Epidemiology

The specific cause of ALL is unknown in most patients, and specific epidemiologic associations can be identified in no more than 10% of childhood ALL and in a much lower proportion of adults.26 27 An extensive review of ALL in children by Buffler et al. details potential occupational exposures in parents of patients, and exposures to aromatic hydrocarbons and household chemicals and pesticides, ionizing radiation, low-frequency magnetic fields, diet, infections, and genetic polymorphisms.26 Numerous potential predisposing features studied or established include positive associations with the specific genetic syndromes noted below, high birth weight,28 ethnicity,29 and a paradoxically negative relation with maternal smoking.30 While extensively investigated, none of these factors offer potent predictive value for improved diagnosis and increased survival other than the increased risk of leukemia in some hereditary and genetic syndromes (see below). In adults, even fewer associations are apparent; genetic features play a negligible role in disease behavior and in defining and predicting prognosis. The following includes some genomic and other associations in children and adults.

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