The Role of Childhood Infections and Immunizations on Childhood Rhabdomyosarcoma: A Report From the Children's Oncology Group

Hari Sankaran, Heather E. Danysh, Michael E. Scheurer, M. Fatih Okcu, Stephen X. Skapek, Douglas S. Hawkins, Logan G. Spector, Erik B. Erhardt, Seymour Grufferman, Philip J. Lupo

Research output: Contribution to journalArticle

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Abstract

Background: Rhabdomyosarcoma (RMS) is a rare, highly malignant tumor arising from primitive mesenchymal cells that differentiate into skeletal muscle. Relatively little is known about RMS susceptibility. Based on growing evidence regarding the role of early immunologic challenges on RMS development, we evaluated the role of infections and immunizations on this clinically significant pediatric malignancy. Procedure: RMS cases (n = 322) were enrolled from the third trial coordinated by the Intergroup Rhabdomyosarcoma Study Group. Population-based controls (n = 322) were pair matched to cases on race, sex, and age. The following immunizations were assessed: diphtheria, pertussis, and tetanus (DPT); measles, mumps, and rubella; and oral polio vaccine. We also evaluated if immunizations were complete versus incomplete. We examined selected infections including chickenpox, mumps, pneumonia, scarlet fever, rubella, rubeola, pertussis, mononucleosis, and lung infections. Conditional logistic regression models were used to calculate an odds ratio (OR) and 95% confidence interval (CI) for each exposure, adjusted for maternal education and total annual income. Results: Incomplete immunization schedules (OR = 5.30, 95% CI: 2.47–11.33) and incomplete DPT immunization (OR = 1.56, 95% CI: 1.06–2.29) were positively associated with childhood RMS. However, infections did not appear to be associated with childhood RMS. Conclusions: This is the largest study of RMS to date demonstrating a possible protective effect of immunizations against the development of childhood RMS. Further studies are needed to validate our findings. Our findings add to the growing body of literature, suggesting a protective role of routine vaccinations in childhood cancer and specifically in childhood RMS.

Original languageEnglish (US)
Pages (from-to)1557-1562
Number of pages6
JournalPediatric Blood and Cancer
Volume63
Issue number9
DOIs
StatePublished - Sep 1 2016

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Rhabdomyosarcoma
Immunization
Infection
Whooping Cough
Mumps
Diphtheria
Rubella
Odds Ratio
Tetanus
Measles
Confidence Intervals
Logistic Models
Immunization Schedule
Scarlet Fever
Maternal Exposure
Neoplasms
Population Control
Chickenpox
Poliomyelitis
Pneumonia

Keywords

  • epidemiology
  • immunizations
  • infections
  • rhabdomyosarcoma
  • soft tissue sarcoma

Cite this

Sankaran, H., Danysh, H. E., Scheurer, M. E., Okcu, M. F., Skapek, S. X., Hawkins, D. S., ... Lupo, P. J. (2016). The Role of Childhood Infections and Immunizations on Childhood Rhabdomyosarcoma: A Report From the Children's Oncology Group. Pediatric Blood and Cancer, 63(9), 1557-1562. https://doi.org/10.1002/pbc.26065

The Role of Childhood Infections and Immunizations on Childhood Rhabdomyosarcoma : A Report From the Children's Oncology Group. / Sankaran, Hari; Danysh, Heather E.; Scheurer, Michael E.; Okcu, M. Fatih; Skapek, Stephen X.; Hawkins, Douglas S.; Spector, Logan G.; Erhardt, Erik B.; Grufferman, Seymour; Lupo, Philip J.

In: Pediatric Blood and Cancer, Vol. 63, No. 9, 01.09.2016, p. 1557-1562.

Research output: Contribution to journalArticle

Sankaran, H, Danysh, HE, Scheurer, ME, Okcu, MF, Skapek, SX, Hawkins, DS, Spector, LG, Erhardt, EB, Grufferman, S & Lupo, PJ 2016, 'The Role of Childhood Infections and Immunizations on Childhood Rhabdomyosarcoma: A Report From the Children's Oncology Group', Pediatric Blood and Cancer, vol. 63, no. 9, pp. 1557-1562. https://doi.org/10.1002/pbc.26065
Sankaran, Hari ; Danysh, Heather E. ; Scheurer, Michael E. ; Okcu, M. Fatih ; Skapek, Stephen X. ; Hawkins, Douglas S. ; Spector, Logan G. ; Erhardt, Erik B. ; Grufferman, Seymour ; Lupo, Philip J. / The Role of Childhood Infections and Immunizations on Childhood Rhabdomyosarcoma : A Report From the Children's Oncology Group. In: Pediatric Blood and Cancer. 2016 ; Vol. 63, No. 9. pp. 1557-1562.
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abstract = "Background: Rhabdomyosarcoma (RMS) is a rare, highly malignant tumor arising from primitive mesenchymal cells that differentiate into skeletal muscle. Relatively little is known about RMS susceptibility. Based on growing evidence regarding the role of early immunologic challenges on RMS development, we evaluated the role of infections and immunizations on this clinically significant pediatric malignancy. Procedure: RMS cases (n = 322) were enrolled from the third trial coordinated by the Intergroup Rhabdomyosarcoma Study Group. Population-based controls (n = 322) were pair matched to cases on race, sex, and age. The following immunizations were assessed: diphtheria, pertussis, and tetanus (DPT); measles, mumps, and rubella; and oral polio vaccine. We also evaluated if immunizations were complete versus incomplete. We examined selected infections including chickenpox, mumps, pneumonia, scarlet fever, rubella, rubeola, pertussis, mononucleosis, and lung infections. Conditional logistic regression models were used to calculate an odds ratio (OR) and 95{\%} confidence interval (CI) for each exposure, adjusted for maternal education and total annual income. Results: Incomplete immunization schedules (OR = 5.30, 95{\%} CI: 2.47–11.33) and incomplete DPT immunization (OR = 1.56, 95{\%} CI: 1.06–2.29) were positively associated with childhood RMS. However, infections did not appear to be associated with childhood RMS. Conclusions: This is the largest study of RMS to date demonstrating a possible protective effect of immunizations against the development of childhood RMS. Further studies are needed to validate our findings. Our findings add to the growing body of literature, suggesting a protective role of routine vaccinations in childhood cancer and specifically in childhood RMS.",
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