1
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Sirirungreung A, Hansen J, Ritz B, Heck JE. Association between medically diagnosed postnatal infection and childhood cancers: A matched case-control study in Denmark, 1978 to 2016. Int J Cancer 2023; 153:994-1002. [PMID: 37243370 PMCID: PMC10524667 DOI: 10.1002/ijc.34604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/28/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
Although the association between infection and childhood cancer has been long investigated, there is limited information on rarer cancers. This article aimed to explore the association between postnatal infection and childhood cancers in the Danish population. A matched case-control study was conducted using Danish nationwide registries from 1978 to 2016. Each childhood cancer case was matched 1:25 with controls by birth date within a week and sex. Postnatal infections were identified from the Danish National Patient Registry, which lists diagnoses seen in hospital, specialist or emergency care services. Multivariable conditional logistic regression was used to estimate adjusted odds ratios (adj.OR) and 95% confidence intervals (CI). Specific types of infections and the number of infection episodes were also considered. The study included 4125 childhood cancer cases and 103 526 matched controls with ages ranging from 0 to 19 years. Medically diagnosed postnatal infections were positively associated with many types of childhood cancer including acute lymphoblastic leukemia (adj.OR = 1.42; 95% CI: 1.23-1.63), acute myeloid leukemia (adj.OR = 1.80; 95% CI: 1.28-2.52), non-Hodgkin lymphoma (adj.OR = 1.53; 95% CI: 1.19-1.97) and central nervous system tumors (adj.OR = 1.57; 95% CI: 1.39-1.77). A higher number of infection episodes were also associated with an increased risk of these cancers. Specific infections such as viral, enteric and urinary tract infections were also strongly associated with specific types of cancer. In conclusion, children who later develop cancer appear to have adverse reactions to infections necessitating referral to specialized health care services, perhaps indicating dysregulated immune function.
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Affiliation(s)
- Anupong Sirirungreung
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Johnni Hansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Julia E Heck
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- College of Health and Public Service, University of North Texas, Denton, TX, USA
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2
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Søegaard SH, Rostgaard K, Kamper-Jørgensen M, Schmiegelow K, Hjalgrim H. Childcare attendance and risk of childhood acute lymphoblastic leukaemia: A register study based on the Danish childcare database. Int J Cancer 2023; 152:1817-1826. [PMID: 36545888 DOI: 10.1002/ijc.34413] [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: 07/29/2022] [Revised: 11/17/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Childhood acute lymphoblastic leukaemia (ALL) is suggested to result from a dysregulated immune response to infections in children with a preleukaemic state. Childcare in early life supposedly may protect against childhood ALL by facilitating sufficient exposure to infections to stimulate and ensure normal maturation of the immune system. We assessed the association between childcare attendance before age 2 years and risk of childhood ALL in a register-based cohort study, including all children aged 2 to 14 years born in Denmark during 1991 to 2014 with available childcare information recorded in the Danish Childcare Database (n = 1 116 185). Cox regression was used to estimate hazard ratios (HRs) comparing children enrolled in childcare and children not enrolled before age 2 years. Further, we assessed the association according to age at enrolment, type of childcare facility and specific ALL subtypes. During 10 460 811 person-years of follow-up, 460 children developed ALL at ages 2 to 14 years. Of these, 57 (12.4%) never attended childcare before age 2 years compared with 10.6% in the total cohort. Compared with homecare, childcare attendance before age 2 years was associated with a statistically non-significantly, marginally decreased risk of childhood ALL with adjusted HR = 0.87 (95% confidence interval [CI]: 0.65-1.16). Risk estimates did neither vary statistically significantly by age at enrolment nor by type of childcare facility and also not between childhood ALL subtypes, including frequently prenatally initiated ALL subtypes. Results from this large, nationwide register-based study provided no evidence that childcare attendance in the first years of life protects against childhood ALL.
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Affiliation(s)
- Signe Holst Søegaard
- Danish Cancer Society Research Centre, Danish Cancer Society, Copenhagen, Denmark.,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Klaus Rostgaard
- Danish Cancer Society Research Centre, Danish Cancer Society, Copenhagen, Denmark.,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | | | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Hjalgrim
- Danish Cancer Society Research Centre, Danish Cancer Society, Copenhagen, Denmark.,Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Haematology, University Hospital Rigshospitalet, Copenhagen, Denmark
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3
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Gallant RE, Arroyo K, Metayer C, Kang AY, de Smith AJ, Wiemels JL. Associations between early-life and in utero infections and cytomegalovirus-positive acute lymphoblastic leukemia in children. Int J Cancer 2023; 152:845-853. [PMID: 36104937 PMCID: PMC10092298 DOI: 10.1002/ijc.34292] [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: 06/03/2022] [Revised: 08/12/2022] [Accepted: 09/02/2022] [Indexed: 01/11/2023]
Abstract
Childhood infections and cytomegalovirus (CMV) are associated with pediatric acute lymphoblastic leukemia (ALL). CMV dysregulates the host immune system and alters the immune response to subsequent antigenic exposures. We suspect that this immune dysregulation contributes to increased numbers of symptomatic infections in childhood allowing for expansion of pre-leukemic clones. We explored the association between childhood infections, maternal infections during pregnancy and CMV-positive ALL. Using a droplet digital PCR assay, we screened diagnostic ALL bone marrow samples from the California Childhood Leukemia Study (1995-2015) for the presence of CMV DNA identifying CMV-positive and CMV-negative cases. We performed a case-only analysis (n = 524) comparing the number and types of childhood infections and maternal infections during pregnancy between CMV-positive and CMV-negative ALL cases using logistic regression. With increasing numbers of infections in the first 12 months of life, children were more likely to classify to the highest tertile of CMV DNA in the bone marrow at diagnosis (OR: 1.04, 95% CI: 1.01-1.08). Specifically, those reporting cough or flu in the first 12 months were more likely to be CMV-positive at ALL diagnosis (OR: 2.15, 95% CI: 1.06-4.37 and OR: 2.06, 95% CI: 1.17-3.63 respectively). Furthermore, those with a history of maternal infection during pregnancy were more likely to be CMV-positive (OR: 2.12, 95% CI: 1.24-3.62). We hypothesize that children with underlying immune dysregulation develop more symptomatic infections in childhood and ultimately CMV-positive ALL; this underlying immune dysregulation may be due to early immune system alterations via CMV exposure (in utero or early infancy) proposing a potential link between CMV and ALL etiology.
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Affiliation(s)
- Rachel E Gallant
- Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Center for Genetic Epidemiology, Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Katti Arroyo
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Catherine Metayer
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Alice Y Kang
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Adam J de Smith
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Joseph L Wiemels
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
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4
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He JR, Yu Y, Fang F, Gissler M, Magnus P, László KD, Ward MH, Paltiel O, Tikellis G, Maule MM, Qiu X, Du J, Valdimarsdóttir UA, Rahimi K, Wiemels JL, Linet MS, Hirst JE, Li J, Dwyer T. Evaluation of Maternal Infection During Pregnancy and Childhood Leukemia Among Offspring in Denmark. JAMA Netw Open 2023; 6:e230133. [PMID: 36808241 PMCID: PMC9941888 DOI: 10.1001/jamanetworkopen.2023.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
IMPORTANCE Maternal infection is common during pregnancy and is an important potential cause of fetal genetic and immunological abnormalities. Maternal infection has been reported to be associated with childhood leukemia in previous case-control or small cohort studies. OBJECTIVE To evaluate the association of maternal infection during pregnancy with childhood leukemia among offspring in a large study. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used data from 7 Danish national registries (including the Danish Medical Birth Register, the Danish National Patient Registry, the Danish National Cancer Registry, and others) for all live births in Denmark between 1978 and 2015. Swedish registry data for all live births between 1988 and 2014 were used to validate the findings for the Danish cohort. Data were analyzed from December 2019 to December 2021. EXPOSURES Maternal infection during pregnancy categorized by anatomic locations identified from the Danish National Patient Registry. MAIN OUTCOMES AND MEASURES The primary outcome was any leukemia; secondary outcomes were acute lymphoid leukemia (ALL) and acute myeloid leukemia (AML). Offspring childhood leukemia was identified in the Danish National Cancer Registry. Associations were first assessed in the whole cohort using Cox proportional hazards regression models, adjusted for potential confounders. A sibling analysis was performed to account for unmeasured familial confounding. RESULTS This study included 2 222 797 children, 51.3% of whom were boys. During the approximately 27 million person-years of follow-up (mean [SD], 12.0 [4.6] years per person), 1307 children were diagnosed with leukemia (ALL, 1050; AML, 165; or other, 92). Children born to mothers with infection during pregnancy had a 35% increased risk of leukemia (adjusted hazard ratio [HR], 1.35 [95% CI, 1.04-1.77]) compared with offspring of mothers without infection. Maternal genital and urinary tract infections were associated with a 142% and 65% increased risk of childhood leukemia, with HRs of 2.42 (95% CI, 1.50-3.92) and 1.65 (95% CI, 1.15-2.36), respectively. No association was observed for respiratory tract, digestive, or other infections. The sibling analysis showed comparable estimates to the whole-cohort analysis. The association patterns for ALL and AML were similar to that for any leukemia. No association was observed for maternal infection and brain tumors, lymphoma, or other childhood cancers. CONCLUSIONS AND RELEVANCE In this cohort study of approximately 2.2 million children, maternal genitourinary tract infection during pregnancy was associated with childhood leukemia among offspring. If confirmed in future studies, our findings may have implications for understanding the etiology and developing preventive measures for childhood leukemia.
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Affiliation(s)
- Jian-Rong He
- Division of Birth Cohort Study, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Yongfu Yu
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Mika Gissler
- Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Sweden
- Department of Child Psychiatry, Turku University Hospital, Turku University, Turku, Finland
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Mary H. Ward
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Ora Paltiel
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gabriella Tikellis
- Murdoch Children’s Research Institute, Royal Children’s Hospital, University of Melbourne, Melbourne, Australia
| | - Milena Maria Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jiangbo Du
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Unnur Anna Valdimarsdóttir
- Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Kazem Rahimi
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Joseph L. Wiemels
- Center for Genetic Epidemiology, University of Southern California, Los Angeles
| | - Martha S. Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jane E. Hirst
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
- George Institute for Global Health, London, United Kingdom
| | - Jiong Li
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Terence Dwyer
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
- Clinical Sciences Theme, Heart Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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5
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Feng Q, Zhou M, Li S, Morimoto L, Hansen H, Myint SS, Wang R, Metayer C, Kang A, Fear AL, Pappas D, Erlich H, Hollenbach JA, Mancuso N, Trachtenberg E, de Smith AJ, Ma X, Wiemels JL. Interaction between maternal killer immunoglobulin-like receptors and offspring HLAs and susceptibility of childhood ALL. Blood Adv 2022; 6:3756-3766. [PMID: 35500222 PMCID: PMC9631572 DOI: 10.1182/bloodadvances.2021006821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/08/2022] [Indexed: 11/20/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) in children is associated with a distinct neonatal cytokine profile. The basis of this neonatal immune phenotype is unknown but potentially related to maternal-fetal immune receptor interactions. We conducted a case-control study of 226 case child-mother pairs and 404 control child-mother pairs to evaluate the role of interaction between HLA genotypes in the offspring and maternal killer immunoglobulin-like receptor (KIR) genotypes in the etiology of childhood ALL, while considering potential mediation by neonatal cytokines and the immune-modulating enzyme arginase-II (ARG-II). We observed different associations between offspring HLA-maternal KIR activating profiles and the risk of ALL in different predicted genetic ancestry groups. For instance, in Latino subjects who experience the highest risk of childhood leukemia, activating profiles were significantly associated with a lower risk of childhood ALL (odds ratio [OR] = 0.59; 95% confidence interval [CI], 0.49-0.71) and a higher level of ARG-II at birth (coefficient = 0.13; 95% CI, 0.04-0.22). HLA-KIR activating profiles were also associated with a lower risk of ALL in non-Latino Asians (OR = 0.63; 95% CI, 0.38-1.01), although they had a lower tumor necrosis factor-α level (coefficient = -0.27; 95% CI, -0.49 to -0.06). Among non-Latino White subjects, no significant association was observed between offspring HLA-maternal KIR interaction and ALL risk or cytokine levels. The current study reports the association between offspring HLA-maternal KIR interaction and the development of childhood ALL with variation by predicted genetic ancestry. We also observed some associations between activating profiles and immune factors related to cytokine control; however, cytokines did not demonstrate causal mediation of the activating profiles on ALL risk.
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Affiliation(s)
- Qianxi Feng
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA
| | - Mi Zhou
- Department of Laboratory Medicine, University of California, San Francisco, CA
| | - Shaobo Li
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA
| | - Libby Morimoto
- School of Public Health, University of California, Berkeley, CA
| | - Helen Hansen
- Department of Neurosurgery, University of California, San Francisco, CA
| | - Swe Swe Myint
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA
| | - Rong Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT
| | | | - Alice Kang
- School of Public Health, University of California, Berkeley, CA
| | - Anna Lisa Fear
- Children’s Hospital Oakland Research Institute, Oakland, CA; and
| | - Derek Pappas
- Children’s Hospital Oakland Research Institute, Oakland, CA; and
| | - Henry Erlich
- Children’s Hospital Oakland Research Institute, Oakland, CA; and
| | - Jill A. Hollenbach
- Department of Neurology and Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Nicholas Mancuso
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA
| | | | - Adam J. de Smith
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA
| | - Xiaomei Ma
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT
| | - Joseph L. Wiemels
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA
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6
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Elevated blood MxA protein levels in children with newly diagnosed B-ALL: A prospective case-control study. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1033655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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7
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Decreased IL-10 accelerates B-cell leukemia/lymphoma in a mouse model of pediatric lymphoid leukemia. Blood Adv 2021; 6:854-865. [PMID: 34727170 PMCID: PMC8945291 DOI: 10.1182/bloodadvances.2021005522] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022] Open
Abstract
B-cell deficiency and DNA damage in the bone marrow of Il10−/− mice are associated with inflammation and mitigated by antibiotics. In ETV6-RUNX1+Cdkn2a−/− mice, low IL-10 accelerates the development of B-cell leukemia/lymphoma in a dose-dependent manner.
Exposures to a wide repertoire of common childhood infections and strong inflammatory responses to those infections are associated with the risk of pediatric B-cell acute lymphoblastic leukemia (B-ALL) in opposing directions. Neonatal inflammatory markers are also related to risk by unknown mechanism(s). Here, we demonstrate that interleukin-10 (IL-10) deficiency, which is associated with childhood B-ALL, indirectly impairs B lymphopoiesis and increases B-cell DNA damage in association with a module of 6 proinflammatory/myeloid-associated cytokines (IL-1α, IL-6, IL-12p40, IL-13, macrophage inflammatory protein-1β/CCL4, and granulocyte colony-stimulating factor). Importantly, antibiotics attenuated inflammation and B-cell defects in preleukemic Cdkn2a−/−Il10−/− mice. In an ETV6-RUNX1+ (E6R1+) Cdkn2a−/− mouse model of B-ALL, decreased levels of IL-10 accelerated B-cell neoplasms in a dose-dependent manner and altered the mutational profile of these neoplasms. Our results illuminate a mechanism through which a low level of IL-10 can create a risk for leukemic transformation and support developing evidence that microbial dysbiosis contributes to pediatric B-ALL.
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8
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Infections and the development of childhood acute lymphoblastic leukemia: a population-based study. Eur J Cancer Prev 2021; 29:538-545. [PMID: 32032155 DOI: 10.1097/cej.0000000000000564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An infectious trigger for childhood acute lymphoblastic leukemia is hypothesized and we assessed the association between the rate, type, and critical exposure period for infections and the development of acute lymphoblastic leukemia. We conducted a matched case-control study using administrative databases to evaluate the association between the rate of infections and childhood acute lymphoblastic leukemia diagnosed between the ages of 2-14 years from Ontario, Canada and we used a validated approach to measure infections. In 1600 cases of acute lymphoblastic leukemia, and 16 000 matched cancer-free controls aged 2-14 years, having >2 infections/year increased the odds of childhood acute lymphoblastic leukemia by 43% (odds ratio = 1.43, 95% confidence interval 1.13-1.81) compared to children with ≤0.25 infections/year. Having >2 respiratory infections/year increased odds of acute lymphoblastic leukemia by 28% (odds ratio =1.28, 95% confidence interval 1.05-1.57) compared to children with ≤0.25 respiratory infections/year. Having an invasive infection increased the odds of acute lymphoblastic leukemia by 72% (odds ratio =1.72, 95% confidence interval 1.31-2.26). Having an infection between the age of 1-1.5 years increased the odds of acute lymphoblastic leukemia by 20% (odds ratio = 1.20, 95% confidence interval 1.04-1.39). Having more infections increased the odds of developing childhood acute lymphoblastic leukemia and having an infection between the ages of 1-1.5 years increased the odds of childhood acute lymphoblastic leukemia.
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9
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Wang S, Maxwell CA, Akella NM. Diet as a Potential Moderator for Genome Stability and Immune Response in Pediatric Leukemia. Cancers (Basel) 2021; 13:cancers13030413. [PMID: 33499176 PMCID: PMC7865408 DOI: 10.3390/cancers13030413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Pediatric acute lymphoblastic leukemia (ALL) is the most prevalent cancer affecting children in developed societies. Here, we review the role of diet in control of the incidence and progression of childhood ALL. Prenatally, ALL risk is associated with higher birthweights of newborns, suggesting that ALL begins to evolve in-utero. Indeed, maternal diet influences the fetal genome and immune development. Postnatally, breastfeeding associates with decreased risk of ALL development. Finally, for the ALL-affected child, certain dietary regimens that impact the hormonal environment may impede disease progression. Improved understanding of the dietary regulation of hormones and immunity may inform better approaches to predict, protect, and ultimately save children afflicted with pediatric leukemia. Abstract Pediatric leukemias are the most prevalent cancers affecting children in developed societies, with childhood acute lymphoblastic leukemia (ALL) being the most common subtype. As diet is a likely modulator of many diseases, this review focuses on the potential for diet to influence the incidence and progression of childhood ALL. In particular, the potential effect of diets on genome stability and immunity during the prenatal and postnatal stages of early childhood development are discussed. Maternal diet plays an integral role in shaping the bodily composition of the newborn, and thus may influence fetal genome stability and immune system development. Indeed, higher birth weights of newborns are associated with increased risk of ALL, which suggests in-utero biology may shape the evolution of preleukemic clones. Postnatally, the ingestion of maternal breastmilk both nourishes the infant, and provides essential components that strengthen and educate the developing immune system. Consistently, breast-feeding associates with decreased risk of ALL development. For children already suffering from ALL, certain dietary regimens have been proposed. These regimens, which have been validated in both animals and humans, alter the internal hormonal environment. Thus, hormonal regulation by diet may shape childhood metabolism and immunity in a manner that is detrimental to the evolution or expansion of preleukemic and leukemic ALL clones.
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Affiliation(s)
- Shanshan Wang
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC V6H 3V4, Canada;
| | - Christopher A. Maxwell
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC V6H 3V4, Canada;
- Michael Cuccione Childhood Cancer Research Program, BC Children’s Hospital, Vancouver, BC V5Z 4H4, Canada
- Correspondence: (C.A.M.); (N.M.A.)
| | - Neha M. Akella
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC V6H 3V4, Canada;
- Correspondence: (C.A.M.); (N.M.A.)
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10
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Inhibition of inflammatory signaling in Pax5 mutant cells mitigates B-cell leukemogenesis. Sci Rep 2020; 10:19189. [PMID: 33154497 PMCID: PMC7644722 DOI: 10.1038/s41598-020-76206-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/22/2020] [Indexed: 12/11/2022] Open
Abstract
PAX5 is one of the most frequently mutated genes in B-cell acute lymphoblastic leukemia (B-ALL), and children with inherited preleukemic PAX5 mutations are at a higher risk of developing the disease. Abnormal profiles of inflammatory markers have been detected in neonatal blood spot samples of children who later developed B-ALL. However, how inflammatory signals contribute to B-ALL development is unclear. Here, we demonstrate that Pax5 heterozygosis, in the presence of infections, results in the enhanced production of the inflammatory cytokine interleukin-6 (IL-6), which appears to act in an autocrine fashion to promote leukemia growth. Furthermore, in vivo genetic downregulation of IL-6 in these Pax5 heterozygous mice retards B-cell leukemogenesis, and in vivo pharmacologic inhibition of IL-6 with a neutralizing antibody in Pax5 mutant mice with B-ALL clears leukemic cells. Additionally, this novel IL–6 signaling paradigm identified in mice was also substantiated in humans. Altogether, our studies establish aberrant IL6 expression caused by Pax5 loss as a hallmark of Pax5-dependent B-ALL and the IL6 as a therapeutic vulnerability for B-ALL characterized by PAX5 loss.
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11
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Morimoto LM, Kwan ML, Deosaransingh K, Munneke JR, Kang AY, Quesenberry C, Kogan S, de Smith AJ, Metayer C, Wiemels JL. History of Early Childhood Infections and Acute Lymphoblastic Leukemia Risk Among Children in a US Integrated Health-Care System. Am J Epidemiol 2020; 189:1076-1085. [PMID: 32322901 DOI: 10.1093/aje/kwaa062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/20/2019] [Accepted: 04/14/2020] [Indexed: 01/03/2023] Open
Abstract
Surrogate measures of infectious exposures have been consistently associated with lower childhood acute lymphoblastic leukemia (ALL) risk. However, recent reports have suggested that physician-diagnosed early-life infections increase ALL risk, thereby raising the possibility that stronger responses to infections might promote risk. We examined whether medically diagnosed infections were related to childhood ALL risk in an integrated health-care system in the United States. Cases of ALL (n = 435) diagnosed between 1994-2014 among children aged 0-14 years, along with matched controls (n = 2,170), were identified at Kaiser Permanente Northern California. Conditional logistic regression was used to estimate risk of ALL associated with history of infections during first year of life and across the lifetime (up to diagnosis). History of infection during first year of life was not associated with ALL risk (odds ratio (OR) = 0.85, 95% confidence interval (CI): 0.60, 1.21). However, infections with at least 1 medication prescribed (i.e., more "severe" infections) were inversely associated with risk (OR = 0.42, 95% CI: 0.20, 0.88). Similar associations were observed when the exposure window was expanded to include medication-prescribed infections throughout the subjects' lifetime (OR = 0.52, 95% CI: 0.32, 0.85).
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12
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Yang TO, Huang KYA, Chen MH, Chen PC, Huang WT. Time-dependent associations between presentation-based infections and subsequent risk of childhood immune cell malignancies. Cancer Epidemiol 2020; 67:101767. [PMID: 32679480 DOI: 10.1016/j.canep.2020.101767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/29/2020] [Accepted: 06/13/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Infection is hypothesised as a contributory cause of childhood immune cell malignancies. Although some have reported associations between individual infections and immune cell malignancies, some could be spurious due to infections caused by malignancies that were already active prior to diagnosis. METHODS Identified from Taiwan Cancer Registry, ∼3000 children with four commonest immune cell malignancies diagnosed during 2001-2015 at age 1-20 years were identified and matched with 1:10 controls. Using logistic regression, we estimated the time-specific case-versus-control odds ratios of seven common infection presentations in their health records. We also compared recorded unexplained lymph nodes between cases and controls to explore for how long malignancy may be active prior to diagnosis. RESULTS Unexplained lymph nodes were increasingly recorded months before the diagnosis of childhood leukaemias and years before the diagnosis of childhood lymphomas. When using p < 0.01 as a guide, large case-control differences in infection records were found mostly within 0-2 months prior to the diagnosis (15 out of 28 comparisons). Changes in odds ratios within 3-35 months (2 out of 28 comparisons) and case-control differences beyond 36+ months prior to diagnosis (7 out of 28 comparisons) was relatively small (∼10 % difference in leukaemias). Statistical power varied according to incidence of malignancy, incidence of infection records, and the age distribution. CONCLUSION Immune cell malignancies were likely to be active some time before the diagnosis. Previous studies using conventional population-based methods may not be able to distinguish any small causal link between infection and immune cell malignancies from spurious associations.
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Affiliation(s)
- TienYu Owen Yang
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK.
| | - Kuan-Ying Arthur Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Guishan District, Taoyuan City, 333, Taiwan
| | - Mei-Huei Chen
- Institute of Population Health Sciences, Taiwan National Health Research Institutes, No. 35, Keyan Road, Zhunan Township, Miaoli County, 350, Taiwan; Department of Pediatrics, National Taiwan University College of Medicine and Hospital, No. 1, Section 1, Ren'ai Road, Zhongzheng District, Taipei City, 100, Taiwan
| | - Pau-Chung Chen
- Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, National Taiwan University College of Public Health, No. 17, Xuzhou Road, Zhongzheng District, Taipei City, 100, Taiwan; Department of Public Health, National Taiwan University College of Public Health, No. 17, Xuzhou Road, Zhongzheng District, Taipei City, 100, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 1, Section 1, Ren'ai Road, Zhongzheng District, Taipei City, 100, Taiwan
| | - Wan-Ting Huang
- Taiwan Centers for Disease Control, No. 6, Linsen South Road, Zhongzheng District, Taipei City, 100, Taiwan
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Figueroa SC, Kennedy CJ, Wesseling C, Wiemels JM, Morimoto L, Mora AM. Early immune stimulation and childhood acute lymphoblastic leukemia in Costa Rica: A comparison of statistical approaches. ENVIRONMENTAL RESEARCH 2020; 182:109023. [PMID: 31911233 PMCID: PMC7605596 DOI: 10.1016/j.envres.2019.109023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/19/2019] [Accepted: 12/09/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Although epidemiologic studies suggest that early immune stimulation is protective against childhood leukemia, evidence for this relationship is equivocal for Hispanic children, who are disproportionately affected by this disease. The complex biological processes underlying immune stimulation and leukemogenesis may benefit from novel statistical approaches that account for mixed exposures and their nonlinear interactions. In this study, we utilized targeted machine learning and traditional statistical methods to investigate the association of multiple measures of early immune stimulation with acute lymphoblastic leukemia (ALL) in Costa Rican children. MATERIALS AND METHODS We used data from a population-based case-control study conducted in Costa Rica (2001-2003). Cases of ALL (n = 240) were diagnosed in 1995-2000 (age >1 year and <15 years at diagnosis) and were identified through the National Cancer Registry and National Children's Hospital. Population controls (n = 578) were frequency-matched to cases by birth year and drawn from the National Birth Registry. Data on surrogate measures of early immune stimulation were collected through in-home interviews. We fitted multivariable models, utilizing targeted causal inference (varimpact), unconditional logistic regression, and latent class analysis (LCA). RESULTS In varimpact analysis, contact with any pet [risk difference (RD) = -0.17, 95% CI: -0.25, -0.10)] or any farm animal (RD = -0.07, 95% CI: -0.13, 0.00) and allergies (RD = -0.08, 95% CI: -0.17, 0.01) were associated with a reduced risk of ALL, whereas experiencing a fever longer than one week was associated with an increased risk (RD = 0.23, 95% CI: 0.12, 0.33). In unconditional logistic regression models, contact with any pet or farm animal and a complete vaccination scheme were inversely associated with odds of ALL (OR = 0.44, 95% CI: 0.31, 0.62; OR = 0.66, 95% CI: 0.49, 0.90; OR = 0.45, 95% CI: 0.24, 0.83; respectively), whereas experiencing a fever longer than one week was positively associated with ALL (OR = 2.44, 95% CI: 1.61, 3.70). Two-class and three-class LCA revealed a group with elevated risk for ALL whose exposure profile was mainly characterized by reduced exposure to pets and farm animals. CONCLUSIONS Using distinct statistical approaches, we observed that exposure to pets and farm animals was inversely associated with ALL risk, whereas having a fever longer than one week (a putative proxy of severe infection) was associated with an increased risk. For multifactorial diseases such as childhood leukemia, we recommend estimating the joint effects of multiple exposures by applying diverse statistical methods and interpreting their results together. Overall, we found support for the hypothesis that early immune stimulation offers protection against childhood ALL.
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Affiliation(s)
- Sophia Colombari Figueroa
- Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, P.O. Box 86-3000, Heredia, Costa Rica; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, 9500 Euclid Avenue NA21, Cleveland, OH, 44195, USA
| | - Chris J Kennedy
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, 1995 University Avenue, Suite 460, Berkeley, CA, 94704, USA
| | - Catharina Wesseling
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, P.O. Box 210, SE-171 77, Stockholm, Sweden
| | - Joseph M Wiemels
- Center for Genetic Epidemiology, Department of Preventative Medicine, University of Southern California, Los Angeles, 1520 San Pablo Street, Los Angeles, CA, 90033, USA
| | - Libby Morimoto
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, 1995 University Avenue, Suite 460, Berkeley, CA, 94704, USA
| | - Ana M Mora
- Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, P.O. Box 86-3000, Heredia, Costa Rica; Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, 1995 University Avenue, Suite 265, Berkeley, CA, 94704, USA.
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14
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Nielsen AB, Zhou M, de Smith AJ, Wang R, McCoy L, Hansen H, Morimoto L, Grønbæk K, Johansen C, Kogan SC, Metayer C, Bracci PM, Ma X, Wiemels JL. Increased neonatal level of arginase 2 in cases of childhood acute lymphoblastic leukemia implicates immunosuppression in the etiology. Haematologica 2019; 104:e514-e516. [PMID: 30923090 PMCID: PMC6821599 DOI: 10.3324/haematol.2019.216465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Amalie B Nielsen
- Department of Epidemiology and Biostatistics, University of California San Francisco, CA, USA
- Department of Hematology, Rigshospitalet, Biotech Research and Innovation Centre, BRIC, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mi Zhou
- Department of Epidemiology and Biostatistics, University of California San Francisco, CA, USA
| | - Adam J de Smith
- Department of Epidemiology and Biostatistics, University of California San Francisco, CA, USA
- Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, CA, USA
| | - Rong Wang
- Department of Chronic Disease Epidemiology, School of Public Health, Yale University, CT, USA
| | - Lucie McCoy
- Department of Neurosurgery, University of California San Francisco, CA, USA
- Division of Epidemiology, School of Public Health, University of California Berkeley, CA, USA
| | - Helen Hansen
- Department of Neurosurgery, University of California San Francisco, CA, USA
| | - Libby Morimoto
- Division of Epidemiology, School of Public Health, University of California Berkeley, CA, USA
| | - Kirsten Grønbæk
- Department of Hematology, Rigshospitalet, Biotech Research and Innovation Centre, BRIC, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Johansen
- Department of Hematology, Rigshospitalet, Biotech Research and Innovation Centre, BRIC, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Scott C Kogan
- Department of Laboratory Medicine, University of California San Francisco, CA, USA
| | - Catherine Metayer
- Division of Epidemiology, School of Public Health, University of California Berkeley, CA, USA
| | - Paige M Bracci
- Department of Epidemiology and Biostatistics, University of California San Francisco, CA, USA
| | - Xiaomei Ma
- Department of Chronic Disease Epidemiology, School of Public Health, Yale University, CT, USA
| | - Joseph L Wiemels
- Department of Epidemiology and Biostatistics, University of California San Francisco, CA, USA
- Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, CA, USA
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15
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Søegaard SH, Rostgaard K, Skogstrand K, Wiemels JL, Schmiegelow K, Hjalgrim H. Neonatal Inflammatory Markers Are Associated with Childhood B-cell Precursor Acute Lymphoblastic Leukemia. Cancer Res 2019; 78:5458-5463. [PMID: 30217873 DOI: 10.1158/0008-5472.can-18-0831] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/24/2018] [Accepted: 07/05/2018] [Indexed: 12/25/2022]
Abstract
It has been proposed that children with acute lymphoblastic leukemia (ALL) are born with a dysregulated immune function that together with postnatal environmental exposures causes childhood ALL. Despite its importance for the understanding of ALL etiology, this hypothesis has been inadequately explored. In a population-based case-control study, we measured the concentrations of 10 cytokines and other inflammatory markers on neonatal dried blood spots from 178 children who at ages 1 to 9 years were diagnosed with B-cell precursor ALL and 178 matched controls. Through linkage with Danish nationwide registers, we also assessed whether neonatal inflammatory markers were associated with previously demonstrated risk factors for childhood ALL. Children who developed B-cell precursor ALL had significantly lower neonatal concentrations of IL8, soluble IL6 receptor (sIL6R) α, TGFβ1, monocyte chemotactic protein (MCP)-1, and C-reactive protein (CRP) and higher concentrations of IL6, IL17, and IL18 compared with matched controls. Concentrations of IL10 were below the detection level for both patients and controls. Birth order (IL18 and CRP), gestational age (sIL6Rα, TGFβ1, and CRP), and sex (sIL6Rα, IL8, and CRP), but not maternal age, infections during pregnancy, birth weight nor mode of delivery were significantly associated with the neonatal concentrations of inflammatory markers. Our findings support the hypothesis that children who later develop B-cell precursor ALL are born with a dysregulated immune function.Significance: Children who develop acute lymphoblastic leukemia are immunologically distinct at birth and could potentially react abnormally to infections in early childhood. Cancer Res; 78(18); 5458-63. ©2018 AACR.
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Affiliation(s)
- Signe Holst Søegaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
| | - Klaus Rostgaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Kristin Skogstrand
- Danish Centre for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Joseph Leo Wiemels
- Department of Preventative Medicine, University of Southern California, Los Angeles
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Hjalgrim
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Department of Hematology, University Hospital Rigshospitalet, Copenhagen, Denmark
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16
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Wen Y, Jin R, Chen H. Interactions Between Gut Microbiota and Acute Childhood Leukemia. Front Microbiol 2019; 10:1300. [PMID: 31275258 PMCID: PMC6593047 DOI: 10.3389/fmicb.2019.01300] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/24/2019] [Indexed: 01/26/2023] Open
Abstract
Childhood leukemia, the commonest childhood cancer, mainly consists of acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Though great progresses have been made in the survival rates of childhood leukemia, the long-term health problems of long-term childhood leukemia survivors remain remarkable. In addition, the deep links between risk factors and childhood leukemia need to be elucidated. What can be done to improve the prevention and the prognosis of childhood leukemia is an essential issue. Gut microbiota, referred to as one of the largest symbiotic microorganisms that is accommodated in the gastrointestinal tract of human or animals, is found to be involved in the progression of various diseases. It is reported that microbiota may keep people in good health by participating in metabolism processes and regulating the immune system. Studies have also explored the potential relationships between gut microbiota and childhood leukemia. This review is meant to illustrate the roles of gut microbiota in the onset of acute childhood leukemia, as well as in the progress and prognosis of leukemia and how the treatments for leukemia affect gut microbiota. Besides, this review is focused on the possibility of building or rebuilding a healthy gut microbiota by adjusting the diet construction so as to help clinicians deal with childhood leukemia.
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Affiliation(s)
- Yuxi Wen
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Runming Jin
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongbo Chen
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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17
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Wiemels JL, Talbäck M, Francis S, Feychting M. Early Infection with Cytomegalovirus and Risk of Childhood Hematologic Malignancies. Cancer Epidemiol Biomarkers Prev 2019; 28:1024-1027. [PMID: 30996022 DOI: 10.1158/1055-9965.epi-19-0044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/05/2019] [Accepted: 03/12/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Congenital cytomegalovirus (CMV) infection was recently identified as a risk factor for childhood acute lymphocytic leukemia by detecting the presence of CMV sequences in neonatal blood spots. In this study, we asked whether clinically apparent CMV infection could be identified prior to hematologic malignancy, using high-quality Swedish population-based registries. METHODS CMV infection was identified with appropriate ICD-9 or ICD-10 codes in the Patient and Medical Birth Registries, and childhood malignancies below the age of 15 years were identified in the Cancer Registry, among 2,782,507 children born in Sweden 1987 to 2014. RESULTS Observing all CMV infections registered earlier than 6 months prior to malignancy diagnosis, an increased HR of CMV-related infections, adjusting for congenital malformations, deformations, and chromosome abnormalities, was detected for hematologic malignancies [HR, 11.2; 95% confidence interval (CI), 5.8-21.5], but not for central nervous system tumors. CONCLUSIONS Higher CMV incidence was detected for children ostensibly exposed through maternal CMV infection during pregnancy with the index child. IMPACT The data are compatible with a congenital infection of CMV leading to increased risk of childhood hematologic malignancies, but not tumors of the central nervous system, although a cautious interpretation is warranted because of the small numbers.
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Affiliation(s)
- Joseph L Wiemels
- Center for Genetic Epidemiology, Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California.
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stephen Francis
- Department of Epidemiology, School of Community Health Sciences, University of Nevada Reno, Reno, Nevada
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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18
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Wallace AD, Francis SS, Ma X, McKean-Cowdin R, Selvin S, Whitehead TP, Barcellos LF, Kang AY, Morimoto L, Moore TB, Wiemels JL, Metayer C. Allergies and Childhood Acute Lymphoblastic Leukemia: A Case-Control Study and Meta-analysis. Cancer Epidemiol Biomarkers Prev 2018; 27:1142-1150. [PMID: 30068517 PMCID: PMC6628274 DOI: 10.1158/1055-9965.epi-17-0584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/30/2017] [Accepted: 07/25/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Allergic disease is suspected to play a role in the development of childhood acute lymphoblastic leukemia (ALL). Studies conducted over the last several decades have yielded mixed results.Methods: We examined the association between allergy, a common immune-mediated disorder, and ALL in the California Childhood Leukemia Study (CCLS), a case-control study of 977 children diagnosed with ALL and 1,037 matched controls (1995-2015). History of allergies in the first year of life was obtained from interviews, mainly reported by mothers. Logistic regression analyses were conducted to estimate ORs and 95% confidence intervals (CIs), controlling for birth order, daycare attendance, and mode of delivery. In addition, we conducted meta-analyses with data from the CCLS and 12 published studies and employed a new method to estimate between-study heterogeneity (R_b).Results: Overall, no associations were observed between childhood ALL risk and specific allergy phenotypes or any allergy, as a group. However, having any allergy was associated with an increased risk of ALL among the youngest study participants. In the meta-analysis random-effects models, reduced odds of ALL were associated with hay fever (metaOR = 0.65; 95% CI, 0.47-0.90); however, restricting the analysis to studies that used medical records for assessment of allergy or recently published studies led to null or attenuated results.Conclusions: Overall, our findings do not support a clear association between allergy and childhood ALL.Impact: The degree to which epidemiologic studies can inform the relationship between allergies and risk of childhood ALL is limited by R_b. Cancer Epidemiol Biomarkers Prev; 27(10); 1142-50. ©2018 AACR.
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Affiliation(s)
- Amelia D Wallace
- School of Public Health, University of California, Berkeley, Berkeley, California.
| | - Stephen S Francis
- School of Community Health Sciences, University of Nevada, Reno, Nevada
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Xiomei Ma
- Department of Epidemiology and Public Health, Yale University, New Haven, Connecticut
| | - Roberta McKean-Cowdin
- Preventive Medicine, University of Southern California, Los Angeles, Los Angeles, California
| | - Steve Selvin
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Todd P Whitehead
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Lisa F Barcellos
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Alice Y Kang
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Libby Morimoto
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Theodore B Moore
- School of Medicine, Pediatrics, University of California, Los Angeles, Los Angeles, California
| | - Joseph L Wiemels
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Catherine Metayer
- School of Public Health, University of California, Berkeley, Berkeley, California
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19
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Abstract
OBJECTIVE We aimed to investigate the effect of failed vacuum delivery leading to an emergency cesarean delivery on the long-term pediatric hematologic morbidity of the offspring. STUDY DESIGN In this population-based cohort study, the risk of long-term hematologic morbidity (up to the age of 18 y) was evaluated in children born following successful vacuum vaginal delivery, as compared with that of children born following a failed procedure leading to an emergent cesarean delivery. Multiple pregnancies and fetuses with congenital malformations were excluded. A Kaplan-Meier survival curve was constructed to compare cumulative pediatric hematologic morbidity, and a Cox proportional hazards model was used to control for confounders. RESULTS A total of 7978 neonates met the inclusion criteria. Vacuum delivery was successful in 7733 cases (96.9%), whereas it failed in 245 cases (3.1%). Total hematologic morbidity of the offspring up to 18 years of age was comparable between the groups (1.6% vs. 0.8%, P=0.8). The Kaplan-Meier survival curve showed no difference in the cumulative incidence of total hematologic morbidity (log rank, P=0.22). In the Cox regression model, failed vacuum delivery was not independently associated with long-term hematologic morbidity, as compared with a successful procedure, while adjusting for multiple confounders (adjusted hazards ratio [HR], 1.8; 95% confidence interval, 0.7-5.0; P=0.25). CONCLUSIONS Failed vacuum delivery does not seem to be associated with an increased risk for pediatric hematologic morbidity of the offspring up to 18 years of age.
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20
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Wiemels JL, Walsh KM, de Smith AJ, Metayer C, Gonseth S, Hansen HM, Francis SS, Ojha J, Smirnov I, Barcellos L, Xiao X, Morimoto L, McKean-Cowdin R, Wang R, Yu H, Hoh J, DeWan AT, Ma X. GWAS in childhood acute lymphoblastic leukemia reveals novel genetic associations at chromosomes 17q12 and 8q24.21. Nat Commun 2018; 9:286. [PMID: 29348612 PMCID: PMC5773513 DOI: 10.1038/s41467-017-02596-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 12/13/2017] [Indexed: 01/07/2023] Open
Abstract
Childhood acute lymphoblastic leukemia (ALL) (age 0-14 years) is 20% more common in Latino Americans than non-Latino whites. We conduct a genome-wide association study in a large sample of 3263 Californian children with ALL (including 1949 of Latino heritage) and 3506 controls matched on month and year of birth, sex, and ethnicity, and an additional 12,471 controls from the Kaiser Resource for Genetic Epidemiology Research on Aging Cohort. Replication of the strongest genetic associations is performed in two independent datasets from the Children's Oncology Group and the California Childhood Leukemia Study. Here we identify new risk loci on 17q12 near IKZF3/ZPBP2/GSDMB/ORMDL3, a locus encompassing a transcription factor important for lymphocyte development (IKZF3), and at an 8q24 region known for structural contacts with the MYC oncogene. These new risk loci may impact gene expression via local (four 17q12 genes) or long-range (8q24) interactions, affecting function of well-characterized hematopoietic and growth-regulation pathways.
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Affiliation(s)
- Joseph L Wiemels
- Department of Epidemiology and Biostatistics, University of California San Francisco, 1450 3rd Street, San Francisco, CA, 94158, USA.
- Department of Neurological Surgery, University of California San Francisco, 1450 3rd Street, San Francisco, CA, 94158, USA.
- Institute for Human Genetics, University of California San Francisco, 1450 3rd Street, San Francisco, CA, 94158, USA.
- Department of Preventative Medicine, University of Southern California, SSB 318D 2001 N. Soto Street, Los Angeles, CA, 90033, USA.
| | - Kyle M Walsh
- Department of Epidemiology and Biostatistics, University of California San Francisco, 1450 3rd Street, San Francisco, CA, 94158, USA
- Department of Neurological Surgery, University of California San Francisco, 1450 3rd Street, San Francisco, CA, 94158, USA
| | - Adam J de Smith
- Department of Epidemiology and Biostatistics, University of California San Francisco, 1450 3rd Street, San Francisco, CA, 94158, USA
| | - Catherine Metayer
- School of Public Health, University of California Berkeley, 1950 University Avenue, Suite 460, Berkeley, CA, 94720, USA
| | - Semira Gonseth
- Department of Epidemiology and Biostatistics, University of California San Francisco, 1450 3rd Street, San Francisco, CA, 94158, USA
- Department of Preventative Medicine, University of Southern California, SSB 318D 2001 N. Soto Street, Los Angeles, CA, 90033, USA
| | - Helen M Hansen
- Department of Neurological Surgery, University of California San Francisco, 1450 3rd Street, San Francisco, CA, 94158, USA
| | - Stephen S Francis
- Department of Epidemiology and Biostatistics, University of California San Francisco, 1450 3rd Street, San Francisco, CA, 94158, USA
- Department of Epidemiology, School of Community Health Sciences, University of Nevada Reno, 1664 N. Virginia Street, Reno, NV, 89557, USA
| | - Juhi Ojha
- Department of Epidemiology and Biostatistics, University of California San Francisco, 1450 3rd Street, San Francisco, CA, 94158, USA
| | - Ivan Smirnov
- Department of Neurological Surgery, University of California San Francisco, 1450 3rd Street, San Francisco, CA, 94158, USA
| | - Lisa Barcellos
- School of Public Health, University of California Berkeley, 1950 University Avenue, Suite 460, Berkeley, CA, 94720, USA
| | - Xiaorong Xiao
- School of Public Health, University of California Berkeley, 1950 University Avenue, Suite 460, Berkeley, CA, 94720, USA
| | - Libby Morimoto
- School of Public Health, University of California Berkeley, 1950 University Avenue, Suite 460, Berkeley, CA, 94720, USA
| | - Roberta McKean-Cowdin
- Department of Preventative Medicine, University of Southern California, SSB 318D 2001 N. Soto Street, Los Angeles, CA, 90033, USA
| | - Rong Wang
- Department of Chronic Diseases Epidemiology, School of Public Health, Yale University, 60 College Street, New Haven, CT, 06520, USA
| | - Herbert Yu
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Josephine Hoh
- Department of Chronic Diseases Epidemiology, School of Public Health, Yale University, 60 College Street, New Haven, CT, 06520, USA
| | - Andrew T DeWan
- Department of Chronic Diseases Epidemiology, School of Public Health, Yale University, 60 College Street, New Haven, CT, 06520, USA
| | - Xiaomei Ma
- Department of Chronic Diseases Epidemiology, School of Public Health, Yale University, 60 College Street, New Haven, CT, 06520, USA.
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Søgaard KK, Farkas DK, Sørensen HT. Pneumonia diagnosis in childhood and incidence of leukaemia, lymphoma and brain cancer: a Danish nationwide cohort study. BMJ Open 2017; 7:e019860. [PMID: 29289943 PMCID: PMC5778340 DOI: 10.1136/bmjopen-2017-019860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES There is an ongoing debate on the possible association between infections in early childhood and subsequent cancer risk, but it remains unclear if a hospital admission for infection is associated with risk of childhood cancer diagnosis. We examined if a hospital-based diagnosis of pneumonia was a clinical marker of the three most common childhood cancers. DESIGN Population-based cohort study. SETTING Denmark, hospital diagnoses, 1994-2013. METHODS Using national health registries, we compared the observed incidence of leukaemia, lymphoma and brain cancer among 83 935 children with a hospital-based pneumonia diagnosis with that expected among children in the general population. We calculated absolute cancer risks and standardised incidence ratios (SIRs) as a measure of relative risk. RESULTS The cancer SIRs were substantially increased during the first 6 months of follow-up; lymphoid leukaemia: 6.2 (95% CI 3.5 to 10.3); myeloid leukaemia: 14.8 (95% CI 6.0 to 30.6); Hodgkin's lymphoma: 60.8 (95% CI 26.2 to 120), non-Hodgkin's lymphoma: 15.9 (95% CI 5.2 to 37.2) and brain cancer: 4.4 (95% CI 1.9 to 8.7). The 6-month absolute risks of leukaemia, lymphoma and brain cancer were all low, reaching 0.05% when combined. An increased risk persisted beyond 5 years for non-Hodgkin's lymphoma and brain cancer. However, the 5-year absolute cancer risk was 0.14%. CONCLUSIONS The short-term incidence of leukaemia, lymphoma and brain cancer was higher than expected and persisted beyond 5 years for non-Hodgkin's lymphoma and brain cancer. However, the absolute cancer risk was low.
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Affiliation(s)
- Kirstine Kobberøe Søgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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22
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Chen HL, Shen LJ, Hsu PN, Shen CY, Hall SA, Hsiao FY. Cumulative Burden of Glucocorticoid-related Adverse Events in Patients with Systemic Lupus Erythematosus: Findings from a 12-year Longitudinal Study. J Rheumatol 2017; 45:83-89. [PMID: 29142034 DOI: 10.3899/jrheum.160214] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this population-based study is to examine the adverse events (AE) associated with longitudinal systemic glucocorticoid (GC) use among an ethnic Chinese systemic lupus erythematosus (SLE) cohort. METHODS Our study subjects were patients with newly diagnosed SLE aged 18 and older who received at least 1 prescription of systemic GC between 2001 and 2012 from Taiwan's National Health Insurance Research Database (NHIRD). The earliest prescription date of systemic GC for each subject was defined as the index date. For each subject, we calculated the average prednisolone-equivalent dose and the medication possession ratio (MPR) of GC use every 90 days for each patient after the index date. Patients with a diagnosis of AE (defined by the International Classification of Diseases-9-Clinical Modification diagnosis code) during the followup were also identified from the NHIRD. Generalized estimating equations adjusted for propensity score were applied to examine the association between longitudinal GC use and risks of prespecified AE (musculoskeletal, gastrointestinal, ophthalmologic, infectious, cardiovascular, neuropsychiatric, metabolic, and dermatologic diseases). RESULTS We identified 11,288 patients with SLE (mean followup: 6.28 yrs). Higher doses and higher MPR of GC were associated with increased risk of osteonecrosis [adjusted OR (aOR) 2.87-9.09]. Similar results were found regarding the risk of osteoporosis (aOR 1.71-3.67), bacterial infection (aOR 2.12-3.89), Cushingoid syndrome (aOR 6.51-62.03), and sleep disorder (aOR 1.42-3.59). CONCLUSION To our knowledge, this is the first study to show that the dose and intensity of longitudinal use of GC were both associated with risk of AE among a nationwide Asian SLE cohort.
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Affiliation(s)
- Hung-Lin Chen
- From the Graduate Institute of Clinical Pharmacy, the Graduate Institute of Immunology, the Graduate Institute of Clinical Medicine, and the School of Pharmacy, College of Medicine, National Taiwan University; Department of Internal Medicine, and Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Department of Epidemiology, Biogen, Cambridge, Massachusetts, USA.,H.L. Chen, MS, Research Associate, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University; L.J. Shen, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Director, Department of Pharmacy, National Taiwan University Hospital; P.N. Hsu, MD, PhD, Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, and Professor, Graduate Institute of Immunology, College of Medicine, National Taiwan University; C.Y. Shen, MD, Visiting Physician, Department of Internal Medicine, National Taiwan University Hospital, and Doctoral Student, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; S.A. Hall, PhD, Associate Director, Department of Epidemiology, Biogen; F.Y. Hsiao, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Adjunct Associate Researcher, Department of Pharmacy, National Taiwan University Hospital. H.L. Chen and L.J. Shen contributed equally as first authors
| | - Li-Jiuan Shen
- From the Graduate Institute of Clinical Pharmacy, the Graduate Institute of Immunology, the Graduate Institute of Clinical Medicine, and the School of Pharmacy, College of Medicine, National Taiwan University; Department of Internal Medicine, and Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Department of Epidemiology, Biogen, Cambridge, Massachusetts, USA.,H.L. Chen, MS, Research Associate, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University; L.J. Shen, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Director, Department of Pharmacy, National Taiwan University Hospital; P.N. Hsu, MD, PhD, Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, and Professor, Graduate Institute of Immunology, College of Medicine, National Taiwan University; C.Y. Shen, MD, Visiting Physician, Department of Internal Medicine, National Taiwan University Hospital, and Doctoral Student, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; S.A. Hall, PhD, Associate Director, Department of Epidemiology, Biogen; F.Y. Hsiao, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Adjunct Associate Researcher, Department of Pharmacy, National Taiwan University Hospital. H.L. Chen and L.J. Shen contributed equally as first authors
| | - Ping-Ning Hsu
- From the Graduate Institute of Clinical Pharmacy, the Graduate Institute of Immunology, the Graduate Institute of Clinical Medicine, and the School of Pharmacy, College of Medicine, National Taiwan University; Department of Internal Medicine, and Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Department of Epidemiology, Biogen, Cambridge, Massachusetts, USA.,H.L. Chen, MS, Research Associate, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University; L.J. Shen, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Director, Department of Pharmacy, National Taiwan University Hospital; P.N. Hsu, MD, PhD, Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, and Professor, Graduate Institute of Immunology, College of Medicine, National Taiwan University; C.Y. Shen, MD, Visiting Physician, Department of Internal Medicine, National Taiwan University Hospital, and Doctoral Student, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; S.A. Hall, PhD, Associate Director, Department of Epidemiology, Biogen; F.Y. Hsiao, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Adjunct Associate Researcher, Department of Pharmacy, National Taiwan University Hospital. H.L. Chen and L.J. Shen contributed equally as first authors
| | - Chieh-Yu Shen
- From the Graduate Institute of Clinical Pharmacy, the Graduate Institute of Immunology, the Graduate Institute of Clinical Medicine, and the School of Pharmacy, College of Medicine, National Taiwan University; Department of Internal Medicine, and Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Department of Epidemiology, Biogen, Cambridge, Massachusetts, USA.,H.L. Chen, MS, Research Associate, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University; L.J. Shen, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Director, Department of Pharmacy, National Taiwan University Hospital; P.N. Hsu, MD, PhD, Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, and Professor, Graduate Institute of Immunology, College of Medicine, National Taiwan University; C.Y. Shen, MD, Visiting Physician, Department of Internal Medicine, National Taiwan University Hospital, and Doctoral Student, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; S.A. Hall, PhD, Associate Director, Department of Epidemiology, Biogen; F.Y. Hsiao, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Adjunct Associate Researcher, Department of Pharmacy, National Taiwan University Hospital. H.L. Chen and L.J. Shen contributed equally as first authors
| | - Susan A Hall
- From the Graduate Institute of Clinical Pharmacy, the Graduate Institute of Immunology, the Graduate Institute of Clinical Medicine, and the School of Pharmacy, College of Medicine, National Taiwan University; Department of Internal Medicine, and Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Department of Epidemiology, Biogen, Cambridge, Massachusetts, USA.,H.L. Chen, MS, Research Associate, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University; L.J. Shen, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Director, Department of Pharmacy, National Taiwan University Hospital; P.N. Hsu, MD, PhD, Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, and Professor, Graduate Institute of Immunology, College of Medicine, National Taiwan University; C.Y. Shen, MD, Visiting Physician, Department of Internal Medicine, National Taiwan University Hospital, and Doctoral Student, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; S.A. Hall, PhD, Associate Director, Department of Epidemiology, Biogen; F.Y. Hsiao, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Adjunct Associate Researcher, Department of Pharmacy, National Taiwan University Hospital. H.L. Chen and L.J. Shen contributed equally as first authors
| | - Fei-Yuan Hsiao
- From the Graduate Institute of Clinical Pharmacy, the Graduate Institute of Immunology, the Graduate Institute of Clinical Medicine, and the School of Pharmacy, College of Medicine, National Taiwan University; Department of Internal Medicine, and Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; Department of Epidemiology, Biogen, Cambridge, Massachusetts, USA. .,H.L. Chen, MS, Research Associate, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University; L.J. Shen, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Director, Department of Pharmacy, National Taiwan University Hospital; P.N. Hsu, MD, PhD, Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, and Professor, Graduate Institute of Immunology, College of Medicine, National Taiwan University; C.Y. Shen, MD, Visiting Physician, Department of Internal Medicine, National Taiwan University Hospital, and Doctoral Student, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; S.A. Hall, PhD, Associate Director, Department of Epidemiology, Biogen; F.Y. Hsiao, PhD, Associate Professor, Graduate Institute of Clinical Pharmacy, and School of Pharmacy, College of Medicine, National Taiwan University, and Adjunct Associate Researcher, Department of Pharmacy, National Taiwan University Hospital. H.L. Chen and L.J. Shen contributed equally as first authors.
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23
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Hwee J, Tait C, Sung L, Kwong JC, Sutradhar R, Pole JD. A systematic review and meta-analysis of the association between childhood infections and the risk of childhood acute lymphoblastic leukaemia. Br J Cancer 2017; 118:127-137. [PMID: 29065105 PMCID: PMC5765221 DOI: 10.1038/bjc.2017.360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 01/02/2023] Open
Abstract
Background: To determine whether childhood infections were associated with the development of childhood acute lymphoblastic leukaemia (ALL). Methods: We included studies that assessed any infection in childhood prior to the diagnosis of ALL in children aged 0–19 years compared to children without cancer. The primary analysis synthesised any infection against the odds of ALL, and secondary analyses assessed the frequency, severity, timing of infections, and specific infectious agents against the odds of ALL. Subgroup analyses by data source were investigated. Results: In our primary analysis of 12 496 children with ALL and 2 356 288 children without ALL from 38 studies, we found that any infection was not associated with ALL (odds ratio (OR)=1.10, 95% CI: 0.95–1.28). Among studies with laboratory-confirmed infections, the presence of infections increased the odds of ALL by 2.4-fold (OR=2.42, 95% CI: 1.54–3.82). Frequency, severity, and timing of infection were not associated with ALL. Conclusions: The hypothesis put forward by Greaves and others about an infectious aetiology are neither confirmed nor refuted and the overall evidence remains inadequate for good judgement. The qualitative difference in the subgroup effects require further study, and future research will need to address the challenges in measuring infectious exposures.
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Affiliation(s)
- Jeremiah Hwee
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada
| | - Christopher Tait
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada
| | - Lillian Sung
- Division of Haematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.,Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON Canada.,Public Health Ontario, Toronto, ON, Canada.,Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
| | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, Canada
| | - Jason D Pole
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada.,Pediatric Oncology Group of Ontario, 480 University Avenue, Suite 1014, Toronto, ON, Canada
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24
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Wallace AD, Francis SS, Shao X, de Smith AJ, Walsh KM, Mckean-Cowdin R, Ma X, Dahl G, Barcellos LF, Wiemels JL, Metayer C. A germ-line deletion of APOBEC3B does not contribute to subtype-specific childhood acute lymphoblastic leukemia etiology. Haematologica 2017; 103:e29-e31. [PMID: 29025908 DOI: 10.3324/haematol.2017.179317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Amelia D Wallace
- School of Public Health, University of California, Berkeley, CA, USA
| | - Stephen S Francis
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Division of Health Sciences, University of Nevada, Reno, NV, USA
| | - Xiaorong Shao
- School of Public Health, University of California, Berkeley, CA, USA
| | - Adam J de Smith
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kyle M Walsh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | | | | | - Gary Dahl
- Pediatrics Hematology/Oncology, Stanford University, Palo Alto, CA, USA
| | - Lisa F Barcellos
- School of Public Health, University of California, Berkeley, CA, USA
| | | | - Catherine Metayer
- School of Public Health, University of California, Berkeley, CA, USA
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25
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Shahein AR, Ballourah W, Papsin BC, Beck CE. An 11-Year-Old Boy With Ear Pain and Facial Palsy. Glob Pediatr Health 2017; 4:2333794X17716327. [PMID: 28695159 PMCID: PMC5495499 DOI: 10.1177/2333794x17716327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/25/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Walid Ballourah
- Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Blake C Papsin
- The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Carolyn E Beck
- The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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26
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In utero cytomegalovirus infection and development of childhood acute lymphoblastic leukemia. Blood 2016; 129:1680-1684. [PMID: 27979823 DOI: 10.1182/blood-2016-07-723148] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 09/17/2016] [Indexed: 02/07/2023] Open
Abstract
It is widely suspected, yet controversial, that infection plays an etiologic role in the development of acute lymphoblastic leukemia (ALL), the most common childhood cancer and a disease with a confirmed prenatal origin in most cases. We investigated infections at diagnosis and then assessed the timing of infection at birth in children with ALL and age, gender, and ethnicity matched controls to identify potential causal initiating infections. Comprehensive untargeted virome and bacterial analyses of pretreatment bone marrow specimens (n = 127 ALL in comparison with 38 acute myeloid leukemia cases in a comparison group) revealed prevalent cytomegalovirus (CMV) infection at diagnosis in childhood ALL, demonstrating active viral transcription in leukemia blasts as well as intact virions in serum. Screening of newborn blood samples revealed a significantly higher prevalence of in utero CMV infection in ALL cases (n = 268) than healthy controls (n = 270) (odds ratio [OR], 3.71, confidence interval [CI], 1.56-7.92, P = .0016). Risk was more pronounced in Hispanics (OR=5.90, CI=1.89-25.96) than in non-Hispanic whites (OR=2.10 CI= 0.69-7.13). This is the first study to suggest that congenital CMV infection is a risk factor for childhood ALL and is more prominent in Hispanic children. Further investigation of CMV as an etiologic agent for ALL is warranted.
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27
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Whitehead TP, Metayer C, Wiemels JL, Singer AW, Miller MD. Childhood Leukemia and Primary Prevention. Curr Probl Pediatr Adolesc Health Care 2016; 46:317-352. [PMID: 27968954 PMCID: PMC5161115 DOI: 10.1016/j.cppeds.2016.08.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Leukemia is the most common pediatric cancer, affecting 3800 children per year in the United States. Its annual incidence has increased over the last decades, especially among Latinos. Although most children diagnosed with leukemia are now cured, many suffer long-term complications, and primary prevention efforts are urgently needed. The early onset of leukemia-usually before 5 years of age-and the presence at birth of "pre-leukemic" genetic signatures indicate that pre- and postnatal events are critical to the development of the disease. In contrast to most pediatric cancers, there is a growing body of literature-in the United States and internationally-that has implicated several environmental, infectious, and dietary risk factors in the etiology of childhood leukemia, mainly for acute lymphoblastic leukemia, the most common subtype. For example, exposures to pesticides, tobacco smoke, solvents, and traffic emissions have consistently demonstrated positive associations with the risk of developing childhood leukemia. In contrast, intake of vitamins and folate supplementation during the preconception period or pregnancy, breastfeeding, and exposure to routine childhood infections have been shown to reduce the risk of childhood leukemia. Some children may be especially vulnerable to these risk factors, as demonstrated by a disproportionate burden of childhood leukemia in the Latino population of California. The evidence supporting the associations between childhood leukemia and its risk factors-including pooled analyses from around the world and systematic reviews-is strong; however, the dissemination of this knowledge to clinicians has been limited. To protect children's health, it is prudent to initiate programs designed to alter exposure to well-established leukemia risk factors rather than to suspend judgment until no uncertainty remains. Primary prevention programs for childhood leukemia would also result in the significant co-benefits of reductions in other adverse health outcomes that are common in children, such as detriments to neurocognitive development.
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Affiliation(s)
- Todd P Whitehead
- Department of Epidemiology, School of Public Health, University of California, Berkeley, CA; Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA.
| | - Catherine Metayer
- Department of Epidemiology, School of Public Health, University of California, Berkeley, CA; Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA
| | - Joseph L Wiemels
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA
| | - Amanda W Singer
- Department of Epidemiology, School of Public Health, University of California, Berkeley, CA
| | - Mark D Miller
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA; Western States Pediatric Environmental Health Specialty Unit, University of California, San Francisco, CA
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28
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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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29
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Reported associations between asthma and acute lymphoblastic leukemia: insights from a hybrid simulation study. Eur J Epidemiol 2016; 31:593-602. [PMID: 26861154 DOI: 10.1007/s10654-016-0126-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 02/02/2016] [Indexed: 02/07/2023]
Abstract
Numerous studies have reported a protective association between asthma and acute lymphoblastic leukemia (ALL), but the causal structure of this association remains unclear. We present a hybrid simulation to examine the compatibility of this association with uncontrolled confounding by infection or another unmeasured factor. We generated a synthetic cohort using inputs on the interrelations of asthma, ALL, infections, and other suggested risk factors from the literature and the Danish National Birth Cohort. We computed odds ratios (ORs) between asthma and ALL in the synthetic cohort with and without adjustment for infections and other (including unmeasured) confounders. Only if infection was an extremely strong risk factor for asthma (OR of 10) and an extremely strong protective factor against ALL (OR of 0.1) was the asthma-ALL association compatible with the literature (OR of 0.78). Similarly, strong uncontrolled confounding by an unmeasured factor could downwardly bias the asthma-ALL association, but not enough to replicate findings in the literature. This investigation illustrates that the reported protective association between asthma and ALL is unlikely to be entirely due to uncontrolled confounding by infections or an unmeasured confounder alone. Simulation can be used to advance our understanding of risk factors for rare outcomes as demonstrated by this study.
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30
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New insights into childhood leukemia etiology. Eur J Epidemiol 2015; 30:1225-7. [PMID: 26686849 DOI: 10.1007/s10654-015-0115-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
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31
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Gradel KO, Kaerlev L. Antibiotic use from conception to diagnosis of child leukaemia as compared to the background population: A nested case-control study. Pediatr Blood Cancer 2015; 62:1155-61. [PMID: 25790083 DOI: 10.1002/pbc.25477] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/16/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND The role of infection in the aetiology of childhood leukaemia is unknown. We used prescriptions of antibiotics from Danish pharmacies as a proxy measure for the occurrence of infections. PROCEDURE We investigated the association between exposure to antibiotics, from conception to leukaemia diagnosis, and the risk of leukaemia. Incident cases of leukaemia among children in Denmark, 1995-2008, with mothers having their earliest conception date in 1995, were individually matched to population controls by age, sex and municipality. Conditional logistic regression analyses assessed antibiotic redemptions in different time periods from conception up to 6 months before the diagnoses of all leukaemia types, acute lymphoblastic leukaemia [ALL] and ALL in 2- to 5-year-old children, adjusting for several potential confounders. RESULTS A total of 120/360 (33.3%) leukaemia mothers and 1,081/3,509 (30.8%) control mothers redeemed antibiotics during pregnancy (P = 0.32). For children, the equivalent numbers were 276 (76.7%) and 2,665 (75.9%) (P = 0.76). Histograms of antibiotic redemptions showed no temporal differences between leukaemia mothers/children and controls, which was confirmed in adjusted regression analyses (OR [95% CI]: 1.02 [0.75-1.38]). Only antibiotics redeemed during the first year after birth differed from this (OR [95% CI] for ALL diagnosed in 2- to 5-year-old children: 0.46 [0.31-0.66]). CONCLUSIONS In this hypothesis generating study, the similar amount and pattern of antibiotic redemptions in children with and without leukaemia indicate that infections play a minor role in the aetiology of childhood leukaemia. However, less antibiotic redemptions during the first year of life conform to Greaves' 'delayed infection hypothesis'.
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Affiliation(s)
- Kim Oren Gradel
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | - Linda Kaerlev
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
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32
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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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33
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Rudant J, Orsi L, Bonaventure A, Goujon-Bellec S, Baruchel A, Petit A, Bertrand Y, Nelken B, Pasquet M, Michel G, Saumet L, Chastagner P, Ducassou S, Réguerre Y, Hémon D, Clavel J. ARID5B, IKZF1 and non-genetic factors in the etiology of childhood acute lymphoblastic leukemia: the ESCALE study. PLoS One 2015; 10:e0121348. [PMID: 25806972 PMCID: PMC4373901 DOI: 10.1371/journal.pone.0121348] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/30/2015] [Indexed: 01/18/2023] Open
Abstract
Genome-wide association studies (GWAS) have identified that frequent polymorphisms in ARID5B and IKZF1, two genes involved in lymphoid differentiation, increase the risk of childhood acute lymphoblastic leukemia (ALL). These findings markedly modified the current field of research on the etiology of ALL. In this new context, the present exploratory study investigated the possible interactions between these at-risk alleles and the non-genetic suspected ALL risk factors that were of sufficient prevalence in the French ESCALE study: maternal use of home insecticides during pregnancy, preconception paternal smoking, and some proxies for early immune modulation, i.e. breastfeeding, history of common infections before age one year, and birth order. The analyses were based on 434 ALL cases and 442 controls of European origin, drawn from the nationwide population-based case-control study ESCALE. Information on non-genetic factors was obtained by standardized telephone interview. Interactions between rs10740055 in ARID5B or rs4132601 in IKZF1 and each of the suspected non-genetic factors were tested, with the SNPs coded as counts of minor alleles (trend variable). Statistical interactions were observed between rs4132601 and maternal insecticide use (p = 0.012), breastfeeding p = 0.017) and repeated early common infections (p = 0.0070), with allelic odds ratios (OR) which were only increased among the children not exposed to insecticides (OR = 1.8, 95%CI: 1.3, 2.4), those who had been breastfed (OR = 1.8, 95%CI: 1.3, 2.5) and those who had had repeated early common infections (OR = 2.4, 95%CI: 1.5, 3.8). The allelic ORs were close to one among children exposed to insecticides, who had not been breastfed and who had had no or few common infections. Repeated early common infections interacted with rs10740055 (p = 0.018) in the case-only design. Further studies are needed to evaluate whether these observations of a modification of the effect of the at-risk alleles by non-genetic factors are chance findings or reflect true underlying mechanisms.
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Affiliation(s)
- Jérémie Rudant
- Institut national de la santé et de la recherche médicale (INSERM) U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Epidemiology of childhood and adolescent cancers team (EPICEA), Villejuif, France
- Paris-Descartes University, UMRS-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Paris, France
- French National Registry of Childhood Hematopoietic Malignancies (RNHE), Villejuif, France
- * E-mail:
| | - Laurent Orsi
- Institut national de la santé et de la recherche médicale (INSERM) U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Epidemiology of childhood and adolescent cancers team (EPICEA), Villejuif, France
- Paris-Descartes University, UMRS-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Paris, France
| | - Audrey Bonaventure
- Institut national de la santé et de la recherche médicale (INSERM) U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Epidemiology of childhood and adolescent cancers team (EPICEA), Villejuif, France
- Paris-Descartes University, UMRS-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Paris, France
| | - Stéphanie Goujon-Bellec
- Institut national de la santé et de la recherche médicale (INSERM) U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Epidemiology of childhood and adolescent cancers team (EPICEA), Villejuif, France
- Paris-Descartes University, UMRS-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Paris, France
- French National Registry of Childhood Hematopoietic Malignancies (RNHE), Villejuif, France
| | - André Baruchel
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Université Paris Diderot-Paris 7, Sorbonne Paris Cité, Paris, France
| | - Arnaud Petit
- Assistance Publique-Hôpitaux de Paris, HUEP, Hôpital Trousseau, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR S_938, Paris, France
| | - Yves Bertrand
- Institut d’Hémato-Oncologie Pédiatrique, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
| | - Brigitte Nelken
- Pôle Enfant, CHRU, Lille, France
- Université Lille Nord de France, Lille, France
| | - Marlène Pasquet
- Hématologie pédiatrique, CHU Toulouse, INSERM U1037, Equipe 16, CRCT, Oncopôle, Toulouse, France
| | - Gérard Michel
- Department of Pediatric Hematology and Oncology, Timone Enfants Hospital, Marseille, France
- Aix-Marseille University, Marseille, France
| | - Laure Saumet
- Hôpital Arnaud de Villeneuve, Montpellier, France
| | | | | | | | - Denis Hémon
- Institut national de la santé et de la recherche médicale (INSERM) U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Epidemiology of childhood and adolescent cancers team (EPICEA), Villejuif, France
- Paris-Descartes University, UMRS-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Paris, France
| | - Jacqueline Clavel
- Institut national de la santé et de la recherche médicale (INSERM) U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Epidemiology of childhood and adolescent cancers team (EPICEA), Villejuif, France
- Paris-Descartes University, UMRS-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Paris, France
- French National Registry of Childhood Hematopoietic Malignancies (RNHE), Villejuif, France
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Ajrouche R, Rudant J, Orsi L, Petit A, Baruchel A, Lambilliotte A, Gambart M, Michel G, Bertrand Y, Ducassou S, Gandemer V, Paillard C, Saumet L, Blin N, Hémon D, Clavel J. Childhood acute lymphoblastic leukaemia and indicators of early immune stimulation: the Estelle study (SFCE). Br J Cancer 2015; 112:1017-26. [PMID: 25675150 PMCID: PMC4366894 DOI: 10.1038/bjc.2015.53] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/04/2015] [Accepted: 01/12/2015] [Indexed: 11/29/2022] Open
Abstract
Background: Factors related to early stimulation of the immune system (breastfeeding, proxies for exposure to infectious agents, normal delivery, and exposure to animals in early life) have been suggested to decrease the risk of childhood acute lymphoblastic leukaemia (ALL). Methods: The national registry-based case–control study, ESTELLE, was carried out in France in 2010–2011. Population controls were frequency matched with cases on age and gender. The participation rates were 93% for cases and 86% for controls. Data were obtained from structured telephone questionnaires administered to mothers. Odds ratios (OR) were estimated using unconditional regression models adjusted for age, gender, and potential confounders. Results: In all, 617 ALL and 1225 controls aged ⩾1 year were included. Inverse associations between ALL and early common infections (OR=0.8, 95% confidence interval (CI): 0.6, 1.0), non-first born (⩾3 vs 1; OR=0.7, 95% CI: 0.5, 1.0), attendance of a day-care centre before age 1 year (OR=0.7, 95% CI: 0.5, 1.0), breastfeeding (OR=0.8, 95% CI: 0.7, 1.0), and regular contact with pets (OR=0.8, 95% CI: 0.7, 1.0) in infancy were observed. Conclusions: The results support the hypothesis that conditions promoting the maturation of the immune system in infancy have a protective role with respect to ALL.
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Affiliation(s)
- R Ajrouche
- 1] Epidemiology of childhood and adolescent cancers, CRESS, INSERM U1153, Villejuif, France [2] Paris-Sud University, Le Kremlin Bicêtre, France
| | - J Rudant
- 1] Epidemiology of childhood and adolescent cancers, CRESS, INSERM U1153, Villejuif, France [2] Paris-Descartes University, Paris, France [3] RNHE-National Registry of Childhood Hematopoietic Malignancies, Villejuif, France
| | - L Orsi
- 1] Epidemiology of childhood and adolescent cancers, CRESS, INSERM U1153, Villejuif, France [2] Paris-Descartes University, Paris, France
| | - A Petit
- 1] AP-HP, Hôpital Armand Trousseau, Paris, France [2] Université Paris 6 Pierre et Marie Curie, Paris, France
| | - A Baruchel
- 1] AP-HP, Hôpital Robert Debré, Paris, France [2] Université Paris 7, Paris, France
| | | | - M Gambart
- Hôpital des Enfants, Toulouse, France
| | - G Michel
- AP-HM, Hôpital la Timone, Marseille, France
| | - Y Bertrand
- Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | - S Ducassou
- Hôpital Pellegrin Tripode, Bordeaux, France
| | | | - C Paillard
- Hôpital de Hautepierre, Strasbourg, France
| | - L Saumet
- Hôpital Arnaud de Villeneuve, Montpellier, France
| | - N Blin
- Hôpital Mère-Enfant, CHU-Nantes, Nantes, France
| | - D Hémon
- 1] Epidemiology of childhood and adolescent cancers, CRESS, INSERM U1153, Villejuif, France [2] Paris-Descartes University, Paris, France
| | - J Clavel
- 1] Epidemiology of childhood and adolescent cancers, CRESS, INSERM U1153, Villejuif, France [2] Paris-Descartes University, Paris, France [3] RNHE-National Registry of Childhood Hematopoietic Malignancies, Villejuif, France
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Mezei G, Sudan M, Izraeli S, Kheifets L. Epidemiology of childhood leukemia in the presence and absence of Down syndrome. Cancer Epidemiol 2014; 38:479-89. [DOI: 10.1016/j.canep.2014.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/10/2014] [Accepted: 07/11/2014] [Indexed: 02/05/2023]
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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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van Laar M, Stark DP, McKinney P, Parslow RC, Kinsey SE, Picton SV, Feltbower RG. Population mixing for leukaemia, lymphoma and CNS tumours in teenagers and young adults in England, 1996-2005. BMC Cancer 2014; 14:698. [PMID: 25248916 PMCID: PMC4180542 DOI: 10.1186/1471-2407-14-698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 09/17/2014] [Indexed: 01/12/2023] Open
Abstract
Background Little aetiological epidemiological research has been undertaken for major cancers occurring in teenagers and young adults (TYA). Population mixing, as a possible proxy for infectious exposure, has been well researched for childhood malignancies. We aimed to investigate effects of population mixing in this older age group using an English national cancer dataset. Methods Cases of leukaemia, lymphoma and central nervous system (CNS) tumours amongst 15–24 year olds in England (diagnosed 1996–2005) were included in the study. Data were obtained by ward of diagnosis and linked to 1991 census variables including population mixing (Shannon index); data on person-weighted population density and deprivation (Townsend score) were also used and considered as explanatory variables. Associations between TYA cancer incidence and census variables were investigated using negative binomial regression, and results presented as incidence rate ratios (IRR) with 95% confidence intervals (CI). Results A total of 6251 cases of leukaemia (21%), lymphoma (49%) and CNS tumours (30%) were analysed. Higher levels of population mixing were associated with a significant decrease in the incidence of CNS tumours (IRR = 0.83, 95% CI = 0.75-0.91), accounted for by astrocytomas and ‘other CNS tumours’; however, there was no association with leukaemia or lymphoma. Incidence of CNS tumours and lymphoma was 3% lower in more deprived areas (IRR = 0.97, 95% CI = 0.96-0.99 and IRR = 0.97, 95% CI =0.96-0.98 respectively). Population density was not associated with the incidence of leukaemia, lymphoma or CNS tumours. Conclusions Our results suggest a possible role for environmental risk factors with population correlates in the aetiology of CNS tumours amongst TYAs. Unlike studies of childhood cancer, associations between population mixing and the incidence of leukaemia and lymphoma were not observed.
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Affiliation(s)
| | | | | | | | | | | | - Richard G Feltbower
- Division of Epidemiology and Biostatistics, School of Medicine, Worsley Building, Clarendon Way, University of Leeds, Leeds LS2 9JT, UK.
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The effect of statin therapy on the incidence of infections: a retrospective cohort analysis. Am J Med Sci 2014; 347:211-6. [PMID: 23426088 DOI: 10.1097/maj.0b013e31828318e2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Statins have been postulated to prevent infection through immunomodulatory effects. OBJECTIVES To compare the incidence of infections in statin users to that in nonusers within the same health care system. METHODS This was a retrospective cohort study of patients enrolled as Tricare Prime or Plus in the San Antonio military multimarket. Statin users were patients who received a statin for at least 3 months between October 1, 2004 and September 30, 2005. Nonusers were patients who did not receive a statin within the study period (October 1, 2003-September 30, 2009). Inpatient and outpatient International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes were used to determine the incidence of infections during the follow-up period (October 1, 2005-September 30, 2009) via multivariable regression analysis and time to infection via Cox regression analysis. RESULTS Of 45,247 patients who met the study criteria, 12,981 (29%) were statin users and 32,266 were nonusers. After adjustments for age, gender, Charlson Comorbidity Score, tobacco use, alcohol abuse/dependence, health care utilization and use of specific medication classes, statin use was associated with an increased incidence of common infections (odds ratio [OR]: 1.13; 95% confidence interval [CI]: 1.06-1.19) but not influenza or fungal infections (OR: 1.06, 95% CI: 0.80-1.39; OR: 0.97; 95% CI: 0.91-1.04, respectively). Time-to-first infection was similar in statin users and nonusers in all infection categories examined. CONCLUSIONS Statin use was associated with an increased incidence of common infections but not influenza or fungal infections. This study does not support a protective role of statins in infection prevention; however, the influence of potential confounders cannot be excluded.
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Francis SS, Selvin S, Metayer C, Wallace AD, Crouse V, Moore TB, Wiemels JL, Buffler PA. Mode of Delivery and Risk of Childhood Leukemia. Cancer Epidemiol Biomarkers Prev 2014; 23:876-81. [DOI: 10.1158/1055-9965.epi-13-1098] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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The role of KIR genes and their cognate HLA class I ligands in childhood acute lymphoblastic leukemia. Blood 2014; 123:2497-503. [PMID: 24518758 DOI: 10.1182/blood-2013-11-540625] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Killer cell immunoglobulin-like receptors (KIRs), via interaction with their cognate HLA class I ligands, play a crucial role in the development and activity of natural killer cells. Following recent reports of KIR gene associations in childhood acute lymphoblastic leukemia (ALL), we present a more in-depth investigation of KIR genes and their cognate HLA ligands on childhood ALL risk. Genotyping of 16 KIR genes, along with HLA class I groups C1/C2 and Bw4 supertype ligands, was carried out in 212 childhood ALL cases and 231 healthy controls. Frequencies of KIR genes, KIR haplotypes, and combinations of KIR-HLA ligands were tested for disease association using logistic regression analyses. KIR A/A genotype frequency was significantly increased in cases (33.5%) compared with controls (24.2%) (odds ratio [OR] = 1.57; 95% confidence interval [CI], 1.04-2.39). Stratifying analysis by ethnicity, a significant difference in KIR genotype frequency was demonstrated in Hispanic cases (34.2%) compared with controls (21.9%) (OR = 1.86; 95% CI, 1.05-3.31). Homozygosity for the HLA-Bw4 allele was strongly associated with increased ALL risk exclusively in non-Hispanic white children (OR = 3.93; 95% CI, 1.44-12.64). Our findings suggest a role for KIR genes and their HLA ligands in childhood ALL etiology that may vary among ethnic groups.
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Urayama KY, Thompson PD, Taylor M, Trachtenberg EA, Chokkalingam AP. Genetic variation in the extended major histocompatibility complex and susceptibility to childhood acute lymphoblastic leukemia: a review of the evidence. Front Oncol 2013; 3:300. [PMID: 24377085 PMCID: PMC3859964 DOI: 10.3389/fonc.2013.00300] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 11/26/2013] [Indexed: 11/13/2022] Open
Abstract
The enduring suspicion that infections and immunologic response may play a role in the etiology of childhood leukemia, particularly acute lymphoblastic leukemia (ALL), is now supported, albeit still indirectly, by numerous epidemiological studies. The cumulative evidence includes, for example, descriptive observations of a peculiar peak incidence at age 2–5 years for ALL in economically developed countries, clustering of cases in situations of population mixing associated with unusual patterns of personal contacts, associations with various proxy measures for immune modulatory exposures early in life, and genetic susceptibility conferred by variation in genes involved in the immune system. In this review, our focus is the extended major histocompatibility complex (MHC), an approximately 7.6 Mb region that is well-known for its high-density of expressed genes, extensive polymorphisms exhibiting complex linkage disequilibrium patterns, and its disproportionately large number of immune-related genes, including human leukocyte antigen (HLA). First discovered through the role they play in transplant rejection, the classical HLA class I (HLA-A, -B, and -C) and class II (HLA-DR, HLA-DQ, and HLA-DP) molecules reside at the epicenter of the immune response pathways and are now the targets of many disease susceptibility studies, including those for childhood leukemia. The genes encoding the HLA molecules are only a minority of the over 250 expressed genes in the xMHC, and a growing number of studies are beginning to evaluate other loci through targeted investigations or utilizing a mapping approach with a comprehensive screen of the entire region. Here, we review the current epidemiologic evidence available to date regarding genetic variation contained within this highly unique region of the genome and its relationship with childhood ALL risk.
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Affiliation(s)
- Kevin Y Urayama
- School of Public Health, University of California , Berkeley, CA , USA ; Center for Clinical Epidemiology, St. Luke's Life Science Institute , Tokyo , Japan
| | - Pamela D Thompson
- Cancer Immunogenetics, St. Mary's Hospital, University of Manchester , Manchester , UK
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Hsiao FY, Hsu WWY. Epidemiology of post-transplant malignancy in Asian renal transplant recipients: a population-based study. Int Urol Nephrol 2013; 46:833-8. [PMID: 24009082 DOI: 10.1007/s11255-013-0544-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 08/14/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Using Taiwan's National Health Insurance Research Database, this large population-based study was conducted to explore the incidences and risk factors of post-transplant malignancy in Asian renal transplant recipients. PATIENTS AND METHODS A total of 642 patients who firstly underwent renal transplant between January 1, 2000 and December 31, 2008 were identified from a 2 million cohort. The primary endpoint was a subsequent hospitalization with a primary diagnosis of malignancy (ICD-9-CM code: 140.xx-239.xx) after renal transplantation. All patients were followed until the occurrence of endpoints or the end of the study (December 31, 2010), whichever came first. Adjusted risks of post-transplant cancer were analyzed using Cox proportional hazards regression model. All models were adjusted for baseline characteristics, comorbid diseases, transplant year, and exposure to immunosuppressive agents. RESULTS Among 642 renal transplant patients, 54 cancers (8.4 %) were identified. The median time between transplant and cancer diagnosis was 46.2 (range 8.5-107.4) months. Cancers of kidney and other unspecified urinary organs was the most common cancer sites, accounted for 18.5 % of the malignancies diagnosed. The next most common cancer sites were trachea, bronchus, and lung (14.8 %), bladder (13.0 %), liver and intrahepatic bile ducts (11.1 %), colon (5.6 %), and prostate (5.6 %). Age at transplantation was a statistically significant risk factor of post-transplant cancer in our study. Increased risks of post-transplant cancer were observed in patients who received immunosuppression agents (cyclosporine (HR 1.26, 95 % CI 0.58-2.77, p = 0.5603), tacrolimus (HR 1.99, 95 % CI 0.66-6.00, p = 0.2197), and mycophenolate (HR 1.00, 95 % CI 0.40-2.45, p = 0.9874)) although the estimates were not statistically significant. CONCLUSIONS Our population-based cohort study offers additional insight into post-transplant cancers in Asian population. Further studies are warranted to assess the association between specific immunosuppression agents and post-transplant cancers.
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Affiliation(s)
- F Y Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, 1 Jen-Ai Road, Section 1, Taipei, 10051, Taiwan,
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Urayama KY, Chokkalingam AP, Metayer C, Hansen H, May S, Ramsay P, Wiemels JL, Wiencke JK, Trachtenberg E, Thompson P, Ishida Y, Brennan P, Jolly KW, Termuhlen AM, Taylor M, Barcellos LF, Buffler PA. SNP association mapping across the extended major histocompatibility complex and risk of B-cell precursor acute lymphoblastic leukemia in children. PLoS One 2013; 8:e72557. [PMID: 23991122 PMCID: PMC3749982 DOI: 10.1371/journal.pone.0072557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 07/12/2013] [Indexed: 02/01/2023] Open
Abstract
The extended major histocompatibility complex (xMHC) is the most gene-dense region of the genome and harbors a disproportionately large number of genes involved in immune function. The postulated role of infection in the causation of childhood B-cell precursor acute lymphoblastic leukemia (BCP-ALL) suggests that the xMHC may make an important contribution to the risk of this disease. We conducted association mapping across an approximately 4 megabase region of the xMHC using a validated panel of single nucleotide polymorphisms (SNPs) in childhood BCP-ALL cases (n=567) enrolled in the Northern California Childhood Leukemia Study (NCCLS) compared with population controls (n=892). Logistic regression analyses of 1,145 SNPs, adjusted for age, sex, and Hispanic ethnicity indicated potential associations between several SNPs and childhood BCP-ALL. After accounting for multiple comparisons, one of these included a statistically significant increased risk associated with rs9296068 (OR=1.40, 95% CI=1.19-1.66, corrected p=0.036), located in proximity to HLA-DOA. Sliding window haplotype analysis identified an additional locus located in the extended class I region in proximity to TRIM27 tagged by a haplotype comprising rs1237485, rs3118361, and rs2032502 (corrected global p=0.046). Our findings suggest that susceptibility to childhood BCP-ALL is influenced by genetic variation within the xMHC and indicate at least two important regions for future evaluation.
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Affiliation(s)
- Kevin Y Urayama
- School of Public Health, University of California, Berkeley, Berkeley, California, USA.
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Hsiao FY, Hsieh PH, Huang WF, Tsai YW, Gau CS. Risk of Bladder Cancer in Diabetic Patients Treated with Rosiglitazone or Pioglitazone: A Nested Case–Control Study. Drug Saf 2013; 36:643-9. [DOI: 10.1007/s40264-013-0080-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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