
A ‘delayed infection’ theory of childhood leukaemia - pera
https://www.icr.ac.uk/news-archive/leading-uk-scientist-reveals-likely-cause-of-childhood-leukaemia
======
Someone1234
I found this line very interesting:

> but primarily in children who experienced 'clean' childhoods in the first
> year of life, without much interaction with other infants or older children.

And:

> Professor Greaves suggests childhood ALL is a paradox of progress in modern
> societies – with lack of microbial exposure early in life resulting in
> immune system malfunction.

Reminds me of childhood asthma which some have claimed is also caused by
under-exposure to contaminants in the air in early childhood.

~~~
londons_explore
I have yet to see compelling evidence that separates the effects of "clean
environments" and "environments with lots of cleaning agents used".

Are there any studies which investigate, for example, the difference between
mechanical cleaning of an environment with a pressure washer and deionised
water, vs chemical cleaning with household cleaners?

~~~
tomtheelder
I think the article actually sort of addresses this, but only in passing and
indirectly by mentioning that what they actually mean is growing up without
breastefeeding and with limited exposure to other children. When they say
clean, they don't really mean how well scrubbed the floors and counters are.

When these sorts of studies are coming out, they are very rarely talking about
the cleanliness of the house, more so the lifestyle and habits of the
occupants.

Now there could well be a correlation between households that clean with
cleaning agents and those that limit interaction and breastfeeding, but I do
think it's very unlikely that that is what is going on.

------
tonyedgecombe
We lost our daughter to ALL. It's quite hard to read anything like this
without thinking what could we have done differently.

~~~
nickswan
So sorry for you loss.

As someone has said further down - this is one theory and isn’t a general
medical consensus.

Our daughter was diagnosed with ALL 12 months ago. She went to baby groups
from 6 weeks and I would never have claimed our house was particularly clean.

What I have always found frustrating is we have never been asked any
environmental questions about our daughters early years. There are many
theories of cause so I would have expected them to get as much information as
possible from us.

~~~
gautamdivgi
Our daughter was diagnosed with ALL a month ago. Again, as you said this seems
to be a theory under discussion and not a general medical consensus. What I've
found in my limited exposure to the medical system so far is that their
singular focus is on the treatment and they rarely if ever look back for data
that could be correlated to a cause. She's our second child and had her first
cold at a few weeks old. Our house has never been particularly tidy and my
older daughter kept bringing in the cough, cold and fever from pre-school.
Interestingly, she had never been a rather sickly child or one that lacked
stamina and has weathered most of the cold and fevers brought home by the
elder child surprisingly well. Then she got her flu shot a couple of months
ago that resulted in a fairly raging reaction (which the doctors dismissed
that the flu shot can't do), which led to appendicitis (unusual for a 3 yr
old) which led to the eventual diagnosis of ALL.

~~~
nickswan
Really sorry for the diagnosis your daughter has had. Our girls were about the
same age at diagnosis. If you have any questions or want to chat anytime feel
free to contact me. L

------
harry8
Seems like childhood leukaemia would only be experienced by eldest children if
this were so. You'd imagine that almost all children living with an older
sibling are exposed to the works to "prime their immune system" from birth.
That seems like such a strong signal it would have been commented on, possibly
named for it, and yet I've never heard of leukaemia as a oldest child disease.

Obviously this is not my field and I have the cynicism of reading and hearing
about cancer breakthroughs since before clickbait had a name.

~~~
triviatise
from a random paper from 1995

[https://academic.oup.com/jnci/article/89/13/939/2526258](https://academic.oup.com/jnci/article/89/13/939/2526258)

<< A total of 704 cases of childhood ALL were identified. Among 0-4 year olds,
the relative risks (RRs) of ALL for birth order positions 1, 2, 3, and 4+ were
1.00 (reference), 0.85 (95% confidence interval [CI] = 0.68-1.07), 0.91 (95%
CI = 0.66-1.25), and 0.57 (95% CI = 0.30-1.06), respectively ( P for trend =
.09).>>

<<Children born second or later in the birth order had an increased risk of
AML (RR = 1.53; 95% CI = 1.01-2.32) compared with firstborns. >>

~~~
ithilglin909
Exposure to siblings might not be helpful, since those children, particularly
young ones, are probably subject to the same environmental factors/presence
(or lack thereof) bacteria and viruses.

~~~
WhompingWindows
You may have misunderstood his rationale. The OP article suggests that kids
need to have early infections and less clean environments in the first year,
as later dirtiness can trigger a mutation that incurs leukemia. The parent
comment says: well, if you have an older sibling, you should be more likely to
be exposed to dirty stuff, since they're in/out of the house, picking up dirt,
kissing dogs, getting sick from daycare, etc.

~~~
kevin_thibedeau
The mutation is already present. Per the article, the proposed trigger is an
immune system that hasn't been desensitized to common environmental pathogens
during early childhood.

------
bmiller2
A family member was diagnosed with ALL this week. That family member also
spent 5 weeks in NICU because they were very premature.

The oncologist noted at time of the ALL diagnosis that NICU babies had a
higher incidence rate of ALL later in life.

Perhaps here is the causation for that anomaly - reduced very-early exposure
to bad microbes in the sterile NICU environment results in an underdeveloped
immune system less able to resist genetic mutations leading to ALL.

Perhaps it's something about _very_ early exposure for infants, as at least in
the case of my family member, the parents were _not_ hypoallergenic and the
child began daycare at a pretty early age (and thus subject to all kinds of
nasty nasty germs)

------
garraeth
Many studies suggesting asthma is caused by microbiome (eg: 1), perhaps this
is as well? The article reads like it might be. Interesting that they don't
mention it directly (I can't find any mention).

(1)
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755449/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755449/)
(google: "asthma caused by microbiome" for more).

------
zeroxzeroiszero
We live in the UK. I have a child who was diagnosed with ALL and successfully
treated. He is now 18 months post treatment. He did have a very serious
infection at the time of diagnoses that was a major threat to his life at the
time. However, we don't fit this proposed model. This was our third child. We
don't run a "clean" household - we don't use antibiotic soap, we skip meat
raised with antibiotics and we did not run to the GP for antibiotics for every
sniffle. My wife breast fed all our children from birth past one year of age.
We allowed the children to play in the dirt, eat a bit of sand in the sand box
and just generally have fun outside. We don't doubt that gut priming is
important but this theory does not explain every case. I understand that the
researcher does not claim it explains every ALL case. I just share this for
those who are wondering what they could have done. I think we ticked all the
boxes of gut priming and our child still got ALL. Be at peace.

~~~
nickswan
Thanks for posting - similar situation here although our daughter is our
eldest. My partner is now questioning herself even though our environment was
just like yours and we don’t fit their model. It’s annoying the way this
theory is being reported.

------
swampthinker
This is why dogs eat their own feces right? It actually makes a significant
impact on their immune system and intestinal health.

~~~
teekert
Suposedly they have already been exposed to bacteria in their own feces. Other
dogs' feces however...

~~~
londons_explore
Traversing the gut backwards is quite a feat for a bacterium...

Consuming ones own faeces could be an effective way to travel from one end to
the other...

Lots of parasites [1] use that method too.

[1]:
[https://en.wikipedia.org/wiki/Pinworm_(parasite)](https://en.wikipedia.org/wiki/Pinworm_\(parasite\))

------
DoubleCribble
>Professor Greaves suggests that childhood leukaemia, in common with type I
diabetes, other autoimmune diseases and allergies...

I suspect we will eventually realize that an obsession with a sterile
household and Anti-Bacterial Everything (TM) has enormous long term health
repercussions, particularly for children. After all, a little case of cowpox
turned out to be really beneficial for young milk maidens [0].

[0][https://en.wikipedia.org/wiki/Cowpox#Discovery](https://en.wikipedia.org/wiki/Cowpox#Discovery)

~~~
wahern
Isn't the FDA banning certain anti-bacterial soaps? See
[https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/u...](https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm517478.htm)
and
[https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm378393.h...](https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm378393.htm)

Hopefully this is still in the works. I like Dial's anti-bacterial foaming
soap, but only because it has the best foaming action. All the alternatives at
the local stores suck in comparison. I'm too lazy to make my own. It'd be nice
if they sold it with the triclosan, but perhaps they'll just put some other
non-regulated antibacterial...

... looking at the Amazon images it looks like they _did_ simply switch to a
new active antibacterial ingredient. _sigh_ :(

UPDATE: New actual active ingredient: Benzalkonium Chloride. See
[https://www.dialsoap.com/Products/Hand-Soap/Spring-Water-
Foa...](https://www.dialsoap.com/Products/Hand-Soap/Spring-Water-Foaming)

------
lifeisstillgood
I do want to emphasise this - this is not some "kids need to play in the dirt
more" rant - but I fear it is going to be just that in every newspaper by
tomorrow.

There is a real pathway identified here - and real monitoring possibilities.
It's just the cynic in me thinks it will be taken the wrong way again.

there never was a golden age of "just enough" dirt. what you had was children
who were the survivors of bacterial warfare who then happened to have superb
immune systems able to take on all comers

(not very)fun fact: Salvador Dali believed he was the reincarnated soul of his
older brother who had died in 1903 at two years old - from Gastro Enteritis.
That's not what children are supposed to die of, and if that's the price to
pay to avoid childhood leukaemia it is too high.

~~~
zamalek
> if that's the price to pay to avoid childhood leukaemia it is too high

Curing leukemia requires multiple rounds of chemotherapy, which are drugs that
attempt to kill as much as possible without killing anything important. They
aren't particularly safe (which is why cancer patients lose their hair). Once
you've cured it, you haven't actually cured it[1]. 10% die from ALL, even
treated.

Gastroenteritis is an infection. Sometimes it's bacterial and a round of
antibiotics (or possibly probiotics) will do the trick. Once it's cured, it's
cured for good. We aren't in 1903. 0.085% die from gastroenteritis usually
because they go untreated.

[1]: [https://xkcd.com/931/](https://xkcd.com/931/)

~~~
lifeisstillgood
I think Inworded that very badly - of course with modern medicine we can treat
Gastroenteritis while still combating leukaemia.

I was too focused on avoiding the "golden past" theory that seems to trot out
too often.

------
lamename
Wonder how this immune system 'priming' benefit is weighed against risks of,
e.g. anti-vaxers contacting infants who are too young to receive
immunizations, or the risks that many illnesses pose for high fevers.

Are there trade-offs or is there a clear answer?

~~~
nonbel
>"anti-vaxers contacting infants who are too young to receive immunizations"

If the infant is too young to receive immunization that means they are
protected by maternal antibodies, so there's nothing to worry about. The real
problem you are thinking of is that the age of many vaccinations need to be
moved up since maternal antibodies from vaccinated mothers wane quicker.

~~~
phyzome
And IIRC the maternal antibodies also make it harder for immunizations to
"take", since the antibodies latch onto the viral particles from the vaccine.
I _think_ I remember something about the MMR vaccine being given at 1 year
because it's less effective when given earlier, for that reason.

~~~
nonbel
Yep, that is exactly the reason vaccination is delayed. They originally tried
giving them at younger ages but stopped because it wasn't working (I've never
seen any report of a health danger).

------
bfoks
A good book about this: [https://www.amazon.com/Missing-Microbes-Overuse-
Antibiotics-...](https://www.amazon.com/Missing-Microbes-Overuse-Antibiotics-
Fueling/dp/0805098100)

------
nighthawk1
I think this matches up well with how centenarians typically grew up around
farm animals. Early exposure to disease builds a stronger immune system to
tackle issues later in life.

~~~
haihaibye
Agriculture was a much higher percentage of the labor force in the past. And
farmers might have had more children than people in cities.

------
greenhatman
Isn't it common for babies to eat dirt if you don't stop them? Just don't stop
them.

~~~
phyzome
Well, you still don't want them getting anthrax or botulism or whatever. And
many people live in cities, where the soil may have substantial lead levels.

As a parent, I tried to thread a path between cleanliness and exposure. Didn't
worry too much about the kid sucking on furniture at home, but did keep her
from licking the subway car, for example. :-P To a certain extent it's just
about not going to all the extra trouble of sanitizing everything.

------
PunchTornado
so one thing is no infections in the early life when the immune system
develops.

It makes some sense.

------
liveoneggs
so could the genetic mutation be tested-for and monitored/treated based on
that?

------
paulpauper
The title is somewhat misleading. I don't think there is such a consensus
among the medical community as to the leading cause of childhood leukemia. He
has a theory.

~~~
dang
We've changed the title to use representative language from the article.

