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High fetal growth, family history increase risk for ALL
High fetal growth independent of gestational age at birth was linked to an increased risk for acute lymphoblastic leukemia in childhood and young adulthood, according to study results.
Children and young adults who were males or who had a family history of ALL also were at increased risk for the disease, results showed.
Casey Crump
“Because the majority of ALL cases are diagnosed in early childhood, perinatal factors may be etiologically important, and their identification may provide insights into mechanisms,” Casey Crump, MD, PhD, of the department of medicine at Stanford University, and colleagues wrote.
Crump and colleagues evaluated data collected from more than 3.5 million individuals (51.4% male) born without Down syndrome — an established risk factor for ALL — in Sweden between 1973 and 2008.
Researchers evaluated the risk for ALL in relation to sex, birth year, fetal growth, gestational age at birth, birth weight, birth length and season of birth.
After 69.7 million years of follow-up, 1,960 (0.05%) of the individuals developed ALL. The median age at the time of diagnosis was 4.7 years (standard deviation [SD], 5.9 years).
Researchers adjusted each analysis for factors associated with ALL, including sex, fetal growth, parental country of birth and family history.
Individuals with a first-degree family history of the disease demonstrated the greatest risk for ALL (incidence rate ratio [IRR] = 7.41; 95% CI, 4.6-11.95).
High fetal growth — determined by the number of SDs away from the mean birth weight for gestational age and sex based on a Swedish reference growth curve — also was significantly associated with an increased risk for ALL (IRR per each SD = 1.07; 95% CI, 1.02-1.11).
Although sex was not determined to be a significant risk factor in relation to other study variables, males had an overall greater risk for ALL compared with females (IRR = 1.2; 95% CI, 1.1-1.31). Individuals with Swedish-born parents displayed a borderline increased risk compared to those with at least one foreign-born parent (IRR = 1.13; 95% CI, 1-1.27). Other variables, including gestational age at birth, were not identified as significant risk factors.
“High fetal growth was associated with an increased risk of ALL independent of gestational age at birth, and irrespective of age at the time of disease onset,” Crump and colleagues concluded. “These findings suggest that growth factor pathways may play an important role in the etiology of ALL from childhood into adulthood.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.