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Perinatal and Familial Risk Factors for Acute Lymphoblastic Leukemia in a Swedish National Cohort

Crump, Casey; Sundquist, Jan LU ; Sieh, Weiva; Winkleby, Marilyn A. and Sundquist, Kristina LU (2015) In Cancer 121(7). p.1040-1047
Abstract
BACKGROUNDPerinatal factors including high birth weight have been found to be associated with acute lymphoblastic leukemia (ALL) in case-control studies. However, to the best of our knowledge, these findings have seldom been examined in large population-based cohort studies, and the specific contributions of gestational age and fetal growth remain unknown. METHODSThe authors conducted a national cohort study of 3,569,333 individuals without Down syndrome who were born in Sweden between 1973 and 2008 and followed for the incidence of ALL through 2010 (maximum age, 38 years) to examine perinatal and familial risk factors. RESULTSThere were 1960 ALL cases with 69.7 million person-years of follow-up. After adjusting for potential confounders,... (More)
BACKGROUNDPerinatal factors including high birth weight have been found to be associated with acute lymphoblastic leukemia (ALL) in case-control studies. However, to the best of our knowledge, these findings have seldom been examined in large population-based cohort studies, and the specific contributions of gestational age and fetal growth remain unknown. METHODSThe authors conducted a national cohort study of 3,569,333 individuals without Down syndrome who were born in Sweden between 1973 and 2008 and followed for the incidence of ALL through 2010 (maximum age, 38 years) to examine perinatal and familial risk factors. RESULTSThere were 1960 ALL cases with 69.7 million person-years of follow-up. After adjusting for potential confounders, risk factors for ALL included high fetal growth (incidence rate ratio [IRR] per additional 1 standard deviation, 1.07; 95% confidence interval [95% CI], 1.02-1.11 [P =.002]; and IRR for large vs appropriate for gestational age, 1.22; 95% CI, 1.06-1.40 [P =.005]), first-degree family history of ALL (IRR, 7.41; 95% CI, 4.60-11.95 [P<.001]), male sex (IRR, 1.20; 95% CI, 1.10-1.31 [P<.001]), and parental country of birth (IRR for both parents born in Sweden vs other countries, 1.13; 95% CI, 1.00-1.27 [P =.045]). These risk factors did not appear to vary by patient age at the time of diagnosis of ALL. Gestational age at birth, season of birth, birth order, multiple birth, parental age, and parental education level were not found to be associated with ALL. CONCLUSIONSIn this large cohort study, high fetal growth was found to be associated with an increased risk of ALL in childhood through young adulthood, independent of gestational age at birth, suggesting that growth factor pathways may play an important long-term role in the etiology of ALL. Cancer 2015;121:1040-1047. (c) 2014 American Cancer Society. The authors conducted what, to their knowledge, is the largest population-based cohort study to date to examine perinatal and familial risk factors for acute lymphoblastic leukemia (ALL) among approximately 3.5 million individuals born in Sweden between 1973 and 2008. High fetal growth was found to be associated with an increased risk of ALL in childhood through young adulthood, independent of gestational age at birth, suggesting that growth factor pathways may play an important long-term role in the etiology of ALL. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cohort studies, fetal development, gestational age, leukemia, risk, factors
in
Cancer
volume
121
issue
7
pages
1040 - 1047
publisher
John Wiley & Sons
external identifiers
  • wos:000351615800012
  • scopus:84925355041
ISSN
1097-0142
DOI
10.1002/cncr.29172
language
English
LU publication?
yes
id
d11ccfa0-9b42-4b8c-ad4d-8b96184375be (old id 5277767)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/?term=25417823
date added to LUP
2015-05-04 08:57:46
date last changed
2017-09-17 04:11:04
@article{d11ccfa0-9b42-4b8c-ad4d-8b96184375be,
  abstract     = {BACKGROUNDPerinatal factors including high birth weight have been found to be associated with acute lymphoblastic leukemia (ALL) in case-control studies. However, to the best of our knowledge, these findings have seldom been examined in large population-based cohort studies, and the specific contributions of gestational age and fetal growth remain unknown. METHODSThe authors conducted a national cohort study of 3,569,333 individuals without Down syndrome who were born in Sweden between 1973 and 2008 and followed for the incidence of ALL through 2010 (maximum age, 38 years) to examine perinatal and familial risk factors. RESULTSThere were 1960 ALL cases with 69.7 million person-years of follow-up. After adjusting for potential confounders, risk factors for ALL included high fetal growth (incidence rate ratio [IRR] per additional 1 standard deviation, 1.07; 95% confidence interval [95% CI], 1.02-1.11 [P =.002]; and IRR for large vs appropriate for gestational age, 1.22; 95% CI, 1.06-1.40 [P =.005]), first-degree family history of ALL (IRR, 7.41; 95% CI, 4.60-11.95 [P&lt;.001]), male sex (IRR, 1.20; 95% CI, 1.10-1.31 [P&lt;.001]), and parental country of birth (IRR for both parents born in Sweden vs other countries, 1.13; 95% CI, 1.00-1.27 [P =.045]). These risk factors did not appear to vary by patient age at the time of diagnosis of ALL. Gestational age at birth, season of birth, birth order, multiple birth, parental age, and parental education level were not found to be associated with ALL. CONCLUSIONSIn this large cohort study, high fetal growth was found to be associated with an increased risk of ALL in childhood through young adulthood, independent of gestational age at birth, suggesting that growth factor pathways may play an important long-term role in the etiology of ALL. Cancer 2015;121:1040-1047. (c) 2014 American Cancer Society. The authors conducted what, to their knowledge, is the largest population-based cohort study to date to examine perinatal and familial risk factors for acute lymphoblastic leukemia (ALL) among approximately 3.5 million individuals born in Sweden between 1973 and 2008. High fetal growth was found to be associated with an increased risk of ALL in childhood through young adulthood, independent of gestational age at birth, suggesting that growth factor pathways may play an important long-term role in the etiology of ALL.},
  author       = {Crump, Casey and Sundquist, Jan and Sieh, Weiva and Winkleby, Marilyn A. and Sundquist, Kristina},
  issn         = {1097-0142},
  keyword      = {cohort studies,fetal development,gestational age,leukemia,risk,factors},
  language     = {eng},
  number       = {7},
  pages        = {1040--1047},
  publisher    = {John Wiley & Sons},
  series       = {Cancer},
  title        = {Perinatal and Familial Risk Factors for Acute Lymphoblastic Leukemia in a Swedish National Cohort},
  url          = {http://dx.doi.org/10.1002/cncr.29172},
  volume       = {121},
  year         = {2015},
}