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British Journal of Cancer (2002) 86, 1064-1069.
doi:10.1038/sj/bjc/6600091
Day-care, early common infections and childhood acute leukaemia: a multicentre French case-control study
F Perrillat1, J Clavel1, M F Auclerc2, A Baruchel3, G Leverger4, B Nelken5, N Philippe6, G Schaison3, D Sommelet7, E Vilmer8 and D Hémon1
1Institut National de la Santé et de la Recherche Médicale, Inserm U170, 16 avenue Paul Vaillant Couturier, 94807 Villejuif, France
2Institut National de la Santé et de la Recherche Médicale, Institute of Hematology, Saint-Louis Hospital, 75010 Paris, France
3Department of Paediatric Haematology, Saint-Louis Hospital, 75010 Paris, France
4Department of Paediatric Haematology, Armand Trousseau Hospital, 75012 Paris, France
5Department of Paediatric Haematology-Oncology, Jeanne de Flandre Hospital, 59000 Lille, France
6Department of Paediatric Oncology, Debrousse Hospital, 69009 Lyon, France
7Department of Paediatric Oncology, Brabois Hospital, 54000 Nancy, France
8Department of Paediatric Haematology-Immunology, Robert Debré Hospital, 75019 Paris, France
Correspondence to: Dr J Clavel, E-mail: clavel@vjf.inserm.fr
Received 30 July 2001; revised 29 November 2001; accepted 29 November 2001
We conducted a case-control study to investigate the role of early infections in the aetiology of childhood acute leukaemias. The study included 280 incident cases (240 acute lymphoblastic leukaemia and 40 acute non-lymphoblastic leukaemia) and 288 hospital controls, frequency matched by age, gender, hospital, catchment area of the hospital and ethnic origin. Data were obtained from standardised face-to-face interviews of the mothers. The interviews included questions on early common infections, day-care attendance, breast-feeding, birth order and infantile diseases. Odds ratios were estimated using an unconditional regression model including the stratification variables, parental socio-economic status and perinatal characteristics. Birth order was not associated with childhood leukaemia (acute lymphoblastic or acute non-lymphoblastic). A statistically-significant inverse association was observed between childhood leukaemia and day-care attendance (odds ratio=0.6, 95% Confidence Interval=(0.4-1.0)), repeated early common infections (
4 per year before age two, odds ratio=0.6 (0.4-1.0)), surgical procedures for ear-nose-throat infections before age two (odds ratio=0.5 (0.2-1.0)) and prolonged breast-feeding (6 months, odds ratio=0.5 (0.2-1.0)). In the multivariate model including day-care attendance, early common infections and breast-feeding, results concerning breast-feeding remained unchanged. A statistically significant interaction between day-care attendance and repeated early common infections was observed. When the interaction was taken into account, the simple effects of day-care and early common infections disappeared (odds ratio=1.1 (0.5-2.3) and odds ratio=0.8 (0.5-1.3), respectively) while the joint effect of day-care attendance and early common infections was negatively associated with childhood leukaemia (odds ratio=0.3 (0.1-0.8)). All the above associations were observed both for acute lymphoblastic leukaemia and acute non-lymphoblastic leukaemia. Our results support Greaves' hypothesis, even though they are not specific of common leukaemia.Ó 2002 Cancer Research UK
Keywords: childhood leukaemia; risk factors; day-care; early infections; breast-feeding
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| Print ISSN: 0007-0920 | Online ISSN: 1532-1827 | © 2002 Cancer Research UK | ||
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