Epidemiology of Acute Lymphoblastic Leukaemia

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Epidemiology of Acute Lymphoblastic
Leukaemia

• Eve Roman

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Numbers of cases and rates by age and sex, all
leukaemias combined, UK
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Number of cases by age, all persons, selected
leukaemias, UK
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Numbers and proportions of leukaemias by type, UK
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Childhood cancer more developed countries
26,864 new cases each year
leukaemia
CNS
NHL
other
kidney
Hodgkins
ovary
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Childhood cancer less developed countries
133,867 new cases each year
leukaemia
NHL
CNS
kidney
other
Hodgkins
liver
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Epidemiology

• Study of the distribution and determinants of
• disease/states of health in human populations

Exposure
Health
Susceptibility
Early Biological effect
Altered structure/ function
Internal Dose
Effective Dose
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ALL in infants, children and adults
Infants
Children
Adults
Philadelphia chromosome
Hyperdiploidy
TEL-AML1 gene fusion
MLL gene fusion
Others
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United Kingdom Childhood Cancer Study(UKCCS)

• Management committee chaired by
• Professor Sir Richard Doll FRS 1992-2004
• Professor Nick Day FRS 2004 -

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UKCCS Main areas of study
Pre-conception In-utero Post-natal
Ionizing radiation
Chemicals drugs
Infections
ELF-EMF
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• Study population
• Children ( 15 years) registered for primary care
  with a General Practitioner (GP)
• Cases - ascertained from multiple sources-
• Treating/referring hospitals
• Cross-checks with cancer registries
• Controls selected from primary care population
  registers and individually matched to cases on-
• date of birth
• sex
• region of residence

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UKCCS Data
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Diagnostics and biological samples
Diagnostics (cases)
Diagnostics (cases)
Diagnostics - multiple sources including -
Treatment trials Cytogenetics databases
(routine specialist) Histopathological review
(solid tumours) Individual clinical
records Biological samples Pre-treatment Remissio
n
Biological samples (cases)
Biological samples (cases)
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Diagnostics and biological samples
Diagnostics (cases)
Diagnostics (cases)
Leukaemia Leukaemia Leukaemia All
Total ALL AML cancers
Interviewed 1737 1461 251 3838
Pre-treatment 1162 993 158 1906
Remission 1125 1000 108 1830
mother 1021 909 97 1620
both parents 853 764 77 1346
Pre-treatment Remission 840 750 82 1238
Biological samples (cases)
Biological samples (cases)
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UKCCS Data
The study provides no evidence that exposure to
magnetic fields associated with electricity
supply in the UK increases risks for childhood
leukaemia, cancers of the central nervous system,
or any other childhood cancer.
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UKCCS Data
Our results are reassuring, in that they do not
suggest any detectable public health risk of
childhood malignancies in the UK population from
radon exposure.
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Greaves hypothesis

• . the common subset of ALL peaking between two
  and five years of age may develop in response to
  infection in children who have been under-exposed
  to one or more common micro-organism in
  infancy..

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Fertlization errors Implantation
errors Fetal loss Intra-uterine growth
problems Congenital anomaly Child health e.g.
Immune function Allergy Development Cancer Adult
health e.g. Fertility Heart disease Cancer
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