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

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-tetanus (DPT), measles-mumps-rubella (MMR), and oral polio vaccine (OPV). We also evaluated if immunizations were complete vs. 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 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.

Sclerosing Spindle Cell Preauricular Rhabdomyosarcoma in a 7-Year-Old Female

“…Radiation therapy is administered with chemotherapy if there is incomplete resection [17,18]. Adherence to immunization schedule (diphtheria, pertussis, tetanus, measles, mumps, rubella and oral polio vaccine) has been shown to have some protective effect preventing development of RMS [19]. Prenatal exposure to ionizing radiation increases the risk of RMS in offspring [20].…”

Maternal and Birth Characteristics and Childhood Embryonal Solid Tumors: A Population-Based Report from Brazil

“…We believe that our result is reliable because it was on the highest category. Maternal education is consider a indicator of social background which can be associated with a variety of health-related factors including risk factors associated with childhood cancer as occupational exposures, dietary patterns, exposure to infectious, immunization, breastfeeding [ 26 – 28 ]. And it has been reported as a confounding factor [ 26 , 27 ].…”

“…A recent paper has shown that genome-wide association was associated with the numbers of years of schooling completed [ 29 ]. Another item that requires attention is that immunization is correlated with education background and incomplete immunization has already been described associated with embryonal tumors [ 28 ]. Human Development Index (HDI) was similar between the different cities that were included on our study so we believe that migration does not interfere on education background [ 30 ].…”

Rhabdomyosarcoma and Extraosseous Ewing Sarcoma

“…Risk factors remain largely unstudied; however, the Children’s Oncology Group (COG) recently published that immunizations may decrease the population risk of developing RMS [8].…”