Abstract
Leukemia is a complex disease, which only became better understood during the last decades following the development of new laboratory techniques and diagnostic methods. Despite our improved understanding of the physiology of the disease, little is yet known about the causes of leukemia. A variety of potential risk factors have been suggested so far, including personal habits and lifestyle, and a wide range of occupational or environmental exposures. A causal association with leukemia has only been documented to date for ionizing radiation, benzene and treatment with cytostatic drugs, but there is an ongoing scientific debate on the possible association of leukemia with a number of other work-related hazards. In this article, we have reviewed scientific studies, published over the past 5 years, which investigated potential associations between leukemia and exposure to occupational risk factors. The systematic literature review took place via electronic databases, using specific search criteria, and independent reviewers have further filtered the search results to identify the number of articles, presented in our paper. A large number of studies included in the review referred to the effects of ionizing radiation, where new data suggest that the effects of exposure to small doses of ionizing radiation should probably be reevaluated. Some other works appear to substantiate a potential association of the disease with certain pesticides. Further research is also suggested regarding the role of infectious agents or exposure to certain chemicals like formaldehyde or butadiene in the pathogenesis of leukemia.
Highlights
The term "leukemia" refers to a group of diseases with different biological background, clinical presentation, prognosis and response to treatment, characterized by a malignant transformation of hematopoietic cells which produce an abnormal leukemic population of cells suppressing the production of normal blood cellular components
A set of criteria was adopted to narrow down the search results, excluding studies published more than 5 years prior to the review, studies that referred to subjects younger than 18 years and studies whose full text was not available in English
The reviewers screened the abstracts of all collected articles and considered for further review only studies that referred to the potential effect of various risk factors in the development of leukemia
Summary
The term "leukemia" refers to a group of diseases with different biological background, clinical presentation, prognosis and response to treatment, characterized by a malignant transformation of hematopoietic cells which produce an abnormal leukemic population (clone) of cells suppressing the production of normal blood cellular components. Used in the treatment of solid organ malignancies are another documented risk factor for developing leukemia, as a number of clinical trials on cancer therapeutics has shown an association between this category of drugs and the development of secondary leukemia [18], AML [19]. Despite their known toxicity to oncology patients and the precautionary measures taken to prevent occupational exposure, a number of workers from different disciplines could be exposed to significant concentrations of cytostatic drugs during their production, transportation, distribution, preparation and administration to patients [20,21,22]. Through this paper we systematically collected and summarized all relevant scientific information that has been published internationally in the English language over the last years, exploring the potential role of occupational "risk factors" in the development of the disease
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