American Journal of Epidemiology Advance Access originally published online on December 20, 2006
American Journal of Epidemiology 2007 165(5):496-504; doi:10.1093/aje/kwk039
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ORIGINAL CONTRIBUTIONS |
Childhood Acute Lymphoblastic Leukemia and Infections in the First Year of Life: A Report from the United Kingdom Childhood Cancer Study
1 Epidemiology and Genetics Unit, Department of Health Sciences, University of York, York, United Kingdom
2 Department of Paediatric and Adolescent Oncology and Haematology, St. James University Hospital, Leeds, United Kingdom
3 Paediatric Haematology/Oncology, John Radcliffe Hospital, Oxford, United Kingdom
4 Information and Services Division, National Health Service in Scotland, Edinburgh, United Kingdom
5 Paediatric Epidemiology Group, University of Leeds, Leeds, United Kingdom
6 CRUK Paediatric and Familial Cancer Research Group, Royal Manchester Children's Hospital, Manchester, United Kingdom
7 Institute of Cancer Research, Chester Beatty Laboratories, London, United Kingdom
8 Young Adult Cancer Trust, Christie Hospital NHS Trust, Manchester, United Kingdom
Correspondence to Prof. Eve Roman, Epidemiology and Genetics Unit, Department of Health Sciences, University of York, YO10 5DD York, United Kingdom (e-mail: eve.roman{at}egu.york.ac.uk).
Received for publication March 28, 2006. Accepted for publication July 26, 2006.
The United Kingdom Childhood Cancer Study was designed to examine the relation between childhood cancer and preceding exposure to infectious diseases. The authors analyzed the relation between diagnosis (1991–1996) of acute lymphoblastic leukemia (ALL) at ages 2–5 years and clinically diagnosed infections in infancy. Almost all study children (96% of both cases and controls) were taken to a general practitioner for a non-immunization-associated visit at least once before their first birthday. Children diagnosed with ALL had significantly more clinically diagnosed infectious episodes in infancy than did controls; the average number of episodes was 3.6 (95% confidence interval (CI): 3.3, 3.9) versus 3.1 (95% CI: 2.9, 3.2). This case-control difference was most apparent in the neonatal period (
1 month); 18% of controls and 24% of ALL cases were diagnosed with at least one infection (odds ratio = 1.4, 95% CI: 1.1, 1.9; p < 0.05). Cases who had more than one neonatal infectious episode tended to be diagnosed with ALL at a comparatively young age; the mean age at ALL diagnosis was 37.7 months for cases with two or more episodes versus 45.3 months for cases with only one episode or none (p < 0.01). These findings support the hypothesis that a dysregulated immune response to infection in the first few months of life promotes transition to overt ALL later in childhood.
child; infection; leukemia, lymphocytic, acute
Abbreviations: ALL, acute lymphoblastic leukemia; CI, confidence interval; OR, odds ratio; UKCCS, United Kingdom Childhood Cancer Study
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