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BJC Open article

British Journal of Cancer (1999) 80, 585–590. doi:10.1038/sj.bjc.6690395 www.bjcancer.com
Published online 9 April 1999

Association of childhood leukaemia with factors related to the immune system

J Schüz1, U Kaletsch1, R Meinert1, P Kaatsch1 and J Michaelis1

1Institut für Medizinische Statistik und Dokumentation der Johannes Gutenberg-Universtität Mainz, D-55101 Mainz, Germany

Received 1 May 1998; Revised 30 October 1998; Accepted 11 November 1998

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Abstract

The childhood peak of common acute lymphoblastic leukaemia has been proposed as being a rare response to delayed exposure to a common infection. In this context, factors related to the child’s immune system are of special interest. Information on such factors was obtained in a recent German case-control study comprising more than 1000 children with acute leukaemia. Neither being the first-born child, nor a short duration of breastfeeding, indicators of a deficit in viral contacts during infancy or the number of infectious diseases, were significant risk factors. We observed a strong association with fewer routine immunizations with a 3.2-fold increase for those children getting less than four immunizations, but this association could partly be explained by reporting bias. While tonsillectomy or appendectomy increased the risk of leukaemia in our studies, a protective effect of allergies could be seen. In summary, we found only weak support for the delayed exposure hypothesis. To some extent this may be due to the chosen surrogate markers which reflect, rather indirectly, immunological isolation in infancy and delayed exposure to common viruses. However, the significant findings for routine immunizations, tonsillectomy and allergies of the child or its parents merit further investigation.

Keywords:

case-control study; childhood leukaemia; Germany; immune system; infections

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