Contributions
Abstract: PB1606
Type: Publication Only
Background
Epidemiologic data suggests heritable factors play a minor role in leukemia causation and environmental factors are a major contributor (Lichtenstein, 2000). Exposure to radiation or toxins is linked to the pathogenesis of a variety of blood cancers and husbands and wives may experience similar environmental exposures. Leukemia in marital partners was first reported by Street in 1950 and rare reports since then have postulated a single causative agent including communicable infections (EBV, HTLV-I and HIV; Lynch, 1984). A larger group of affected couples would allow for the evaluation of commonalities and potential etiology.
Aims
To review cases where both marital partners were diagnosed with leukemia to determine patterns and identify common risk factors.
Methods
A retrospective review of patients (pts) presenting to our centre with leukemia between 2012 and 2017 was performed to determine if they previously had a spouse with a leukemia diagnosis. Data collected included basic demographics, diagnosis, order of onset, interval from marriage and between leukemia diagnoses, environmental exposures, comorbidities, family history of malignancy and treatment outcomes.
Results
Between 02/12 and 03/17, 5 pts presented with leukemia (2 ALL, 1 AML, 1 CML and 1 CLL) who had previously had a spouse with leukemia (2 ALL, 1 AML, 1 CML and 1 CLL). Three couples were Caucasian, 1 Asian and 1 South Asian; all marriages were non-consanguineous. None of the 10 pts had a family history of leukemia. Median age at time of first leukemia (L1) (3 wives, 2 husbands) was 44 years (y) (range 29-57) and of second leukemia (L2) was 62 y (range 45-72). None of the couples had the same leukemia subtype. Interval from L1 to L2 was a median of 14.5 y (range 0.8-21). Median duration of marriage at time of L1 was 16 y (range 7-35) and L2 was 27 y (range 17-45). Comorbidities included a prior malignancy in 2 pts (Hodgkin lymphoma and basal cell Ca). Seven pts were lifetime non-smokers; the remaining 3 pts had not smoked for 17-38 yrs. Excessive alcohol intake was seen in only 1 pt; 5 had never consumed alcohol. Five pts had potential occupational toxin exposures (2 health professionals, 1 marine engineer, 1 transportation industry worker and 1 construction worker); one other pt had previously received radiotherapy. Marital partners fell into 2 groups - either both had occupational toxin exposures (3 couples) or neither did (2 couples). The latter group included 2 wives with Ph+ CML whose husbands had ALL with common translocations [t(4;11), t(8;14)]. In both of these couples, the wife had a striking family history of solid tumours. Six of 10 pts are alive -- 4 pts after allogeneic SCT, 1 pt with CML who received TKI for 10 y but is off therapy for 2 y without recurrence and 1 pt with CLL who has not yet required therapy. Four pts have died from leukemia progression (2 AML, 2 ALL).
Conclusion
In a short time period, 5 pts presented to our tertiary care centre with a leukemia having previously had a spouse with leukemia. Specific etiology was difficult to determine in most cases but certain patterns were identified. Leukemia typically developed many years after marriage, L1 at a median of 16 y and L2 at a median of 27 y. Potential occupational exposures were found in both marital partners in 3 cases; in the other 2 partners, the wife developed CML and the husband developed ALL with a classic translocation. This case series significantly adds to the sparse literature on spousal leukemia and suggests that the partner of a pt with leukemia is at increased risk for developing leukemia .
Session topic: 1. Acute lymphoblastic leukemia – Biology & Translational Research
Keyword(s): familial, Philadelphia chromosome, T(4
Abstract: PB1606
Type: Publication Only
Background
Epidemiologic data suggests heritable factors play a minor role in leukemia causation and environmental factors are a major contributor (Lichtenstein, 2000). Exposure to radiation or toxins is linked to the pathogenesis of a variety of blood cancers and husbands and wives may experience similar environmental exposures. Leukemia in marital partners was first reported by Street in 1950 and rare reports since then have postulated a single causative agent including communicable infections (EBV, HTLV-I and HIV; Lynch, 1984). A larger group of affected couples would allow for the evaluation of commonalities and potential etiology.
Aims
To review cases where both marital partners were diagnosed with leukemia to determine patterns and identify common risk factors.
Methods
A retrospective review of patients (pts) presenting to our centre with leukemia between 2012 and 2017 was performed to determine if they previously had a spouse with a leukemia diagnosis. Data collected included basic demographics, diagnosis, order of onset, interval from marriage and between leukemia diagnoses, environmental exposures, comorbidities, family history of malignancy and treatment outcomes.
Results
Between 02/12 and 03/17, 5 pts presented with leukemia (2 ALL, 1 AML, 1 CML and 1 CLL) who had previously had a spouse with leukemia (2 ALL, 1 AML, 1 CML and 1 CLL). Three couples were Caucasian, 1 Asian and 1 South Asian; all marriages were non-consanguineous. None of the 10 pts had a family history of leukemia. Median age at time of first leukemia (L1) (3 wives, 2 husbands) was 44 years (y) (range 29-57) and of second leukemia (L2) was 62 y (range 45-72). None of the couples had the same leukemia subtype. Interval from L1 to L2 was a median of 14.5 y (range 0.8-21). Median duration of marriage at time of L1 was 16 y (range 7-35) and L2 was 27 y (range 17-45). Comorbidities included a prior malignancy in 2 pts (Hodgkin lymphoma and basal cell Ca). Seven pts were lifetime non-smokers; the remaining 3 pts had not smoked for 17-38 yrs. Excessive alcohol intake was seen in only 1 pt; 5 had never consumed alcohol. Five pts had potential occupational toxin exposures (2 health professionals, 1 marine engineer, 1 transportation industry worker and 1 construction worker); one other pt had previously received radiotherapy. Marital partners fell into 2 groups - either both had occupational toxin exposures (3 couples) or neither did (2 couples). The latter group included 2 wives with Ph+ CML whose husbands had ALL with common translocations [t(4;11), t(8;14)]. In both of these couples, the wife had a striking family history of solid tumours. Six of 10 pts are alive -- 4 pts after allogeneic SCT, 1 pt with CML who received TKI for 10 y but is off therapy for 2 y without recurrence and 1 pt with CLL who has not yet required therapy. Four pts have died from leukemia progression (2 AML, 2 ALL).
Conclusion
In a short time period, 5 pts presented to our tertiary care centre with a leukemia having previously had a spouse with leukemia. Specific etiology was difficult to determine in most cases but certain patterns were identified. Leukemia typically developed many years after marriage, L1 at a median of 16 y and L2 at a median of 27 y. Potential occupational exposures were found in both marital partners in 3 cases; in the other 2 partners, the wife developed CML and the husband developed ALL with a classic translocation. This case series significantly adds to the sparse literature on spousal leukemia and suggests that the partner of a pt with leukemia is at increased risk for developing leukemia .
Session topic: 1. Acute lymphoblastic leukemia – Biology & Translational Research
Keyword(s): familial, Philadelphia chromosome, T(4