohort. Our study included all children born in Taiwan 2004-2014 for whom there was a birth record (n = 2,079,037), of which 1900 children had been diagnosed with cancer prior to age 12. We conducted multivariable hazard regression to examine associations between demographic and gestational factors with cancer. Greater parity (family with 2+ older children) was related to acute myeloid leukemia [Hazard ratio (HR) = 2.15, 95% confidence interval (CI): 1.31, 3.55), central nervous system tumors (HR = 1.67, CI: 1.13, 2.48) and neuroblastoma (HR = 1.67, CI: 1.07, 2.63). Hepatoblastoma cases had a higher risk of low birth weight (<2,500 g; HR = 3.01, CI: 1.85, 4.91), very preterm birth (<33 weeks gestation; HR = 13.71, CI: 7.45, 25.23), plural pregnancies (HR = 2.37, CI: 1.10, 5.14) and both small (HR = 2.13, CI: 1.23, 3.67) and large (HR = 1.83, CI: 1.01, 3.32) for gestational age. Germ cell tumors were more common among children born in rural areas (HR = 1.63, CI: 1.02, 2.60). Despite that Taiwan has lower rates of both high and low birthweight compared to other developed nations, we observed several similar associations to those reported in Western Countries. Further research should examine unique exposures in Taiwan that may be contributing to higher incidence of certain cancer types.
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Affiliation(s)
- Julia E Heck
- Department of Epidemiology, Fielding School of Public Health, University of California-Los Angeles (UCLA), Los Angeles, CA.,Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA
| | - Pei-Chen Lee
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chia-Kai Wu
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hsin-Yun Tsai
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California-Los Angeles (UCLA), Los Angeles, CA
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California-Los Angeles (UCLA), Los Angeles, CA.,Department of Statistics, UCLA College of Letters and Science, Los Angeles, CA.,Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Chung-Yi Li
- Department of Public Health, National Cheng Kung University, Tainan, Taiwan.,Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
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20
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Zhu X, Liu Y, Chen G, Guo Q, Zhang Z, Zhao L, Wei R, Yin X, Zhang Y, Wang B, Li X. Association between NAT2 polymorphisms and acute leukemia risk: A meta-analysis. Medicine (Baltimore) 2019; 98:e14942. [PMID: 30896661 PMCID: PMC6709067 DOI: 10.1097/md.0000000000014942] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND N-acetyl-transferase 2 (NAT2) polymorphisms have been demonstrated to be associated with acute leukemia (AL); however, the results remain controversial. The present meta-analysis was performed to provide more precise results. METHODS Pubmed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases were used to identify eligible studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the strength of the association between NAT2 polymorphisms and AL risk. RESULTS Increased risk was found under both heterozygous (OR 1.24, 95% CI 1.02-1.51) and recessive model (OR 1.28, 95% CI 1.06-1.55) for rs1801280. The slow acetylator phenotype (OR 1.22, 95% CI 1.07-1.40) also increased AL risk. Subgroup analysis demonstrated that rs1801280 increased AL risk under the recessive model (OR 1.14, 95% CI 0.93-1.41) in Caucasian population and the co-dominant (OR 1.77, 95% CI 1.40-2.23), homozygous (OR 3.06, 95% CI 1.88-4.99), dominant (OR 2.22, 95% CI 1.56-3.17), recessive model (OR 2.06, 95% CI 1.35-3.16) in the Mixed populations. Association between rs1799929 and decreased AL risk was found in the co-dominant (OR 0.82, 95% CI 0.70-0.97), homozygous (OR 0.65, 95% CI 0.46-0.93), heterozygous (OR 0.71, 95% CI 0.51-1.00), and the recessive model (OR 0.68, 95% CI 0.49-0.94) in the Caucasian group. As for rs1799931, the same effects were found in the co-dominant (OR 0.68, 95% CI 0.49-0.94) and the dominant model (OR 0.68, 95% CI 0.48-0.97) in the mixed group. CONCLUSION rs1801280 and the slow acetylator phenotype are risk factors for AL.
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Affiliation(s)
- Xiaoxiao Zhu
- Laboratory for molecular immunology, Institute of Basic Medicine, Shandong Academy of Medical Sciences
| | - Yanbing Liu
- Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University
| | | | - Qiang Guo
- Laboratory for molecular immunology, Institute of Basic Medicine, Shandong Academy of Medical Sciences
| | - Zhen Zhang
- Laboratory for molecular immunology, Institute of Basic Medicine, Shandong Academy of Medical Sciences
| | - Lin Zhao
- Laboratory for molecular immunology, Institute of Basic Medicine, Shandong Academy of Medical Sciences
| | - Ran Wei
- Laboratory for molecular immunology, Institute of Basic Medicine, Shandong Academy of Medical Sciences
| | - Xunqiang Yin
- Laboratory for molecular immunology, Institute of Basic Medicine, Shandong Academy of Medical Sciences
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences
| | - Yunhong Zhang
- Laboratory for molecular immunology, Institute of Basic Medicine, Shandong Academy of Medical Sciences
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences
| | - Bin Wang
- Department of peripheral vascular disease, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xia Li
- Laboratory for molecular immunology, Institute of Basic Medicine, Shandong Academy of Medical Sciences
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21
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González-Quezada BA, Flores-Aguilar H, Olaya-Vargas A, Salazar-Rosales H, Pérez-García M, Valero-Saldaña LM, Acosta-Maldonado BL, Ovilla-Martínez R, Gorodezky C. IFNG +874 A/T is associated with acute lymphoblastic leukemia in Mexican Mestizos. Cytokine 2018; 111:265-271. [PMID: 30212785 DOI: 10.1016/j.cyto.2018.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 01/02/2023]
Abstract
Acute lymphoblastic leukemia (ALL), the most common type of cancer in children worldwide, has one of the highest incidence rates in Mexico. It is a multifactorial disease and different cytokine single nucleotide polymorphisms (SNP), have been associated with ALL expression. Few studies have been published analyzing IFNG +874 T/A and IL2 -330 G/T in this type of leukemia. These SNPs are involved in high or low expression, and are central to cellular immunity, influencing greatly tumor growth. The purpose of this work was to explore the association of IFNG +874 A/T (rs2430561) and IL2 -330 G/T (rs2069762) SNPs with ALL susceptibility and/or protection in 488 Mexican Mestizos patients, as compared to 950 Mexican Mestizo healthy controls. The results demonstrated that IFNG +874 T allele (pc = 0.00004, OR = 0.673) and the TT genotype (pc = 0.00015, OR = 0.349), protect against ALL expression with no specific gender association; however, the TT homozygote genotype (vs. TA+AA) seems more protective in males (pc = 0.00683). IL2 -330 G/T does not contribute to the development of ALL. In healthy Mexicans, the most common genotypes for IL2 and IFNG, are the low cytokine producers, suggesting that the genetic background in this ethnic group, may be partly responsible for the high incidence of ALL. These results show for the first time in Mexicans, the relevant role that IFNG SNP has in the genetic etiology of ALL. Thus, a large group of patients belonging to different ethnicities will be very helpful to study in order to demonstrate if these SNPs contribute to the genetic etiology of ALL, as shown here in Mexican Mestizos.
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Affiliation(s)
- Betsy Annel González-Quezada
- Department of Immunology and Immunogenetics, InDRE, Secretary of Health, Francisco P. Miranda #177, col. Lomas de Plateros, Del. Álvaro Obregón, CP 01480 Mexico City, Mexico; Fundación Comparte Vida, A.C. Galileo #92, col. Polanco, Del. Miguel Hidalgo, CP 11550 Mexico City, Mexico.
| | - Hilario Flores-Aguilar
- Department of Immunology and Immunogenetics, InDRE, Secretary of Health, Francisco P. Miranda #177, col. Lomas de Plateros, Del. Álvaro Obregón, CP 01480 Mexico City, Mexico; Fundación Comparte Vida, A.C. Galileo #92, col. Polanco, Del. Miguel Hidalgo, CP 11550 Mexico City, Mexico.
| | - Alberto Olaya-Vargas
- Instituto Nacional de Pediatría, Secretary of Health, Insurgentes Sur #3700, Letra C, Delegación Coyoacán, CP. 04530 Mexico City, Mexico
| | - Haydee Salazar-Rosales
- Instituto Nacional de Pediatría, Secretary of Health, Insurgentes Sur #3700, Letra C, Delegación Coyoacán, CP. 04530 Mexico City, Mexico
| | - Martín Pérez-García
- Instituto Nacional de Pediatría, Secretary of Health, Insurgentes Sur #3700, Letra C, Delegación Coyoacán, CP. 04530 Mexico City, Mexico
| | - Luis Manuel Valero-Saldaña
- Instituto Nacional de Cancerología, Secretary of Health, Av. San Fernando #22, Col. Sección 16, C.P. 14080 Mexico City, Mexico
| | - Brenda Lizeth Acosta-Maldonado
- Instituto Nacional de Cancerología, Secretary of Health, Av. San Fernando #22, Col. Sección 16, C.P. 14080 Mexico City, Mexico
| | - Roberto Ovilla-Martínez
- Hospital Ángeles Lomas, Hacienda de las Palmas, Col. Valle de las Palmas, CP 52763 State of Mexico, Mexico
| | - Clara Gorodezky
- Department of Immunology and Immunogenetics, InDRE, Secretary of Health, Francisco P. Miranda #177, col. Lomas de Plateros, Del. Álvaro Obregón, CP 01480 Mexico City, Mexico; Fundación Comparte Vida, A.C. Galileo #92, col. Polanco, Del. Miguel Hidalgo, CP 11550 Mexico City, Mexico.
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22
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A Rare Case of Spontaneous Remission of Terminal Deoxynucleotidyl Transferase Negative B-acute Lymphoblastic Leukemia. J Pediatr Hematol Oncol 2018; 40:e176-e178. [PMID: 28678092 DOI: 10.1097/mph.0000000000000906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Spontaneous remission of untreated pediatric leukemia is an extremely rare occurrence. The underlying mechanism may be because of an immune-mediated process or increased cortisol production during stress or infection. We describe a rare case of terminal deoxynucleotidyl transferase negative B-acute lymphoblastic leukemia with concurrent infection that went into remission without treatment with chemotherapy or corticosteroids. Though B-acute lymphoblastic leukemia can rarely go into spontaneous remission, these patients require close follow-up as most patients will eventually develop recurrence.
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Marcotte EL, Richardson MR, Roesler MA, Spector LG. Cesarean Delivery and Risk of Infant Leukemia: A Report from the Children's Oncology Group. Cancer Epidemiol Biomarkers Prev 2018; 27:473-478. [PMID: 29358226 DOI: 10.1158/1055-9965.epi-17-0778] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/25/2017] [Accepted: 01/10/2018] [Indexed: 01/30/2023] Open
Abstract
Background: Studies have reported increased risks of pediatric acute lymphoblastic leukemia (ALL) among children born by cesarean delivery (CD). However, no previous study has examined the impact of CD on risk of infant leukemia specifically.Methods: In this study, 443 infants diagnosed with acute leukemia, including both ALL and acute myelogenous leukemia (AML), were identified at Children's Oncology Group institutions between January 1996 and December 2006; 324 controls frequency matched by year of birth were identified though random digit dialing and random selection from U.S. birth registries. Using interview data and, for a subset of participants, medical record data, we analyzed CD overall and by indications that likely resulted in pre-labor CD (PLCD) or emergency CD (ECD). Odds ratios (ORs) and 95% confidence intervals (CIs) for risk of ALL and AML were estimated using multivariable unconditional logistic regression models, adjusted for year of birth, birth weight, and maternal race.Results: We observed an increased point estimate for the association between CD and ALL (OR, 1.52 and 95% CI, 1.02-2.25). We did not observe an association between CD and AML (OR, 1.02 and 95% CI, 0.64-1.62). In analyses of indication for CD, we observed elevated effect estimates for the associations of both PLCD and ECD and infant ALL.Conclusions: Our analysis suggests an increased risk of infant ALL following CD, including both PLCD and ECD. Altered microbiota colonization may be involved in development of leukemia in infants, but clear biological mechanisms have yet to be determined.Impact: This study provides the first in-depth examination of CD and infant leukemia. Cancer Epidemiol Biomarkers Prev; 27(4); 473-8. ©2018 AACR.
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Affiliation(s)
- Erin L Marcotte
- Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota. .,University of Minnesota Masonic Cancer Center, Minneapolis, Minnesota
| | - Michaela R Richardson
- Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Michelle A Roesler
- Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Logan G Spector
- Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.,University of Minnesota Masonic Cancer Center, Minneapolis, Minnesota
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24
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Morra ME, Kien ND, Elmaraezy A, Abdelaziz OAM, Elsayed AL, Halhouli O, Montasr AM, Vu TLH, Ho C, Foly AS, Phi AP, Abdullah WM, Mikhail M, Milne E, Hirayama K, Huy NT. Early vaccination protects against childhood leukemia: A systematic review and meta-analysis. Sci Rep 2017; 7:15986. [PMID: 29167460 PMCID: PMC5700199 DOI: 10.1038/s41598-017-16067-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 11/02/2017] [Indexed: 02/06/2023] Open
Abstract
Leukemia is the most commonly diagnosed childhood cancer, although its etiology is still largely unknown. Growing evidence supports a role for infection in the etiology of acute lymphocytic leukemia (ALL), and the involvement of the immune system suggests that vaccination may also play a role. However, the findings presented in the published literature are inconsistent. Therefore, we conducted a PRISMA systematic review and meta-analysis. 14 studies were identified and meta-analyzed. Vaccinations studied comprised Bacillus Calmette-Guérin (BCG) vaccine, Triple vaccine, Hepatitis B vaccine (HBV), Polio, Measles, Rubella, Mumps, trivalent MMR vaccine and Haemophilus influenza type B (HiB) vaccine. We observed a protective association between any vaccination in the first year of life and risk of childhood leukemia (summary odds ratio (OR) 0.58 [95% confidence interval (CI) 0.36-0.91]). When individual vaccines were analysed, some evidence of an association was seen only for BCG (summary OR 0.73 [95% CI 0.50-1.08]). In conclusion, early vaccination appears to be associated with a reduced risk of childhood leukemia. This finding may be underpinned by the association observed for BCG. Given the relatively imprecise nature of the results of this meta-analysis, our findings should be interpreted cautiously and replicated in future studies.
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Affiliation(s)
| | - Nguyen Dang Kien
- Department of Obstetrics and Gynecology, Thai Binh University of Medicine and Pharmacy, Thai Binh, 30000, Vietnam
| | - Ahmed Elmaraezy
- Faculty of Medicine, Al Azhar University, Cairo, 11884, Egypt
| | | | | | - Oday Halhouli
- University of Jordan, Faculty of Medicine, Amman, 11942, Jordan
| | | | - Tran Le-Huy Vu
- University of California, Los Angeles, CA, 90095, United States
| | - Chau Ho
- Hoan My Cuu Long Hospital, Can Tho, 900000, Vietnam
| | - Amr Sayed Foly
- Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Anh Phan Phi
- Department of Pharmacology, Loyola University Chicago, Illinois, 60546, USA
| | | | - Marina Mikhail
- Department of Dermatology, Cairo University Hospital, Cairo, 11562, Egypt
| | - Elizabeth Milne
- Telethon Kids Institute, The University of Western Australia, Crawley, Australia.
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Nguyen Tien Huy
- Evidence Based Medicine Research Group & Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam.
- Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
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25
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Arellano-Galindo J, Barrera AP, Jiménez-Hernández E, Zavala-Vega S, Campos-Valdéz G, Xicohtencatl-Cortes J, Ochoa SA, Cruz-Córdova A, Crisóstomo-Vázquez MDP, Fernández-Macías JC, Mejía-Aranguré JM. Infectious Agents in Childhood Leukemia. Arch Med Res 2017; 48:305-313. [PMID: 29157671 DOI: 10.1016/j.arcmed.2017.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/18/2017] [Indexed: 11/26/2022]
Abstract
Acute leukemia is the most common pediatric cancer, representing one-third of all cancers that occurs in under 15 year olds, with a varied incidence worldwide. Although a number of advances have increased the knowledge of leukemia pathophysiology, its etiology remains less well understood. The role of infectious agents, such as viruses, bacteria, or parasites, in the pathogenesis of leukemia has been discussed. To date, several cellular mechanisms involving infectious agents have been proposed to cause leukemia following infections. However, although leukemia can be triggered by contact with such agents, they can also be beneficial in developing immune stimulation and protection despite the risk of leukemic clones. In this review, we analyze the proposed hypotheses concerning how infectious agents may play a role in the origin and development of leukemia, as well as in a possible mechanism of protection following infections. We review reported clinical observations associated with vaccination or breastfeeding, that support hypotheses such as early life exposure and the resulting early immune stimulation that lead to protection.
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Affiliation(s)
- José Arellano-Galindo
- Área de Virología, Laboratorio de Infectología, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Alberto Parra Barrera
- Laboratorio de Cáncer y Hematopoyesis, Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, México
| | - Elva Jiménez-Hernández
- Departamento de Hematología Pediátrica, Unidad Médica de Alta Especialidad, Centro Médico Nacional la Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Sergio Zavala-Vega
- Área de Virología, Laboratorio de Infectología, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Guillermina Campos-Valdéz
- Área de Virología, Laboratorio de Infectología, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Juan Xicohtencatl-Cortes
- Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Sara A Ochoa
- Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Ariadnna Cruz-Córdova
- Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | | | - Juan Carlos Fernández-Macías
- Área de Virología, Laboratorio de Infectología, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Juan Manuel Mejía-Aranguré
- Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Pediatría, Ciudad de México, México; Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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26
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Wang R, Wiemels JL, Metayer C, Morimoto L, Francis SS, Kadan-Lottick N, DeWan AT, Zhang Y, Ma X. Cesarean Section and Risk of Childhood Acute Lymphoblastic Leukemia in a Population-Based, Record-Linkage Study in California. Am J Epidemiol 2017; 185:96-105. [PMID: 27986703 PMCID: PMC5253971 DOI: 10.1093/aje/kww153] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/11/2016] [Indexed: 01/07/2023] Open
Abstract
The relationship of mode of delivery to risk of childhood acute lymphoblastic leukemia (ALL) is uncertain. After linking birth records and cancer registry data from California, we conducted a population-based case-control study to investigate the role of delivery by cesarean section (C-section) in the etiology of childhood ALL. This study included 5,081 cases and 18,927 matched controls born in 1978-2009; more detailed data were available on type of C-section (i.e., elective vs. emergency) for a subset of 1,552 cases and 5,688 controls. No association was observed between C-section overall and childhood ALL risk (<15 years of age), but elective C-section was associated with a significantly elevated risk of ALL (odds ratio (OR) = 1.17, 95% confidence interval (CI): 1.01, 1.36). At the peak ages of ALL incidence (2-4 years), C-section was associated with an 11% higher risk of ALL (OR = 1.11, 95% CI: 1.01, 1.22) compared with vaginal delivery, and the magnitude of the association was larger for elective C-section (OR = 1.38, 95% CI: 1.11, 1.70). Emergency C-section was not associated with childhood ALL. Because of design features minimizing nonparticipation and inaccurate recall, this record linkage-based study is less prone to bias. Our results suggest that delivery by elective C-section was associated with a higher risk of childhood ALL, especially at the peak ages of incidence. It is important to evaluate possible mechanisms, because this potential risk factor is modifiable.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Xiaomei Ma
- Correspondence to Dr. Xiaomei Ma, Yale School of Public Health, P.O. Box 208034, 60 College Street, New Haven, CT 06520-8034, United States (e-mail: )
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27
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Acute Lymphoblastic Leukemia Presenting With Pancytopenia Followed by a 14-Month-Long Period of Transient Remission Possibly Supporting the Adrenal Hypothesis of Leukemogenesis. J Pediatr Hematol Oncol 2016; 38:e271-e273. [PMID: 27509378 DOI: 10.1097/mph.0000000000000648] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
A small group of children with acute lymphoblastic leukemia (ALL) have a preleukemic phase of pancytopenia followed by a period of spontaneous remission before the diagnosis (pre-ALL). A 6-year-old girl presented with pancytopenia, fever, and myelodysplasia. Following transient remission pre-B ALL was diagnosed 14 months later. Clonal B-lineage blasts at the period of pancytopenia were identified retrospectively. The interval between pre-ALL and ALL-diagnosis was longer than previously reported. The infection was clinically severe and might have induced a significant endogenous corticosteroids production resulting in the long-lasting remission. The case supports the adrenal and the Coley's toxin hypothesis in leukemogenesis.
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28
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Erdmann F, Winther JF, Dalton SO, Lightfoot T, Zeeb H, Simony SB, Deltour I, Ferro G, Bautz A, Schmiegelow K, Schüz J. Survival From Childhood Hematological Malignancies in Denmark: Is Survival Related to Family Characteristics? Pediatr Blood Cancer 2016; 63:1096-104. [PMID: 26937602 DOI: 10.1002/pbc.25950] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/27/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Due to diverse findings as to the role of family factors for childhood cancer survival even within Europe, we explored a nationwide, register-based cohort of Danish children with hematological malignancies. METHODS All children born between 1973 and 2006 and diagnosed with a hematological malignancy before the age of 20 years (N = 1,819) were followed until 10 years from diagnosis. Kaplan-Meier curves and Cox proportional hazards models estimating hazard ratios (HR) and 95% confidence intervals (CI) were used to assess the impact of family characteristics on overall survival in children with hematological malignancies. RESULTS Having siblings and increasing birth order were associated with reduced survival from acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Associations with AML were strongest and statistically significant. HRs of 1.62 (CI 0.85; 3.09) and 5.76 (CI 2.01; 16.51) were observed for the fourth or later born children with ALL (N = 41) and AML (N = 9), respectively. Children with older parents showed a tendency toward inferior ALL survival, while for AML young maternal age was related to poorer survival. Based on small numbers, a trend toward poorer survival from non-Hodgkin lymphoma was observed for children having siblings and for children of younger parents. CONCLUSIONS Further research is warranted to gain further knowledge on the impact of family factors on childhood cancer survival in other populations and to elaborate potential underlying mechanisms and pathways of those survival inequalities.
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Affiliation(s)
- Friederike Erdmann
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | | | | | - Tracy Lightfoot
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, UK
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology BIPS GmbH, Bremen, Germany
| | - Sofie Bay Simony
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Isabelle Deltour
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | - Gilles Ferro
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | - Andrea Bautz
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics & Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
- Division of Pediatric Hematology/Oncology, Perlmutter Cancer Center, New York University Langone Medical Center, New York, New York
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
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29
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Marcotte EL, Thomopoulos TP, Infante-Rivard C, Clavel J, Petridou ET, Schüz J, Ezzat S, Dockerty JD, Metayer C, Magnani C, Scheurer ME, Mueller BA, Mora AM, Wesseling C, Skalkidou A, Rashed WM, Francis SS, Ajrouche R, Erdmann F, Orsi L, Spector LG. Caesarean delivery and risk of childhood leukaemia: a pooled analysis from the Childhood Leukemia International Consortium (CLIC). Lancet Haematol 2016; 3:e176-85. [PMID: 27063976 PMCID: PMC5283076 DOI: 10.1016/s2352-3026(16)00002-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 12/10/2015] [Accepted: 12/23/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Results from case-control studies have shown an increased risk of acute lymphoblastic leukaemia (ALL) in young children born by caesarean delivery, and prelabour caesarean delivery in particular; however, an association of method of delivery with childhood leukaemia subtypes has yet to be established. We therefore did a pooled analysis of data to investigate the association between childhood leukaemia and caesarean delivery. METHODS We pooled data from 13 case-control studies from the Childhood Leukemia International Consortium done in nine countries (Canada, Costa Rica, Egypt, France, Germany, Greece, Italy, New Zealand, and the USA) for births from 1970-2013. We analysed caesarean delivery overall and by indications that probably resulted in prelabour caesarean delivery or emergency caesarean delivery. We used multivariable logistic regression models, adjusted for child's birthweight, sex, age, ethnic origin, parental education, maternal age, and study, to estimate odds ratios (ORs) and 95% CIs for the risk of ALL and acute myeloid leukaemia (AML) in children aged 0-14 years at diagnosis. FINDINGS The studies provided data for 8780 ALL cases, 1332 AML cases, and 23 459 controls, of which the birth delivery method was known for 8655 (99%) ALL cases, 1292 (97%) AML cases, and 23 351 (>99%) controls. Indications for caesarean delivery were available in four studies (there were caesarean deliveries for 1061 of 4313 ALL cases, 138 of 664 AML cases, and 1401 of 5884 controls). The OR for all indications of caesarean delivery and ALL was 1·06 (95% CI 0·99-1·13), and was significant for prelabour caesarean delivery and ALL (1·23 [1·04-1·47]; p=0·018). Emergency caesarean delivery was not associated with ALL (OR 1·02 [95% CI 0·81-1·30]). AML was not associated with caesarean delivery (all indications OR 0·99 [95% CI 0·84-1·17]; prelabour caesarean delivery 0·83 [0·54-1·26]; and emergency caesarean delivery 1·05 [0·63-1·77]). INTERPRETATION Our results suggest an increased risk of childhood ALL after prelabour caesarean delivery. If this association is causal, maladaptive immune activation due to an absence of stress response before birth in children born by prelabour caesarean delivery could be considered as a potential mechanism. FUNDING National Cancer Institute.
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Affiliation(s)
| | - Thomas P Thomopoulos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Claire Infante-Rivard
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Jacqueline Clavel
- INSERM Unit 1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Epidemiology of Childhood and Adolescent Cancers Team, Villejuif, France; Paris-Descartes University, UMRS-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Paris, France
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Joachim Schüz
- International Agency for Research on Cancer, Section of Environment and Radiation, Lyon, France
| | - Sameera Ezzat
- National Liver Institute, Menoufia University, Menoufia, Egypt
| | - John D Dockerty
- Dean's Department and Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Catherine Metayer
- University of California, School of Public Health, Berkeley, CA, USA
| | - Corrado Magnani
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, SCDU Epidemiologia dei Tumori, Novara, Italy
| | - Michael E Scheurer
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology-Oncology, Houston, TX, USA; Texas Children's Cancer Center, Houston, TX, USA
| | - Beth A Mueller
- Epidemiology Department, University of Washington School of Public Health, Seattle, WA, USA; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ana M Mora
- Central American Institute for Studies on Toxic Substances, Universidad Nacional, Heredia, Costa Rica; Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Catharina Wesseling
- Central American Institute for Studies on Toxic Substances, Universidad Nacional, Heredia, Costa Rica
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Obstetrics and Gynecology, Akademiska Sjukhuset, Uppsala, Sweden
| | - Wafaa M Rashed
- Research Department, Children's Cancer Hospital Egypt 57357, Cairo, Egypt
| | - Stephen S Francis
- University of California, School of Public Health, Berkeley, CA, USA; University of California, San Francisco, Neuro and Molecular Epidemiology Laboratory, San Francisco, CA, USA
| | - Roula Ajrouche
- INSERM Unit 1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Epidemiology of Childhood and Adolescent Cancers Team, Villejuif, France; Paris-Descartes University, UMRS-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Paris, France
| | - Friederike Erdmann
- International Agency for Research on Cancer, Section of Environment and Radiation, Lyon, France
| | - Laurent Orsi
- INSERM Unit 1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Epidemiology of Childhood and Adolescent Cancers Team, Villejuif, France; Paris-Descartes University, UMRS-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Paris, France
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30
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Reis RDS, Santos MDO, de Camargo B, Oliveira JFP, Thuler LCS, Pombo-de-Oliveira MS. Early childhood leukemia incidence trends in Brazil. Pediatr Hematol Oncol 2016; 33:83-93. [PMID: 26925506 DOI: 10.3109/08880018.2015.1130763] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Incidence rates of childhood leukemia vary between different regions of the world. The objective of this study was to test possible trends in incidence rate of early childhood leukemia (children <5 years old at the diagnosis) in Brazil. Data from 18 population-based cancer registries (PBCRs) were analyzed (period 1999-2010). The analysis consisted of frequencies, age-adjusted incidence rates, and joinpoint regression results, including annual average percent change (AAPC) in incidence rates and 95% confidence intervals (CIs). The median age-adjusted incidence rate (AAIR) of overall early childhood leukemia was 61 per million. The AAIR for acute lymphoid leukemia (ALL) was 44 per million and nonlymphoid acute leukemia (NLAL) was 14 per million. The median ALL/NLAL ratio was 3.0, suggesting higher incidence rate of NLAL in these settings. The joinpoint analysis demonstrated increased leukemia incidence rate in João Pessoa (AAPC = 20; 95% CI: 3.5, 39.4) and Salvador (AAPC = 8.68; 95% CI: 1.0, 16.9), respectively, whereas incidence rate in São Paulo PBCR decreased (AAPC = -4.02%; 95% CI: -6.1%, -1.9%). Correlation between ALL AAIR and selected variables of socioeconomic (SES) factors was not observed. Increased AAIR regionally overtime was observed. However, the interpretation for such phenomenon should be cautious because it might reflect the access to health care, diagnosis procedures, and improvement of PBCR´s quality. The observed trend supports the necessity of further ecological studies.
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Affiliation(s)
- Rejane de Souza Reis
- a Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer , Rio de Janeiro , Brazil
| | - Marceli de Oliveira Santos
- a Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer , Rio de Janeiro , Brazil
| | - Beatriz de Camargo
- b Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer , Rio de Janeiro , Brazil
| | - Julio Fernando Pinto Oliveira
- a Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer , Rio de Janeiro , Brazil
| | | | - Maria S Pombo-de-Oliveira
- b Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer , Rio de Janeiro , Brazil
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Wiemels J, Ma X. Stressful exit from the womb and risk of childhood leukaemia. LANCET HAEMATOLOGY 2016; 3:e155-6. [PMID: 27063969 DOI: 10.1016/s2352-3026(16)00019-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 01/26/2016] [Indexed: 01/28/2023]
Affiliation(s)
- Joseph Wiemels
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA 94158, USA.
| | - Xiaomei Ma
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
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Schmiegelow K. Treatment-related toxicities in children with acute lymphoblastic leukaemia predisposition syndromes. Eur J Med Genet 2016; 59:654-660. [PMID: 26876989 DOI: 10.1016/j.ejmg.2016.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 02/09/2016] [Accepted: 02/09/2016] [Indexed: 12/11/2022]
Abstract
Although most children with acute lymphoblastic leukaemia (ALL) do not harbor germline mutations that strongly predispose them to development of this malignancy, large syndrome registries and detailed mapping of exomes or whole genomes of familial leukaemia kindreds have revealed that 3-5% of all childhood ALL cases are due to such germline mutations, but the figure may be higher. Most of these syndromes are primarily characterized by their non-malignant phenotype, whereas ALL may be the dominating or even only striking manifestation of the syndrome in some families. Identification of such ALL patients is important in order to adjust therapy and offer genetic counseling and cancer surveillance to mutation carriers in the family. In the coming years large genomic screening projects are expected to reveal further hitherto unrecognised familial ALL syndromes. The treatment of ALL cases harboring cancer predisposing mutations can be challenging for both the physician and the patient due to their preexisting symptoms, their reduced tolerance to radio- and/or chemotherapy with enhanced risk of life-threatening organ toxicities, and the paucity of data from ALL patients with the same or similar syndromes being treated by contemporary protocols. Recent studies clearly indicate that many of these patients stand a good chance of cure, and that they should be offered chemotherapy with the intention to cure. Some of these syndromes are characterized by reduced tolerance to radiotherapy and/or specific anticancer agents, while others are not. This review summarises our current knowledge on the risk of acute toxicities for these ALL patients and provides guidance for treatment adjustments.
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Affiliation(s)
- Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark; Institute of Clinical Medicine, University of Copenhagen, Denmark; Division of Pediatric Hematology/Oncology, New York, USA; Perlmutter Cancer Center, NYU Langone Medical Center, New York, USA.
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Choi J, Polcher A, Joas A. Systematic literature review on Parkinson's disease and Childhood Leukaemia and mode of actions for pesticides. ACTA ACUST UNITED AC 2016. [DOI: 10.2903/sp.efsa.2016.en-955] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Sun J, Zheng J, Tang L, Healy J, Sinnett D, Dai YE. Association between CEBPE Variant and Childhood Acute Leukemia Risk: Evidence from a Meta-Analysis of 22 Studies. PLoS One 2015; 10:e0125657. [PMID: 25938438 PMCID: PMC4418706 DOI: 10.1371/journal.pone.0125657] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/16/2015] [Indexed: 01/20/2023] Open
Abstract
The CCAAT/enhancer binding proteins (CEBPs) have been involved in the etiology of acute leukemia (AL) and investigated in numerous genetic association studies, however, the results were inconclusive. The current meta-analysis was conducted to clarify the effect of CEBPE rs2239633 variant on childhood AL risk. Electronic literature search was performed on August 15, 2014, from databases of Medline, PubMed, Embase, and Web of Science. A total of 22 case-control studies were eligible for the pooled analysis. The results demonstrated that rs2239633 A allele was significantly associated with a decreased risk of childhood AL (A vs G: OR=0.87, 95%CI = 0.80, 0.94, p<0.001), especially in B-cell ALL subgroup (A vs G: OR = 0.79, 95%CI = 0.74, 0.83, p<0.001), but not among T-cell ALL or AML subgroups. In the stratified analysis by ethnicity, the association was observed in Europeans (A vs G: OR = 0.80, 95%CI = 0.76, 0.84, p<0.001) but not in Asian and mixed populations. Moreover, the results of sensitivity and cumulative meta-analysis indicated the robustness of our results. Also, Begg’s and Egger’s tests did not indicate any evidence of obvious asymmetry. In summary, our study provided evidence that CEBPE rs2239633 variant is associated with decreased risk of childhood B-cell ALL in Europeans.
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Affiliation(s)
- Jian Sun
- Department of Anesthesiology, Huai’an Matenal and Child Health Hospital, Huai’an, Jiangsu, China
| | - Jinyu Zheng
- Department of Neurosurgery, The Affiliated Huai'an Hospital of Xuzhou Medical College, Huai'an, China
| | - Linjun Tang
- Department of Neurosurgery, Tongling People's Hospital, Tongling, An’hui, People's Republic of China
| | - Jasmine Healy
- Sainte-Justine University Hospital Research Center, Montreal, Quebec, Canada
| | - Daniel Sinnett
- Sainte-Justine University Hospital Research Center, Montreal, Quebec, Canada
- Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Yue-e Dai
- Nanjing Children’s Hospital, Affiliated with Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
- * E-mail:
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Rudant J, Lightfoot T, Urayama KY, Petridou E, Dockerty JD, Magnani C, Milne E, Spector LG, Ashton LJ, Dessypris N, Kang AY, Miller M, Rondelli R, Simpson J, Stiakaki E, Orsi L, Roman E, Metayer C, Infante-Rivard C, Clavel J. Childhood acute lymphoblastic leukemia and indicators of early immune stimulation: a Childhood Leukemia International Consortium study. Am J Epidemiol 2015; 181:549-62. [PMID: 25731888 DOI: 10.1093/aje/kwu298] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/29/2014] [Indexed: 01/04/2023] Open
Abstract
The associations between childhood acute lymphoblastic leukemia (ALL) and several proxies of early stimulation of the immune system, that is, day-care center attendance, birth order, maternally reported common infections in infancy, and breastfeeding, were investigated by using data from 11 case-control studies participating in the Childhood Leukemia International Consortium (enrollment period: 1980-2010). The sample included 7,399 ALL cases and 11,181 controls aged 2-14 years. The data were collected by questionnaires administered to the parents. Pooled odds ratios and 95% confidence intervals were estimated by unconditional logistic regression adjusted for age, sex, study, maternal education, and maternal age. Day-care center attendance in the first year of life was associated with a reduced risk of ALL (odds ratio = 0.77, 95% confidence interval: 0.71, 0.84), with a marked inverse trend with earlier age at start (P < 0.0001). An inverse association was also observed with breastfeeding duration of 6 months or more (odds ratio = 0.86, 95% confidence interval: 0.79, 0.94). No significant relationship with a history of common infections in infancy was observed even though the odds ratio was less than 1 for more than 3 infections. The findings of this large pooled analysis reinforce the hypothesis that day-care center attendance in infancy and prolonged breastfeeding are associated with a decreased risk of ALL.
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Abstract
A 20-month-old girl diagnosed with T-cell acute lymphoblastic leukemia was treated according to the Nordic NOPHO ALL2000 protocol. The patient developed severe immunosuppression and experienced life-threatening adenovirus infection, which was treated with ribavirin and cidofovir. α-fetoprotein was 20- to 30-fold elevated, and genetic analysis confirmed the diagnosis of ataxia telangiectasia. Despite receiving only 7 weeks of anti-leukemic therapy, she has stayed in first remission now 8 years after the diagnosis. We speculate that this could be because of increased chemosensitivity of ATM-mutated leukemic cells, adenovirus causing a direct oncolytic effect, and/or high levels of endogenous cortisol during her severe infection.
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Maia RDRP, Wünsch Filho V. Infection and childhood leukemia: review of evidence. Rev Saude Publica 2014; 47:1172-85. [PMID: 24626555 PMCID: PMC4206105 DOI: 10.1590/s0034-8910.2013047004753] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 07/09/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze studies that evaluated the role of infections as well as indirect
measures of exposure to infection in the risk of childhood leukemia,
particularly acute lymphoblastic leukemia. METHODS A search in Medline, Lilacs, and SciELO scientific publication databases
initially using the descriptors "childhood leukemia" and "infection" and
later searching for the words "childhood leukemia" and "maternal infection
or disease" or "breastfeeding" or "daycare attendance" or "vaccination"
resulted in 62 publications that met the following inclusion criteria:
subject aged ≤ 15 years; specific analysis of cases diagnosed with acute
lymphoblastic leukemia or total leukemia; exposure assessment of mothers' or
infants' to infections (or proxy of infection), and risk of leukemia. RESULTS Overall, 23 studies that assessed infections in children support the
hypothesis that occurrence of infection during early childhood reduces the
risk of leukemia, but there are disagreements within and between studies.
The evaluation of exposure to infection by indirect measures showed evidence
of reduced risk of leukemia associated mainly with daycare attendance. More
than 50.0% of the 16 studies that assessed maternal exposure to infection
observed increased risk of leukemia associated with episodes of influenza,
pneumonia, chickenpox, herpes zoster, lower genital tract infection, skin
disease, sexually transmitted diseases, Epstein-Barr virus, and
Helicobacter pylori. CONCLUSIONS Although no specific infectious agent has been identified, scientific
evidence suggests that exposure to infections has some effect on childhood
leukemia etiology.
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Musolino C, Allegra A, Minciullo PL, Gangemi S. Allergy and risk of hematologic malignancies: associations and mechanisms. Leuk Res 2014; 38:1137-44. [PMID: 25171954 DOI: 10.1016/j.leukres.2014.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 08/02/2014] [Accepted: 08/04/2014] [Indexed: 12/12/2022]
Abstract
Increasing evidence indicates that a dysregulated immune system, as the one found in allergic disorders, can affect survival of tumor cells. A possible association between allergies and risk of hematologic malignancies has been examined in several epidemiological studies; however, results were not always consistent. The aim of this review is to report the preclinical and clinical data, which support a correlation between allergy and hematologic neoplasms. Immune system modulation could represent a powerful tool in the prevention and treatment of hematologic malignancies.
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Affiliation(s)
- C Musolino
- Division of Hematology, Department of General Surgery and Oncology, University of Messina, Messina, Italy
| | - A Allegra
- Division of Hematology, Department of General Surgery and Oncology, University of Messina, Messina, Italy.
| | - P L Minciullo
- School and Division of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University Hospital "G. Martino", Messina, Italy
| | - S Gangemi
- School and Division of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University Hospital "G. Martino", Messina, Italy; Institute of Clinical Physiology, IFC CNR, Messina Unit, Messina, Italy
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The concurrent occurrence of Leishmania chagasi infection and childhood acute leukemia in Brazil. Rev Bras Hematol Hemoter 2014; 36:356-62. [PMID: 25305169 PMCID: PMC4318380 DOI: 10.1016/j.bjhh.2014.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 06/04/2014] [Indexed: 11/22/2022] Open
Abstract
Objective This study investigated the co-existence of Leishmania chagasi infection and childhood leukemia in patients naïve to treatment; this has serious clinical and epidemiological implications. Methods The seroprevalence of L. chagasi antibodies prior to any treatment was investigated in children with clinical features of acute leukemia. Serological tests were performed in 470 samples drawn from under 14-year-old children from different regions of Brazil with clinical suspicion of acute leukemia. Acute leukemia subtypes were characterized by immunophenotyping using flow cytometry. Morphological analyses of bone marrow aspirates were systematically performed to visualize blast cells and/or the formation of L. chagasi amastigotes. Data analysis used a standard univariate procedure and the Pearson's chi-square test. Results The plasma of 437 children (93%) displayed antibodies against L. chagasi by indirect immunofluorescence assay and enzyme-linked immunosorbent assay tests. Of the 437 patients diagnosed from 2002 to 2006, 254 had acute lymphoblastic leukemia, 92 had acute myeloid leukemia, and 91 did not have acute leukemia. The seroprevalence of L. chagasi antibodies according to the indirect immunofluorescence assay test (22.5%) was similar in children with or without acute leukemia (p-value = 0.76). The co-existence of visceral leishmanasis and acute leukemia was confirmed in 24 children. The overall survival of these children was poor with a high death rate during the first year of leukemia treatment. Conclusion In the differential diagnosis of childhood leukemia, visceral leishmanasis should be considered as a potential concurrent disease in regions where L. chagasi is endemic.
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O’Neill KA, Bunch KJ, Murphy MFG. Intrauterine growth and childhood leukemia and lymphoma risk. Expert Rev Hematol 2014; 5:559-76. [DOI: 10.1586/ehm.12.39] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Núñez-Enríquez JC, Fajardo-Gutiérrez A, Buchán-Durán EP, Bernáldez-Ríos R, Medina-Sansón A, Jiménez-Hernández E, Amador-Sanchez R, Peñaloza-Gonzalez JG, Paredes-Aguilera R, Alvarez-Rodriguez FJ, Bolea-Murga V, de Diego Flores-Chapa J, Flores-Lujano J, Bekker-Mendez VC, Rivera-Luna R, Del Carmen Rodriguez-Zepeda M, Rangel-López A, Dorantes-Acosta EM, Núñez-Villegas N, Velazquez-Aviña MM, Torres-Nava JR, Reyes-Zepeda NC, Cárdenas-Cardos R, Flores-Villegas LV, Martinez-Avalos A, Salamanca-Gómez F, Gorodezky C, Arellano-Galindo J, Mejía-Aranguré JM. Allergy and acute leukaemia in children with Down syndrome: a population study. Report from the Mexican inter-institutional group for the identification of the causes of childhood leukaemia. Br J Cancer 2013; 108:2334-8. [PMID: 23695017 PMCID: PMC3681010 DOI: 10.1038/bjc.2013.237] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 04/17/2013] [Accepted: 04/22/2013] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Allergies have been described as protective factors against the development of childhood acute leukaemia (AL). Our objective was to investigate the associations between allergy history and the development of AL and acute lymphoblastic leukaemia (ALL) in children with Down syndrome (DS). METHODS A case-control study was performed in Mexico City. The cases (n=97) were diagnosed at nine public hospitals, and the controls (n=222) were recruited at institutions for children with DS. Odds ratios (OR) were calculated. RESULTS Asthma was positively associated with AL development (OR=4.18; 95% confidence interval (CI): 1.47-11.87), whereas skin allergies were negatively associated (OR=0.42; 95% CI: 0.20-0.91). CONCLUSION Our findings suggest that allergies and AL in children with DS share biological and immune mechanisms. To our knowledge, this is the first study reporting associations between allergies and AL in children with DS.
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Affiliation(s)
- J C Núñez-Enríquez
- Unidad de Investigación Médica en Epidemiologia Clínica, Hospital de Pediatría, Centro Médico Nacional (CMN) Siglo XXI, Instituto Mexicano del Seguro Social, Avenida Cuauhtémoc 330, Delegación Cuauhtémoc, México D.F. 06720, México.
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Vestergaard TR, Rostgaard K, Grau K, Schmiegelow K, Hjalgrim H. Hospitalisation for infection prior to diagnosis of acute lymphoblastic leukaemia in children. Pediatr Blood Cancer 2013; 60:428-32. [PMID: 22915267 DOI: 10.1002/pbc.24286] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 07/16/2012] [Indexed: 01/27/2023]
Abstract
BACKGROUND It has been proposed that infections in infancy and early childhood are associated with a reduced risk of childhood acute lymphoblastic leukaemia (ALL). We tested this hypothesis in a register-based study of hospitalisations for infectious diseases prior to diagnosis of childhood ALL. PROCEDURE A nation-wide cohort encompassing all Danish children aged 0-14 years and born between 1977 and 2008 (N = 1,778,129) was established and followed for hospitalisations for infectious diseases and risk of childhood ALL. The exposure was lagged 1 year to limit reverse causality. In the statistical analyses exposure was defined as (time dependent) number of early or late (before 2 or at/after 2 years of age) hospitalisations to further explore possible age-dependent associations. RESULTS A total of 815 children were diagnosed with ALL during follow-up. Risk of ALL was associated neither with hospitalisations for infectious diseases before (incidence rate ratio = 0.92, 95% confidence interval 0.78-1.07) nor at/after 2 years of age (incidence rate ratio = 1.04, 95% confidence interval 0.81-1.32). This also applied to subsets of ALL supposedly initiated prenatally. CONCLUSION The absence of association between hospitalisation for infections and risk of childhood ALL directs future investigations of the role of infections in development of childhood ALL towards exploration of less severe infections.
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Schmiegelow K, Lausten Thomsen U, Baruchel A, Pacheco CE, Pieters R, Pombo-de-Oliveira MS, Andersen EW, Rostgaard K, Hjalgrim H, Pui CH. High concordance of subtypes of childhood acute lymphoblastic leukemia within families: lessons from sibships with multiple cases of leukemia. Leukemia 2011; 26:675-81. [PMID: 22005784 DOI: 10.1038/leu.2011.274] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Polymorphic genes have been linked to the risk of acute lymphoblastic leukemia (ALL). Surrogate markers for a low burden of early childhood infections are also related to increased risk for developing childhood ALL. It remains uncertain, whether siblings of children with ALL have an increased risk of developing ALL. This international collaboration identified 54 sibships with two (N = 51) or more (N = 3) cases of childhood ALL (ages <18 years). The 5-year event-free survival for 61 patients diagnosed after 1 January 1990 was 0.83 ± 0.05. Ages at diagnosis (Spearman correlation coefficient, r(S) = 0.41, P = 0.002) were significantly correlated, but not WBCs (r(S) = 0.23, P = 0.11). In 18 sibships with successful karyotyping in both cases, six were concordant for high-hyperdiploidy (N = 3), t(12;21) [ETV6/RUNX1] (N = 1), MLL rearrangement (N = 1) or t(1;19)(q23/p13) (N = 1). Eleven sibships were ALL-subtype concordant, being T-cell ALL (T-ALL) (N = 5, of a total of six sibships, where the first-born had T-ALL) or B-lineage ALL belonging to the same cytogenetic subset (N = 6), a finding that differs significantly from the expected chance distribution (κ: 0.58; P < 0.0001). These data indicate strong genetic and/or environmental risk factors for childhood ALL that are restricted to specific ALL subtypes, which must be taken into account, when performing epidemiological studies to reveal etiological factors.
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Affiliation(s)
- K Schmiegelow
- Pediatric Clinics, The Juliane Marie Centre, The University Hospital Rigshospitalet, Copenhagen, Denmark.
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Richardson RB. Promotional etiology for common childhood acute lymphoblastic leukemia: the infective lymphoid recovery hypothesis. Leuk Res 2011; 35:1425-31. [PMID: 21903265 DOI: 10.1016/j.leukres.2011.07.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 07/12/2011] [Accepted: 07/18/2011] [Indexed: 11/28/2022]
Abstract
This paper speculates on the role of infection in modifying a young child's risk of promoting precursor B-cell acute lymphoblastic leukemia (ALL). It is suggested that the heat shock instigated by infections, particularly in infancy, stimulates Th1 pro-inflammatory cytokines and an apoptosis-inhibitory environment. This infective stress also increases the number of cooperating oncogenic mutations in pre-leukemic cells, especially if the primary adaptive immune response is delayed. The glucocorticoid release that follows leads to acute thymic involution, a decline in antitumor immunity, and maturation arrest of B-lymphocytes. The infective lymphoid recovery hypothesis addresses an apparent contradiction-that a non-hygienic environment primes the adaptive immune response and is protective against childhood ALL, while multiple infections occurring later increase the risk of childhood ALL. In affluent (compared to less-affluent) societies, the characteristic ALL incidence peak in early childhood, and the shortened time to diagnosis, arise from surviving recurrent infections and the accumulated loss and recovery of lymphoid tissue. Evidence supporting the hypothesis, such as the role of lymphoid tissue reconstitution cytokines that stimulate proliferation stress on B-cell progenitors, comes from the study of children with congenital syndromes that are susceptible to leukemia.
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Affiliation(s)
- Richard B Richardson
- Radiological Protection Research and Instrumentation Branch, Atomic Energy of Canada Limited (AECL), Chalk River Laboratories, Chalk River, ON, Canada.
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Pérez-Saldivar ML, Fajardo-Gutiérrez A, Bernáldez-Ríos R, Martínez-Avalos A, Medina-Sanson A, Espinosa-Hernández L, Flores-Chapa JDD, Amador-Sánchez R, Peñaloza-González JG, Alvarez-Rodríguez FJ, Bolea-Murga V, Flores-Lujano J, Rodríguez-Zepeda MDC, Rivera-Luna R, Dorantes-Acosta EM, Jiménez-Hernández E, Alvarado-Ibarra M, Velázquez-Aviña MM, Torres-Nava JR, Duarte-Rodríguez DA, Paredes-Aguilera R, Del Campo-Martínez MDLÁ, Cárdenas-Cardos R, Alamilla-Galicia PH, Bekker-Méndez VC, Ortega-Alvarez MC, Mejia-Arangure JM. Childhood acute leukemias are frequent in Mexico City: descriptive epidemiology. BMC Cancer 2011; 11:355. [PMID: 21846410 PMCID: PMC3171387 DOI: 10.1186/1471-2407-11-355] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 08/17/2011] [Indexed: 11/15/2022] Open
Abstract
Background Worldwide, acute leukemia is the most common type of childhood cancer. It is particularly common in the Hispanic populations residing in the United States, Costa Rica, and Mexico City. The objective of this study was to determine the incidence of acute leukemia in children who were diagnosed and treated in public hospitals in Mexico City. Methods Included in this study were those children, under 15 years of age and residents of Mexico City, who were diagnosed in 2006 and 2007 with leukemia, as determined by using the International Classification of Childhood Cancer. The average annual incidence rates (AAIR), and the standardized average annual incidence rates (SAAIR) per million children were calculated. We calculated crude, age- and sex-specific incidence rates and adjusted for age by the direct method with the world population as standard. We determined if there were a correlation between the incidence of acute leukemias in the various boroughs of Mexico City and either the number of agricultural hectares, the average number of persons per household, or the municipal human development index for Mexico (used as a reference of socio-economic level). Results Although a total of 610 new cases of leukemia were registered during 2006-2007, only 228 fit the criteria for inclusion in this study. The overall SAAIR was 57.6 per million children (95% CI, 46.9-68.3); acute lymphoblastic leukemia (ALL) was the most frequent type of leukemia, constituting 85.1% of the cases (SAAIR: 49.5 per million), followed by acute myeloblastic leukemia at 12.3% (SAAIR: 6.9 per million), and chronic myeloid leukemia at 1.7% (SAAIR: 0.9 per million). The 1-4 years age group had the highest SAAIR for ALL (77.7 per million). For cases of ALL, 73.2% had precursor B-cell immunophenotype (SAAIR: 35.8 per million) and 12.4% had T-cell immunophenotype (SAAIR 6.3 per million). The peak ages for ALL were 2-6 years and 8-10 years. More than half the children (58.8%) were classified as high risk. There was a positive correlation between the average number of persons per household and the incidence of the pre-B immunophenotype (Pearson's r, 0.789; P = 0.02). Conclusions The frequency of ALL in Mexico City is among the highest in the world, similar to those found for Hispanics in the United States and in Costa Rica.
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Affiliation(s)
- María Luisa Pérez-Saldivar
- Unidad de Investigación en Epidemiología Clínica, Unidad Médica de Alta Especialidad UMAE Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano de Seguridad Social, México DF, México
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46
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Borst L, Wallerek S, Dalhoff K, Rasmussen KK, Wesenberg F, Wehner PS, Schmiegelow K. The impact of CYP3A5*3 on risk and prognosis in childhood acute lymphoblastic leukemia. Eur J Haematol 2011; 86:477-83. [PMID: 21418106 DOI: 10.1111/j.1600-0609.2011.01608.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Acute lymphoblastic leukemia (ALL) is the most common cancer in childhood; however, little is known of the molecular etiology and environmental exposures causing the disease. Cytochrome P450 3A5 (CYP3A5) plays a crucial role in the catalytic oxidation of endogenous metabolites and toxic substances, including chemotherapeutic agents. The aim of this study was to investigate the role of a single-nucleotide polymorphism (CYP3A5*3 6986A>G), which renders low enzyme activity, in the risk of developing ALL and in the outcome for children with ALL. PATIENTS AND METHODS Six hundred and sixteen childhood patients with ALL and 203 controls were genotyped by allelic discrimination. RESULTS Individuals with the A allele had a 64% increased risk of developing childhood ALL (odds ratio = 1.64; 95% CI, 1.009-2.657). In general, event-free survival (EFS) did not differ in relation to CYP3A5 genotype. However, for patients with T-ALL, presence of the A allele was associated with better prognosis (EFS = 94.1%), while patients with the low-activity GG genotype only had an EFS of 61.5% (P = 0.015). Thus, for patients with T-ALL having no A allele and therefore low expression of CYP3A5, the risk of experiencing an event was almost eight times higher compared to those having at least one A allele (P = 0.045, hazard ratio = 7.749; 95% CI, 1.044-57.52). CONCLUSIONS This study shows that genetics may play a role in the risk of developing childhood ALL and indicates that improved treatment stratification of childhood patients with ALL may require addition of host genetic information.
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Affiliation(s)
- Louise Borst
- Pediatric Clinic II, The Juliane Marie Centre, The University Hospital Rigshospitalet, Copenhagen.
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Vestergaard TR, Juul A, Lausten-Thomsen U, Lausen B, Hjalgrim H, Kvist TK, Andersen EW, Schmiegelow K. Duration of adrenal insufficiency during treatment for childhood acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2011; 33:442-9. [PMID: 21792040 DOI: 10.1097/mph.0b013e3182260cbe] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Children with acute lymphoblastic leukemia (ALL) recive high doses of glucocorticosteroid as part of their treatment. This may lead to suppression of the hypothalamic-pituitary-adrenal axis, acute adrenal insufficiency, and ultimately to life-threatening conditions. This study explores the adrenal function in 96 children with ALL treated according to common protocols. After cessation of induction glucocorticosteroid therapy, they received hydrocortisone substitution therapy (10 mg/m/24 h) until an adrenocorticotropic hormone test (250 μg tetracosatide) showed a sufficient adrenal response [plasma (p)-cortisol ≥500 nM]. At the first adrenocorticotropic hormone test, 67% of the patients had adrenal insufficiency. When including these patients in a multivariate model, not adjusting for risk factors, the mean elapsed time between end of induction therapy and adrenal sufficiency was 8.5 months (95% confidence interval: 6.3;10.7). Low 0-minute p-cortisol (P=0.02) and low rise in p-cortisol (P<0.0001) at first test caused a longer time of adrenal insufficiency. In addition, patients with B-cell precursor leukemia reached adrenal sufficiency later than those with T-cell leukemia (P=0.067). As adrenal insufficiency is frequent in children treated for ALL and as they often experience infections and other stressors, the adrenal response should be determined and hydrocortisone substitution therapy should be considered during such episodes in patients with adrenal insufficiency.
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Azevedo-Silva F, Camargo BD, Pombo-de-Oliveira MS. Implications of infectious diseases and the adrenal hypothesis for the etiology of childhood acute lymphoblastic leukemia. Braz J Med Biol Res 2010; 43:226-9. [PMID: 20401428 DOI: 10.1590/s0100-879x2010007500011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 02/01/2010] [Indexed: 02/02/2023] Open
Abstract
Acute leukemia is the most frequent cancer in children. Recently, a new hypothesis was proposed for the pathogenesis of childhood acute lymphoblastic leukemia (ALL). The so-called 'adrenal hypothesis' emphasized the role of endogenous cortisol in the etiology of B-cell precursor ALL. The incidence peak of ALL in children between 3 to 5 years of age has been well documented and is consistent with this view. The adrenal hypothesis proposes that the risk of childhood B-cell precursor ALL is reduced when early childhood infections induce qualitative and quantitative changes in the hypothalamus-pituitary-adrenal axis. It suggests that the increased plasma cortisol levels would be sufficient to eliminate all clonal leukemic cells originating during fetal life. Because Brazil is a continental and tropical country, the exposure to infections is diversified with endemic viral and regionally non-viral infections, with some characteristics that support the recent adrenal hypothesis. Here we discuss this new hypothesis in terms of data from epidemiological studies and the possible implications of the diversity of infections occurring in Brazilian children.
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Affiliation(s)
- F Azevedo-Silva
- Centro de Pesquisa, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil
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Rudant J, Orsi L, Menegaux F, Petit A, Baruchel A, Bertrand Y, Lambilliotte A, Robert A, Michel G, Margueritte G, Tandonnet J, Mechinaud F, Bordigoni P, Hémon D, Clavel J. Childhood acute leukemia, early common infections, and allergy: The ESCALE Study. Am J Epidemiol 2010; 172:1015-27. [PMID: 20807738 DOI: 10.1093/aje/kwq233] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This study investigated the role of factors considered related to early stimulation of the immune system in the etiology of childhood acute leukemia. The national registry-based case-control study ESCALE was carried out in France in 2003-2004. Population controls were frequency matched to cases on age and gender. Data were obtained from structured telephone questionnaires administered to mothers. Odds ratios were estimated using unconditional regression models adjusted for potential confounders. Included were 634 acute lymphoblastic leukemia cases, 86 acute myeloblastic leukemia cases, and 1,494 controls aged ≥1 year. Negative associations were observed between acute lymphoblastic leukemia and birth order (P for trend < 0.0001), attendance at a day-care center before age 1 year (odds ratio (OR) = 0.8, 95% confidence interval (CI): 0.6, 1.1), prolonged breastfeeding (OR = 0.7, 95% CI: 0.5, 1.0), repeated early common infections (OR = 0.7, 95% CI: 0.6, 0.9), regular contact with farm animals (OR = 0.6, 95% CI: 0.5, 0.8), frequent farm visits in early life (OR = 0.4, 95% CI: 0.3, 0.6), and history of asthma (OR = 0.7, 95% CI: 0.4, 1.0) or eczema (OR = 0.7, 95% CI: 0.6, 0.9). Results support the hypothesis that repeated early infections and asthma may play a role against childhood acute leukemia.
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Affiliation(s)
- Jérémie Rudant
- CESP Centre for Research in Epidemiology and Population Health, INSERM, Villejuif, France
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Han S, Lee KM, Park SK, Lee JE, Ahn HS, Shin HY, Kang HJ, Koo HH, Seo JJ, Choi JE, Ahn YO, Kang D. Genome-wide association study of childhood acute lymphoblastic leukemia in Korea. Leuk Res 2010; 34:1271-4. [PMID: 20189245 DOI: 10.1016/j.leukres.2010.02.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 01/20/2010] [Accepted: 02/01/2010] [Indexed: 02/01/2023]
Abstract
We conducted a genome-wide association study of childhood acute lymphoblastic leukemia (ALL) in a case-control study conducted in Korea. Incident childhood ALL cases (n=50) and non-cancer controls (n=50) frequency-matched to cases by age and sex, recruited from three teaching hospitals in Seoul between 2003 and 2008, were genotyped using Affymetrix SNP Array 6.0 platform. ALL risks were estimated as odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for age and birth weight. The false discovery rate (FDR) was used for adjusting multiple tests. Of these 1 million SNPs, six SNPs in 4 genes (HAO1 rs6140264, EPB41L2 rs9388856, rs9388857, rs1360756, C2orf3 12105972, MAN2A1 rs3776932) were strongly associated with childhood ALL risk (P(dominant)<or=0.0001 and P(trend)<0.006). These SNPs remained significant after FDR adjustment (FDR value <0.2). Our genome-wide association study in Korea children identified a few genetic variations as potential susceptibility markers for ALL, warranting further replication studies among various ethnic groups.
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Affiliation(s)
- Sohee Han
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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