title: Alcohol drinking and risk of leukemia-a systematic review and meta-analysis of the dose-risk relation.
abstract: The association between alcohol and leukemia risk has been addressed in several studies in the past two decades, but results have been inconsistent. Therefore, we conducted a systematic review and meta-analysis to quantify the dose-risk relation. Through the literature search up to August 2013, we identified 18 studies, 10 case-control and 8 cohorts, carried out in a total of 7142 leukemia cases. We derived pooled meta-analytic estimates using random-effects models, taking into account the correlation between estimates, and we performed a dose-risk analysis using a class of nonlinear random-effects meta-regression models. Stratified analyses were carried out on leukemia subtypes and groups, in order to identify possible etiologic differences. Compared with nondrinkers, the relative risks (RRs) for all leukemia were 0.94 [95% confidence interval (CI), 0.85-1.03], 0.90 (95% CI, 0.80-1.01) and 0.91 (95% CI, 0.81-1.02) for any, light (≤ 1 drink/day) and moderate to heavy (>1 drink/day) alcohol drinking, respectively. The summary RRs for any alcohol drinking were 1.47 (95% CI, 0.47-4.62) for acute lymphoblastic leukemia, 0.94 (95% CI 0.77-1.15) for chronic lymphocytic leukemia, 1.02 (95% CI, 0.86-1.21) for acute myeloid leukemia and 0.93 (95% CI 0.75-1.14) for chronic myeloid leukemia. The subgroup analysis on geographical area for all leukemia combined showed RRs of 0.84 (95% CI, 0.76-0.93), 0.92 (95% CI, 0.83-1.01) and 1.32 (95% CI, 1.02-1.70) for studies conducted in America, Europe and Asia, respectively. We did not find an increased risk of leukemia among alcohol drinkers. If any, a modest favorable effect emerged for light alcohol drinking, with a model-based risk reduction of approximately 10% in regular drinkers.
authors.affiliation: Department of Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Rota
authors.affiliation: Department of Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Porta
authors.affiliation: Department of Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Pelucchi
authors.affiliation: Department of Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: Eva
authors.initials: E
authors.lastname: Negri
authors.affiliation: Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy; Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Bagnardi
authors.affiliation: Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
authors.forename: Rino
authors.initials: R
authors.lastname: Bellocco
authors.affiliation: Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corrao
authors.affiliation: The Tisch Cancer Institute and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, USA.
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. Electronic address: carlo.lavecchia@unimi.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: La Vecchia
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects*; D006801:Humans; D007938:Leukemia / Q000453:epidemiology*; D012307:Risk Factors
keywords: Alcohol drinking; Dose–risk relation; Leukemia; Meta-analysis; Systematic review