Mode of Delivery and Risk of Childhood Leukemia
A partir des données de la cohorte américaine "California Childhood Leukemia Study", cette étude évalue l'association entre une naissance par césarienne et le risque de leucémie pédiatrique
Background: Childhood infection and immune response have long been suspected in the etiology of childhood leukemia, specifically acute lymphoblastic leukemia (ALL). Normal primary inoculation of the core human microbiome is circumvented by caesarian section(CS) delivery, which is a proposed modulator of both immune response and early life infection. Methods: In this study we examined CS delivery and the risk of childhood leukemia using data from the California Childhood Leukemia Study (CCLS) case-control study and additive logistic regression models. Results: We observed no association between CS and acute myeloid leukemia (AML; OR=0.96, CI=0.52-1.55,). We observed a suggestive association for ALL and CS (OR= 1.22,CI=0.97-1.54). When examining common ALL (cALL), defined as ALL with expression of CD10 and CD19 surface antigens and diagnosis occurring between 2 and 5.9 years of age,we found a significant association with CS (OR 1.44 CI=1.0-2.06 ). ALL subjects that are not cALL showed a similar risk as ALL overall (OR= 1.15, CI=0.91-1.44). Because of previous findings suggesting effect modification, we stratified cALL subjects by Hispanic status. While we observed no relationship for CS in non-Hispanics (OR= 1.14, CI=0.72-1.79), we did observe a strong association between cALL and CS in Hispanics (OR=2.34, CI=1.23-4.46). Conclusion: Within the CCLS, CS delivery appears to be associated with cALL and Hispanic subjects may be driving the association. Impact: Further research combined with investigations into response to early infection and the microbiome are warranted.