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Acute lymphoblastic leukemia incidence during socioeconomic transition: selective increase in children from 1 to 4 years

Leukemia volume 16, pages 720–725 (2002)Cite this article

Abstract

Pre-school acute lymphoblastic leukemia (ALL) peak is consistent in developed but not in developing countries and its magnitude apparently correlates with the socioeconomic status. A population-based study describing ALL incidence during socioeconomic transition has been lacking. Central European post-communist countries (with very low foreign migration and centralized statistics) offer reliable data for the period before and during major socioeconomic changes. Population-based data on Czech ALL patients younger than 18 years were taken from two independent Czech national registries partially overlapping in time (1980–1998, n = 1236 and 1991–1999, n = 570). During the 1980s and 1990s, ALL incidence among children 1–4 years increased 1.5 times (P = 0.01). This increase was more prominent in females than in males (slopes 0.13 and 0.09, P values 0.03 and >0.05, respectively). No significant change was observed in other age groups (0, 5–9, 10–14, 15–17 years or all others combined). We discuss possible underlying socioeconomic factors including infant care and breast-feeding, hygiene, birth order, industry and pollution. Moreover, we try to pinpoint the immunophenotypic/molecular-genetic subsets of ALL that might be socioeconomically affected. Selective increase of ALL in children 1–4 years old provides epidemiological evidence that etiology and/or trigger mechanisms are different for a considerable proportion of these children and that these mechanisms are exogenous.

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Acknowledgements

We thank our colleagues Drs Lanska, Kamberska, Jechova, Ales and Benes for help with statistical data and demography, Drs Bartunkova and Provaznik for immunologist's and epidemiologist's remarks and P Hanusova and J Ridoskova for technical help. Supported by a grant No. 6406–3 from the Czech Ministry of Health and by the Czech Ministry of Education Programs No. 111300001 and No. 111300003; partly supported by the Terry Fox Run. This study was presented at the Annual meeting of the American Society of Hematology in San Francisco, USA, 2000.

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Authors and Affiliations

  1. Institute of Immunology, 2nd Medical School, Charles University, Prague, Czech Republic

    O Hrušák, A Poloučková & T Kalina

  2. 2nd Department of Pediatrics, 2nd Medical School, Charles University, Prague, Czech Republic

    J Trka, J Zuna & J Starý

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Hrušák, O., Trka, J., Zuna, J. et al. Acute lymphoblastic leukemia incidence during socioeconomic transition: selective increase in children from 1 to 4 years. Leukemia 16, 720–725 (2002). https://doi.org/10.1038/sj.leu.2402422

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