Fernando Sánchez-Vizcaíno and Juan Manuel Alonso Domínguez.
O leukemia It is a type of cancer that occurs in the bone marrow and is classified, according to the hematopoietic line affected, into lymphoid (if lymphocytes are affected) and myeloid (when occurring in any other blood element); and, depending on its speed of progression, in acute or chronic. O acute myeloid leukemia (AML) It is the type of leukemia that is the focus of a study resulting from an international collaboration that led to Jimenez Diaz Foundationwith the participation of the University of Bristol (United Kingdom), and which showed that in the month of January there is an increase in its diagnosis.
The idea of carrying out this research arose from the hypothesis defended by several hematologists that diagnosed cases of AML tend to occur in clusters. “For this reason, we decided to assess the temporal distribution of diagnosed AML cases in Spain between the years 2004-2015”, he explains. Juan Manuel Alonso Dominguezspecialist in the Department of Hematology and Hemotherapy at the Madrid hospital and one of the main authors of the study, carried out within the framework of the Health Research Institute of the Fundación Jiménez Díaz (IIS-FJD), and whose results were published in the scientific journal ¡British Journal of Hematology’of recognized international prestige in the specialty.
The aim of the study was to investigate the diagnostic temporal pattern of cases of acute myeloid leukemia in the general population and by age and sex strata. Thus, a temporary aggregation was found in the diagnosis of this type of leukemia that “could indicate the existence of a seasonal etiological factor this would explain this temporary association”, details Fernando Sanchez-VizcainoProfessor of Veterinary Public Health at the University of Bristol and first signatory to the study.
To carry out the research, anonymous data from patients admitted to Spanish hospitals with acute myeloid leukemia were used. between the years 2004 and 2015, obtained from the Ministry of Health. In addition, the population at risk was estimated from the census recorded by the Instituto Nacional de Estatística in the same period. “The monthly incidence of AML was derived for the study period, which was analyzed using models Poisson’s generalized linear multivariablesthat take into account the temporal dependence of the observations through the introduction of autoregressive and moving average components”, explains Sánchez-Vizcaíno, adding that they analyzed 26,472 caseswhich was “the largest series of acute myeloid leukemia cases ever analyzed for this purpose”.
Seasonal risk factors in AML
According to the results of the work, in January the incidence of cases increases of the LMA, “with a minimum average difference of 7 percent in relation to February, and with a maximum average difference of 16 percent in relation to November and August”, explains Sanchez-Vizcaíno. The fact that the diagnosis of acute myeloid leukemia is seasonal would imply that seasonal risk factors such as infectious or environmental agentsinfluence the development and/or proliferation of the disease.
“Our results showed an annual spike, which would be more consistent with exposure to a viral agent than exposure to an environmental factor,” says Alonso. In this order, it continues “the etiological mechanism must be different from that exerted by chronic viral pressure, as it is an aggressive and acute disease that probably requires a short incubation period. The alternative and more plausible mechanism would be for a viral agent to stimulate the rapid proliferation of pre-existing and quiescent leukemic stem cells”, he explains.
Among the study’s lead authors are Sánchez-Vizcaíno, a veterinary epidemiologist with experience in the development of surveillance systems of antimicrobial resistance and prescribing using a “One Health” approach, as well as in the application of quantitative epidemiological methods for the prevention and control of transboundary zoonotic diseases; and Alonso, who focuses all of his professional activity on AML, caring for patients, performing molecular diagnosis and carrying out clinical and translational research in this pathology.
This study is a clear example of multidisciplinary workstarting from the idea and identification of Alonso’s working hypothesis, while the epidemiological design of the study and the execution of the statistical analyzes were led by Sánchez-Vizcaíno.
Other lines of research
The results make it necessary to carry out complementary epidemiological studies to investigate the association between seasonal risk factors and the increase in cases of acute myeloid leukemia in winter. Likewise, Alonso indicates that “there is a theory widely accepted in the scientific community that postulates that AML and other tumors are produced from a tumor stem cell, which would have to be removed to eradicate the tumor. With treatments, most of the tumor is eliminated, but these stem cells are usually not eradicated, giving rise to relapses”, therefore, “clarifying how the virus triggers the replication of the leukemic stem cell could help to unravel the mechanisms that regulate stem cell quiescence”. This study, which may have important therapeutic repercussions, is a line of research that Alonso is already developing at the IIS-FJD.
The authors explain that, in order to continue this interesting line of research, the first step is to obtain the funding needed to be able to develop the complex experiments described above. To this end, we are forming a network of collaborators with other leading international research groups in their respective disciplines to jointly request Assists of national and European public research. “We are also in the process of contacting several private companies to explore with them new collaboration opportunities in the development of our scientific aspirations”, conclude Alonso and Sánchez-Vizcaíno.
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