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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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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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Musolino C, Allegra A, Minciullo PL, Gangemi S. Allergy and risk of hematologic malignancies: associations and mechanisms. Leuk Res 2014; 38:1137-44. [PMID: 25171954 DOI: 10.1016/j.leukres.2014.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 08/02/2014] [Accepted: 08/04/2014] [Indexed: 12/12/2022]
Abstract
Increasing evidence indicates that a dysregulated immune system, as the one found in allergic disorders, can affect survival of tumor cells. A possible association between allergies and risk of hematologic malignancies has been examined in several epidemiological studies; however, results were not always consistent. The aim of this review is to report the preclinical and clinical data, which support a correlation between allergy and hematologic neoplasms. Immune system modulation could represent a powerful tool in the prevention and treatment of hematologic malignancies.
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Affiliation(s)
- C Musolino
- Division of Hematology, Department of General Surgery and Oncology, University of Messina, Messina, Italy
| | - A Allegra
- Division of Hematology, Department of General Surgery and Oncology, University of Messina, Messina, Italy.
| | - P L Minciullo
- School and Division of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University Hospital "G. Martino", Messina, Italy
| | - S Gangemi
- School and Division of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University Hospital "G. Martino", Messina, Italy; Institute of Clinical Physiology, IFC CNR, Messina Unit, Messina, Italy
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Sidaway GH. Powerline bioactivity - more than magnetism. SPRINGERPLUS 2013; 2:454. [PMID: 24058895 PMCID: PMC3777017 DOI: 10.1186/2193-1801-2-454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 07/29/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Previous work on the possible public health impact of electricity utilization has mostly considered low frequency electromagnetic fields, particularly those associated with high voltage overhead powerlines, but no generally accepted biological mechanism has been proposed. The present study seeks to expand the area of debate to include airborne electroactivity. FINDINGS From a literature survey it is concluded that there is statistically significant published evidence consistent with the involvement of airborne electroactive agents in the powerline proximity modulation of some cytokine activity. Attention is drawn to overhead line fault associated corona discharge action as a source of potentially bioactive agents deserving careful study in view of the widespread close residential proximity to overhead power distribution lines in many countries. Particular attention is given to the role of electricity access associated faults as a possible explanation for the high childhood leukaemia rates in certain districts of Mexico City. CONCLUSIONS Despite more than 30 years research worldwide there is no generally accepted biological mechanism to explain the adverse health impact of overhead powerline residential proximity. Expanding the area of consideration to include airborne electroactivity may provide the basis for a plausible outline model of such a mechanism. More attention should be given to this research area.
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Lariou MS, Dikalioti SK, Dessypris N, Baka M, Polychronopoulou S, Athanasiadou-Piperopoulou F, Kalmanti M, Fragandrea I, Moschovi M, Germenis AE, Petridou ET. Allergy and risk of acute lymphoblastic leukemia among children: A nationwide case control study in Greece. Cancer Epidemiol 2013. [PMID: 23182223 DOI: 10.1016/j.canep.2012.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Chang JS, Tsai YW, Tsai CR, Wiemels JL. Allergy and risk of childhood acute lymphoblastic leukemia: a population-based and record-based study. Am J Epidemiol 2012; 176:970-8. [PMID: 23171876 DOI: 10.1093/aje/kws263] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A deficit of normal immune stimulation in early childhood is a suspected risk factor for both childhood acute lymphoblastic leukemia (ALL) and allergies. The present study utilized a population-based case-control design using medical claims data from the National Health Insurance Research Database of Taiwan to evaluate the association between allergy and childhood leukemia. Eight hundred forty-six childhood ALL patients who were newly diagnosed during 2000 to 2008 and were older than 1 but less than 10 years of age were individually matched with 3,374 controls based on sex, birth date, and time of diagnosis (reference date for the controls). Conditional logistic regression was performed to assess the association between childhood ALL and allergies. An increased risk of ALL was observed with having an allergy less than 1 year before the case's ALL diagnosis (odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.5, 2.0), more than 1 year before the case's diagnosis (OR = 1.3, 95% CI: 1.1, 1.5), and before the age of 1 year (OR = 1.4, 95% CI: 1.1, 1.7). These results suggest that the pathogenesis of childhood ALL and allergy share a common biologic mechanism.
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Affiliation(s)
- Jeffrey S Chang
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan.
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Linabery AM, Spector LG. Invited commentary: childhood acute lymphoblastic leukemia and allergies: biology or bias? Am J Epidemiol 2012; 176:979-83; discussion 984-5. [PMID: 23171875 DOI: 10.1093/aje/kws265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Previous epidemiologic studies have shown an inverse association between a personal history of atopy/allergies, both overall and among asthma, eczema, and hay fever investigated separately, and childhood acute lymphoblastic leukemia (ALL) with some consistency; however, in most of these studies, exposure data were collected by maternal interview. Now, in a population-based and records-based study in this issue of the Journal (Am J Epidemiol. 2012;176(11):970-978), Chang et al. report an increased risk for allergic conditions across different etiologic time periods, calling the former paradigm into doubt. A review of the basic biology literature shows that proposed mechanisms support either a positive or an inverse association. In light of this ambiguity, it is epidemiology's turn to determine the direction of association.
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Affiliation(s)
- Amy M Linabery
- Division of Pediatric Epidemiologyand Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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Chang JS, Tsai YW, Tsai CR, Wiemels JL. Chang et al. Respond to "Allergies and ALL: Biology or Bias?". Am J Epidemiol 2012. [DOI: 10.1093/aje/kws262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chang JS, Zhou M, Buffler PA, Chokkalingam AP, Metayer C, Wiemels JL. Profound deficit of IL10 at birth in children who develop childhood acute lymphoblastic leukemia. Cancer Epidemiol Biomarkers Prev 2011; 20:1736-40. [PMID: 21653647 DOI: 10.1158/1055-9965.epi-11-0162] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Childhood acute lymphoblastic leukemia (ALL) may originate via abnormal immune responses to infectious agents. It is unknown whether prenatal immune development may differ in children who develop the disease. The current study examines the association between neonatal cytokine profiles, a proxy measure for a child's prenatal immune development, and childhood ALL. METHODS Neonatal blood spots of 116 childhood ALL cases and 116 controls living in California were ascertained. Eleven cytokines associated with Th1, Th2, and Th17 lymphocytes were measured using a multiplex bead-based assay. Unconditional logistic regression was done to estimate the odds ratio (OR) by measuring the association between neonatal cytokines and ALL adjusted for age, sex, race/ethnicity, and household income. RESULTS Of the 11 cytokines measured, 5 [interleukin (IL)4, IL6, IL10, IL12, and IL13] were detectable. Except for IL12, the other 4 cytokines were all significantly lower among cases than controls. In a multivariable model including the 5 cytokines, only IL10 remained independently associated with childhood ALL with an OR = 0.04, 95% CI: 0.01 to 0.18, comparing the highest tertile to the lowest tertile. CONCLUSIONS A child's neonatal level of IL10, a key regulator for modulating the intensity and duration of immune responses, is associated with his/her subsequent risk of developing ALL. IMPACT The current analysis shows that children with ALL may have a dysregulated immune function present at birth.
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Affiliation(s)
- Jeffrey S Chang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94143-0520, USA.
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Metwally NS, Ali SA, Mohamed AM, Khaled HM, Ahmed SA. Levels of certain tumor markers as differential factors between bilharzial and non-biharzial bladder cancer among Egyptian patients. Cancer Cell Int 2011; 11:8. [PMID: 21473769 PMCID: PMC3097143 DOI: 10.1186/1475-2867-11-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 04/07/2011] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND/OBJECTIVE Bladder cancer is the commonest type of malignant tumors as a result of schistosomaisis which is a major healthy problem in many subtropical developing countries. The aim of this study is to comparatively elucidate the underlying biochemical tumor markers in schistosomal bladder cancer versus non-schistosomal bladder cancer when compared to normal healthy ones. METHODS This work was performed on tissue specimens from total 25 patients and serum samples from total 30 patients versus ten healthy individuals served as control. The investigated parameters in serum are: xanthine oxidase (XO), fructosamine, lactate dehydrogense (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), total proteins, essential and non- essential amino acids profile, hydroxyproline, total immunoglobulin E (IgE) and tumor necrosis factor alpha (TNF-α). In addition, the current investigation also extended to study some markers in tumor bladder tissues including, pyruvate kinase enzyme (PK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST) and alanine aminotransferase (ALT). RESULTS Results showed that biharzial bladder cancer patients recored more significant elevation in serum XO, fructosamine, LDH, AST, ALT, hydroxyproline, IgE and TNF-α than in bladder cancer patients when compared to control ones. While, in tissues there were significant increase in PK, LDH, AST & ALT activities of schistosomal bladder cancer than in bladder cancer as compared to control healthy patients. CONCLUSIONS It could be concluded that, bilharzial and non-bilharzial bladder cancer showed distinct biochemical profile of tumor development and progression which can be taken into consideration in diagnosis of bladder cancer.
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Affiliation(s)
- Nadia S Metwally
- Theraputic Chemistry Department, National Research Center, Dokki, Egypt
| | - Sanaa A Ali
- Theraputic Chemistry Department, National Research Center, Dokki, Egypt
| | - Azza M Mohamed
- Theraputic Chemistry Department, National Research Center, Dokki, Egypt
| | | | - Samia A Ahmed
- Theraputic Chemistry Department, National Research Center, Dokki, Egypt
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