Abstract
Infectious etiologies have been hypothesized for acute leukemias because of their high incidence in early childhood, but have seldom been examined for acute myeloid leukemia (AML). We conducted the first large cohort study to examine perinatal factors including season of birth, a proxy for perinatal infectious exposures, and risk of AML in childhood through young adulthood. A national cohort of 3,569,333 persons without Down syndrome who were born in Sweden in 1973–2008 were followed up for AML incidence through 2010 (maximum age 38 years). There were 315 AML cases in 69.7 million person-years of follow-up. We found a sinusoidal pattern in AML risk by season of birth (P < 0.001), with peak risk among persons born in winter. Relative to persons born in summer (June–August), incidence rate ratios for AML were 1.72 (95 % CI 1.25–2.38; P = 0.001) for winter (December–February), 1.37 (95 % CI 0.99–1.90; P = 0.06) for spring (March–May), and 1.27 (95 % CI 0.90–1.80; P = 0.17) for fall (September–November). Other risk factors for AML included high fetal growth, high gestational age at birth, and low maternal education level. These findings did not vary by sex or age at diagnosis. Sex, birth order, parental age, and parental country of birth were not associated with AML. In this large cohort study, birth in winter was associated with increased risk of AML in childhood through young adulthood, possibly related to immunologic effects of early infectious exposures compared with summer birth. These findings warrant further investigation of the role of seasonally varying perinatal exposures in the etiology of AML.
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Abbreviations
- ALL:
-
Acute lymphoblastic leukemia
- AML:
-
Acute myeloid leukemia
- CI:
-
Confidence interval
- DOB:
-
Date of birth
- ICD:
-
International classification of diseases
- IRR:
-
Incidence rate ratio
- SD:
-
Standard deviation
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Acknowledgments
This work was supported by the National Cancer Institute at the National Institutes of Health [grant number R03 CA171017]; the Swedish Research Council; and ALF project grant, Region Skåne/Lund University, Sweden. The funding agencies had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. There were no conflicts of interest.
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Crump, C., Sundquist, J., Sieh, W. et al. Perinatal risk factors for acute myeloid leukemia. Eur J Epidemiol 30, 1277–1285 (2015). https://doi.org/10.1007/s10654-015-0063-0
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DOI: https://doi.org/10.1007/s10654-015-0063-0