Age-Specific Incidence of Acute Lymphoblastic Leukemia in U.S. Children: In Utero Initiation Model

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Abstract
A large body of evidence supports the hypothesis that an infectious agent is involved in the etiology of acute lymphoblastic leukemia (ALL) in children, particularly those cases occurring in children between 2 and 5 years of age ( 1 – 4 ). Recently, a specific virus has been posited as a candidate etiologic agent for childhood ALL, with leukemia occurring as a consequence of primary infections of women during pregnancy that lead to in utero infection and to subsequent increased risk of developing ALL in early childhood ( 5 ). Since a critical component of this proposal is that in utero infection by a leukemiainducing agent is the first step in development of many cases of childhood ALL, we were interested to see if a mathematical model with clinically reasonable parameters in which the critical leukemogenic event occurred in utero could be developed to explain the observed incidence of ALL among young children in the United States.