Support For Infrastructure of Childhood Leukemia Environmental Research

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ABSTRACT Leukemia is the most common pediatric cancer affecting more than 40,000 children worldwide each year. During the last decades, childhood leukemia incidence has increased in the US by ~35% overall, with an even larger rise among LatinX. Similar trends are also observed in several Latin American countries. This rapid increase points to the critical role of environmental factors in the development childhood leukemia, possibly in combination with genetic factors. Despite improved prognosis of childhood leukemia overall, there are major differences by subtype, region, racial/ethnic group, and socio-economic status, and leukemia survivors remain at risk for serious lifelong complications. Altogether, these observations highlight the need to support more research and prevention to reduce leukemia burden and disparity. The overall objective of this U24 competing renewal is to expand the support of existing population studies (here case-control design) to accelerate childhood leukemia environmental research and prevention, with a focus on LatinX populations. In the first R24 cycle (2017-22), we maintained and enhanced the resources and data sharing of two NIEHS-funded studies with large numbers of LatinX children in California, United States and Guatemala. To further address childhood leukemia disparity in LatinX, while increasing diversity of the research team, we now propose to (i) include additional childhood leukemia studies with low-resources in Mexico and Costa Rica, (ii) coordinate research translation/prevention among participating countries, and (iii) collaborate with LatinX researchers and health workers in California and Latin America. The four participating studies have enrolled 8,480 childhood leukemia cases and 4,462 controls, and have collected a wealth of environmental/genetic data and biospecimens providing the most comprehensive resources in LatinX populations worldwide. Individually or as part of the Childhood Cancer and Leukemia Consortium (CLIC), these studies have produced seminal findings, documenting the prenatal origin of childhood leukemia and identifying many factors that contribute to the increased or decreased risks of the disease including chemical exposures, diet/vitamins, breastfeeding, immune response, birthweight and genetic factors. The maintenance of these resources and the enhancement of data sharing procedures are needed to efficiently expand ongoing etiologic and tumor-biology studies of childhood leukemia, especially myeloid subtypes which are more common in LatinX, and uncover sources of disparity in leukemia risk and outcomes. To achieve our goals, we plan to (1) use an interoperable management system REDCap to provide unifying support for management, harmonization, storage and sharing of study resources; (2) enrich case-control studies by conducting linkages to population-level databases on exposures to potential carcinogenic agents/mixtures and social/built environments; (3) facilitate broader data use nationally and internationally with the CLIC Consortium, and (4) expand community engagement with the public, lay health workers, and health professionals in the US and Latin American countries to increase awareness about preventable risk factors of childhood leukemia.