A systematic review and meta-analysis of the association between childhood infections and the risk of childhood acute lymphoblastic leukaemia

Hwee, Jeremiah; Tait, Christopher; Sung, Lillian; Kwong, Jeffrey C.; Sutradhar, Rinku; Pole, Jason D.

doi:10.1038/bjc.2017.360

Cited by 18 publications

(17 citation statements)

References 87 publications

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“…These infections were chosen a priori based on the knowledge gained from a systematic review and meta-analysis of common infections in children and the association with the development of childhood acute lymphoblastic leukemia. [ 15 ] We thought these infections would account for the majority of infection-related physician visits. We hierarchically defined each visit to assess whether the visit was for an infection, the corresponding anatomical region, and the specific infectious syndrome.…”

Section: Methodsmentioning

confidence: 99%

Use of physician billing claims to identify infections in children

et al. 2018

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While medical records have detailed information, they are limited in reach to the availability and accessibility of those records. On the other hand, administrative data while limited in scope, have a much further reach in coverage of an entire population. However, few studies have validated the use of administrative data for identifying infections in pediatric populations. Pediatric patients from Ontario, Canada aged <18 years were randomly sampled from the Electronic Medical Record Administrative data Linked Database (EMRALD). Using physician diagnoses from the electronic medical record (EMR) as the reference standard, we determined the criterion validity of physician billing claims in administrative data for identifying infectious disease syndromes from 2012 to 2014. Diagnosis codes were assessed by infection category (respiratory, skin and soft tissue, gastrointestinal, urinary tract and otitis externa) and for all infections combined. Sensitivity analyses assessed the performance if patients had more than one reason to visit the physician. We analysed 2,139 patients and found 33.3% of all visits were for an infection, and respiratory infections accounted for 67.6% of the infections. When we combined all infection categories, sensitivity was 0.74 (95% CI 0.70–0.77), specificity was 0.95 (95% CI 0.93–0.96), positive predictive value (PPV) was 0.87 (95% CI 0.84–0.90), and negative predictive value (NPV) was 0.88 (95% CI 0.86–0.89). For respiratory infections, sensitivity was 0.77 (95% CI 0.73–0.81), specificity was 0.96 (95% CI 0.95–0.97), PPV was 0.85 (95% CI 0.81–0.88), and NPV was 0.94 (95% CI 0.92–0.95). Similar performance was observed for skin and soft tissue, gastrointestinal, urinary tract, and otitis externa infections, but with lower sensitivity. Performance measures were highest when the patient visited the physician with only one health complaint. We found when using linked EMR data as the reference standard, administrative billing codes are reasonably accurate in identifying infections in a pediatric population.

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Section: Methodsmentioning

confidence: 99%

Use of physician billing claims to identify infections in children

et al. 2018

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“…A number of risk factors display significant associations with B-ALL, but not T-ALL, as shown in Fig. 2A-D and Supplementary Table S1, including home paint exposure prior to conception, during pregnancy, and after birth (72), preconception paternal smoking (107), older paternal age (105), prelabor caesarean delivery (84), increasing birth weight (98,108), increasing birth order (98), being breast fed (109), infections during childhood (89,110), and daycare attendance (91,(111)(112)(113).…”

Section: Risk Of All By Immunophenotypementioning

confidence: 99%

Is There Etiologic Heterogeneity between Subtypes of Childhood Acute Lymphoblastic Leukemia? A Review of Variation in Risk by Subtype

Williams

Yang

Hirsch

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Although substantial advances in the identification of cytogenomic subtypes of childhood acute lymphoblastic leukemia (ALL) have been made in recent decades, epidemiologic research characterizing the etiologic heterogeneity of ALL by subtype has not kept pace. The purpose of this review is to summarize the current literature concerning subtype-specific epidemiologic risk factor associations with ALL subtype defined by immunophenotype (e.g., B-cell vs. T-cell) and cytogenomics (including gross chromosomal events characterized by recurring numerical and structural abnormalities, along with cryptic balanced rearrangements, and focal gene deletions). In case-control analyses investigating nongenetic risk factors, home paint exposure is associated with hyperdi-ploid, MLL-rearranged, and ETV6-RUNX1 subtypes, yet there are few differences in risk factor associations between T-and B-ALL. Although the association between maternal smoking and ALL overall has been null, maternal smoking is associated with an increasing number of gene deletions among cases. GWAS-identified variants in ARID5B have been the most extensively studied and are strongly associated with hyperdiploid B-ALL. GATA3 single nucleotide variant rs3824662 shows a strong association with Ph-like ALL (OR ¼ 3.14). However, there have been relatively few population-based studies of adequate sample size to uncover risk factors that may define etiologic heterogeneity between and within the currently defined cytogenomic ALL subtypes.

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“…Some studies indicate that early immune stimulation (e.g., via exposure to infection) may be protective against ALL (Rudant et al 2015;Hwee et al 2018). Using data pooled across 11 studies from the Childhood Leukemia International Consortium, Rudant et al (2015) reported a 23% reduction in risk of ALL among children who attended day care (a proxy for immune stimulation) in the first year of life, with a trend for lower risks at younger start dates.…”

Section: Pediatric Leukemiasmentioning

confidence: 99%

“…Importantly, not all studies support an infectious etiology of ALL. Designing epidemiologic studies to evaluate these hypotheses is challenging-for example, prospective studies are unfeasible due to the rarity of ALL, and factors like recall bias and temporal ambiguity threaten the validity of retrospective studies (Hwee et al 2018).…”

Section: Pediatric Leukemiasmentioning

confidence: 99%

Epidemiology and Etiology of Leukemia and Lymphoma

Bispo

Pinheiro

Kobetz

2019

Cold Spring Harb Perspect Med

175

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Available evidence suggests that the incidence of leukemia and lymphoma tends to be higher in highly developed regions of the world and among Whites in the United States. Temporal trends in incidence are dynamic and multifactorial; for instance, the incidence of non-Hodgkin's lymphoma increased around the turn of the century, in part because of the acquired immune deficiency syndrome (AIDS) epidemic. Most leukemias and lymphomas are sporadic and the specific etiology remains elusive. Still, research shows that these malignancies often develop in the context of genetic abnormalities, immunosuppression, and exposure to risk factors like ionizing radiation, carcinogenic chemicals, and oncogenic viruses. The prognosis varies by subtype, with poorer survival outcomes for acute leukemias among adults, and more favorable outcomes for Hodgkin's lymphoma. At a time when specific prevention efforts targeting these malignancies are nonexistent, there is a great need to ensure equitable access to diagnostic services and treatments worldwide.

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A systematic review and meta-analysis of the association between childhood infections and the risk of childhood acute lymphoblastic leukaemia

Cited by 18 publications

References 87 publications

Use of physician billing claims to identify infections in children

Use of physician billing claims to identify infections in children

Is There Etiologic Heterogeneity between Subtypes of Childhood Acute Lymphoblastic Leukemia? A Review of Variation in Risk by Subtype

Epidemiology and Etiology of Leukemia and Lymphoma

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