Epstein Barr virus Human I lymphocyte virus KTLV1 and HTLV2

Social Habits

Cigarette smoking Maternal marijuana use Maternal ethanol use

Kost ma rn Ys syndrome Neurofibromatosis type 1 Familial monosomy 7 Diamond-Blackfan anemia

Adapted from Ret 6.

While leukemia is rarely a hereditary disease some genetic associations are evident. For example, among identical twins, the concordance for ALL in the initially unaffected twin is 20% to 25% within 1 year. While the incidence in fraternal twins is much less, there is still a fourfold increase in the risk of leukemia in the initially unaffected twin as compared with the normal population. One explanation for this association may be a shared placental circulation, which allows for transmission of disease from one twin to the other. Additionally, leukemia is known to be increased in several chromosomally abnormal populations. Patients with Down's syndrome have a 20 times increased risk of developing leukemia compared with the rest of the population. Patients with Klinefelter's syndrome and Bloom's syndrome also have an increased incidence of leukemias.

Exposure to environmental agents such as agricultural chemicals, pesticides, and radiation have also been periodically associated with leukemia, however none of these agents is linked conclusively with the development of leukemia. An increased frequency of ALL is associated with higher socioeconomic status. It is postulated that less social contact in early infancy and thus a late exposure to some common infectious agents may have some impact. In most individual instances, there is no reasonable or obvious explanation for the development of leukemia.

Risk factors for the development of AML include exposure to environmental toxins, Hispanic ethnicity, and genetics.6 Of greater concern is the increased prevalence of AML as a secondary malignancy, resulting from chemotherapy and radiation treatment for other cancers. Alkylating agents, such as ifosfamide and cyclophosphamide, and topoisomerase inhibitors, such as etoposide, are linked to an increased risk of my-elodysplastic syndrome (MDS) and AML.9

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