Prior medical conditions and the risk of adult leukemia in Shanghai, People's Republic of China

Abstract

A population-based case-control interview study of 486 adult leukemia cases and 502 healthy controls was carried out in Shanghai, People's Republic of China during 1987-89 to evaluate the etiologic role of prior medical conditions, medications, and diagnostic X-rays. Risks were examined separately for 236 cases with acute non-lymphocytic leukemia (ANLL), 79 with chronic myeloid leukemia (CML), 81 with acute lymphocytic leukemia (ALL), and 21 with chronic lymphocytic leukemia (CLL). Little difference was found between cases and controls for prior history of diabetes, hypertension, allergic conditions, most medications, and diagnostic X-rays. A few significant associations were observed for appendectomy, tuberculosis, and for several other chronic disorders with specific leukemia cell types, but the odds ratio estimates for most of these ranged from two to three and, with the exception of the two specified above, were based generally on five or fewer exposed controls. In contrast to an association with childhood leukemia in Shanghai, prior use of chloramphenicol was not linked with ANLL or other forms of adult leukemia. Further research is needed to clarify the relation of specific medical conditions and exposures with particular subtypes of leukemia, and to examine reasons for the low incidence of CLL in China and other Asian populations.

Chronic Immune Stimulation Might Act As a Trigger for the Development of Acute Myeloid Leukemia or Myelodysplastic Syndromes

“…There are little data in the literature on the role of infections in the etiology of AML. 12,13 In review articles, the general conclusion is that there is either no association or that there are insufficient data. 21,22 The mechanisms for an increased risk for AML and MDS among patients with a previous infection are not clear but may involve an underlying immune dysfunction that could also predispose to AML/MDS.…”

“…12 Furthermore, in a study with results that were based on 236 patients, a significantly increased risk for AML was observed in patients with previous tuberculosis, whereas various other types of infections and chronic conditions were not associated with an excess risk. 13 …”

Association of childhood leukaemia with factors related to the immune system

“…Possibly the resection of lymphatic tissue and the resulting hampering of the immune system might be a potential aetiological mechanism, but also the resection as a consequence of prior susceptibility to infectious diseases should be considered as an indicator of a biological link. Zheng et al (1993) reported an association between appendectomy, tonsillectomy and adult leukaemia. If the inverse association between allergies of the child and acute leukaemia, also observed by Nishi and Miyake (1989) and Petridou et al (1997), is not due to reporting bias, the protective effect of allergies could be interpreted as a proxy for a well-functioning, even overreacting immune system.…”

Genetic and immune-related factors in the pathogenesis of lymphoproliferative and plasma cell malignancies

“…[60][61][62][63][64] Recent large population-based investigations from Scandinavia support the hypothesis that common infectious agents such as encapsulated bacteria 65 might play a role in the pathogenesis of CLL, while auto-antigens Table 2. Relative risk (odds ratio, OR and 95% confidence interval, 95% CI) for lymphoproliferative and plasma cell tumors in relation to a personal history of selected autoimmune diseases.…”