Childhood Leukemia and Infectious Diseases in the First Year of Life: A Register-Based Case-Control Study

Steensel-Moll, H A van; Valkenburg, H. A.; Zanen, G E van

doi:10.1093/oxfordjournals.aje.a114431

Cited by 94 publications

(73 citation statements)

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“…Our finding of around a two-fold greater risk of childhood ALL among children born into surroundings where there is little overcrowding supports the hypothesis that childhood ALL is caused by an inappropriate immunological response to a common infection or infections in children whose immune systems are not 'programmed' by early exposure to these infections (Greaves and Alexander, 1993;Greaves, 1997). In support of this hypothesis, several studies have reported that early exposure to infection (van Steensel-Moll et al, 1986;Kaatsch et al, 1996;McKinney et al, 1999) is associated with a reduced risk of childhood ALL. However, contrary to what may be expected if this hypothesis is correct, we and several other investigators (Shaw et al, 1984;Shu et al, 1988;Kaye et al, 1991;McKinney et al, 1999;Schuz et al, 1999;Rosenbaum et al, 2000) did not find that later-born infants had a lower risk of ALL than first-born infants.…”

Section: Socioeconomic Status and Household Densitysupporting

confidence: 80%

Association of early life factors and acute lymphoblastic leukaemia in childhood: historical cohort study

et al. 2002

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In a historical cohort study of all singleton live births in Northern Ireland from 1971 -86 (n=434 933) associations between early life factors and childhood acute lymphoblastic leukaemia were investigated. Multivariable analyses showed a positive association between high paternal age (535 years) and acute lymphoblastic leukaemia (relative risk=1.49; 95% confidence interval (CI)=0.96 -2.31) but no association with maternal age. High birth weight (53500 g) was positively associated with acute lymphoblastic leukaemia (relative risk=1.66; 95% CI=1.18 -2.33). Children of mothers with a previous miscarriage or increased gestation (540 weeks) had reduced risks of ALL (respective relative risks=0.49; 95% CI=0.29 -0.80, and 0.67; 95% CI=0.48 -0.94). Children born into more crowded households (51 person per room) had substantially lower risks than children born into less crowded homes with also some evidence of a lower risk for children born into homes with three adults (relative risks=0.56; 95% CI=0.35 -0.91 and 0.58; 95% CI=0.21 -1.61 respectively). These findings indicate that several early life factors, including living conditions in childhood and maternal miscarriage history, influence risk of acute lymphoblastic leukaemia in childhood.

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Section: Socioeconomic Status and Household Densitysupporting

confidence: 80%

Association of early life factors and acute lymphoblastic leukaemia in childhood: historical cohort study

et al. 2002

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“…However, a number of investigations have addressed the role of early common infections in the aetiology of leukaemia in children without DS, particularly ALL. While a few studies have observed either positive or null associations between acute leukaemia and early common infections, (Dockerty et al, 1999;Schuz et al, 1999;Naumburg et al, 2002), most investigations have reported negative associations (van Steensel-Moll et al, 1986;McKinney et al, 1999;Schuz et al, 1999;Neglia et al, 2000;Perrillat et al, 2002;JourdanDa Silva et al, 2004) Van Steensel-Moll et al observed a significant negative association between ALL and common colds in the first year of life (van Steensel-Moll et al, 1986). Neglia et al observed a significant trend towards reduction in the risk of ALL with increasing frequency of ear infections in the first year of life and Perrillat et al reported a negative association between risk of ALL and a history of four or more ear infections in the first two years of life (Neglia et al, 2000;Perrillat et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

“…Greaves hypothesised that exposure to common infections in early childhood may protect the child against ALL by contributing to normal maturation of the immune system, whereas children whose exposure is delayed will be at comparatively higher risk (Greaves, 1988(Greaves, , 1997Greaves and Alexander, 1993). Some studies have supported the possible role of delayed infection in the aetiology of childhood leukaemia (van Steensel-Moll et al, 1986;McKinney et al, 1999;Schuz et al, 1999;Neglia et al, 2000). However, results have been inconsistent, potentially due to the heterogeneity of childhood leukaemia and insufficient study power to test the hypothesis within leukaemia subgroups (Ross, 1999;Jourdan-Da Silva et al, 2004).…”

mentioning

confidence: 99%

Childhood and maternal infections and risk of acute leukaemia in children with Down syndrome: a report from the Children's Oncology Group

et al. 2004

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Children with Down syndrome (DS) are highly susceptible to acute leukaemia. Given the potential role of infections in the aetiology of leukaemia in children without DS, we investigated whether there was an association between early-life infections and acute leukaemia in children with DS. Maternal infections during pregnancy were also examined. We enrolled 158 incident cases of acute leukaemia in children with DS (97 acute lymphoblastic leukaemia (ALL) and 61 acute myeloid leukaemia (AML)) diagnosed at Children's Oncology Group institutions between 1997 and 2002. DS controls (N ¼ 173) were selected from the cases' primary care clinics and frequency matched on age at leukaemia diagnosis. Data were collected on demographics, child's medical history, mother's medical history, and other factors by maternal interview. Analyses were conducted using unconditional logistic regression adjusted for potential confounders. A significant negative association was observed between acute leukaemia and any infection in the first 2 years of life (adjusted odds ratio (OR) ¼ 0.55, 95% confidence interval (CI) (0.33 -0.92); OR ¼ 0.53, 95% CI (0.29 -0.97); and OR ¼ 0.59, 95% CI (0.28 -1.25) for acute leukaemia combined, ALL, and AML respectively). The association between acute leukaemia and maternal infections during pregnancy was in the same direction but not significant. This study offers support for the hypothesis that early-life infections may play a protective role in the aetiology of acute leukaemia in children with DS.

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“…Other epidemiological data provide persuasive, although indirect, evidence to support the hypothesis (Greaves and Alexander, 1993;Greaves, 1997) that delayed first exposure to an unknown infectious agent (or agents) may cause ALL at the childhood peak ages. The evidence includes the evolution of the peak as societies 'modernize', and increased risk for children likely to have been protected from early infection relative to their peers -with increases in firstborn children (Fraumeni and Miller, 1967), those substantially younger than their siblings (Kaye et al, 1991), those living in isolated areas (Alexander et al, 1990), and decreases in those hospitalized for infectious disease as infants (van Steensel-Moll et al, 1986) and those attending preschool groups as infants (Petridou et al, 1993). Series Al was chosen to address the above hypothesis.…”

Section: Discussionmentioning

confidence: 99%

Spatial temporal patterns in childhood leukaemia: further evidence for an infectious origin

Alexander

Boyle²,

Carli³

et al. 1998

Br J Cancer

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Summary The EUROCLUS project included information on residence at diagnosis for 13 351 cases of childhood leukaemia diagnosed in the period 1980-89 in defined geographical regions in 17 countries. A formal algorithm permits identification of small census areas as containing case excesses. The present analysis examines spatial-temporal patterns of the cases (n = 970) within these clustered areas. The objectives were, first, to compare these results with those from an analysis conducted for UK data for the period 1966-83, and, second, to extend them to consider infant leukaemias. A modification of the Knox test investigates, within the small areas, temporal overlap between cases in a subgroup of interest at a putative critical time and all other cases at any time between birth and diagnosis. Critical times were specified in advance as follows: for cases of acute lymphoblastic leukaemia aged 2-4 years, the 18-month period preceding diagnosis; for cases of total leukaemia aged 5-14 years, 1 year before to 1 year after birth; and for infant cases (diagnosed < 1 year), 1 year before to 6 months after birth. Each of the analyses found evidence of excess space-time overlap compared with that expected; these were 10% (P = 0.005), 15% (P = 0.0002) and 26% (P = 0.03) respectively. The results are interpreted in terms of an infectious origin of childhood leukaemia.Keywords: infection; childhood leukaemia; acute lymphoblastic leukaemia; delayed exposure; infant leukaemia; in utero exposure; cluster Leukaemia is the most frequent childhood malignancy (Parkin et al, 1988), but the cause of the majority of cases remains unknown (Doll, 1989). Reports of clusters of leukaemia, usually involving children, have been frequent throughout this century (Alexander, 1993), but their aetiological significance remains obscure. The EUROCLUS project was established to investigate the geographical pattern of the disease using specialist registry data from a wide spectrum of European countries, and also from Queensland, Australia. The primary objective was to determine whether the disease showed a general tendency to cluster within small areas. The results (Alexander et al, 1998) show statistically significant evidence of clustering, although the magnitude is small. The only previous investigation of spatial clustering of childhood leukaemia (CL) in a large dataset was conducted in the UK (Draper, 1990 (1993) and Kinlen (1995). A second objective of EUROCLUS was to test these hypotheses and make comparisons with the results of the UK analysis (Alexander, 1992). Specific subgroups of interest are (a) cases of acute lymphoblastic leukaemia (ALL) in the childhood peak, and (b) cases of CL aged 5-14 years. Critical times, specified in advance are for (a) the 18-month period preceding diagnosis, and for (b), 1 year before to 1 year after birth.A third subgroup of interest that had not been included in the UK analysis is infant leukaemia (diagnosed < 1 year or < 18 months), which has recently emerged as an interesting biological entity as a large...

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Childhood Leukemia and Infectious Diseases in the First Year of Life: A Register-Based Case-Control Study

Cited by 94 publications

References 0 publications

Association of early life factors and acute lymphoblastic leukaemia in childhood: historical cohort study

Association of early life factors and acute lymphoblastic leukaemia in childhood: historical cohort study

Childhood and maternal infections and risk of acute leukaemia in children with Down syndrome: a report from the Children's Oncology Group

Spatial temporal patterns in childhood leukaemia: further evidence for an infectious origin

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