title: The Role of Childhood Infections and Immunizations on Childhood Rhabdomyosarcoma: A Report From the Children's Oncology Group.
abstract: Rhabdomyosarcoma (RMS) is a rare, highly malignant tumor arising from primitive mesenchymal cells that differentiate into skeletal muscle. Relatively little is known about RMS susceptibility. Based on growing evidence regarding the role of early immunologic challenges on RMS development, we evaluated the role of infections and immunizations on this clinically significant pediatric malignancy.
  
  
  
  RMS cases (n = 322) were enrolled from the third trial coordinated by the Intergroup Rhabdomyosarcoma Study Group. Population-based controls (n = 322) were pair matched to cases on race, sex, and age. The following immunizations were assessed: diphtheria, pertussis, and tetanus (DPT); measles, mumps, and rubella; and oral polio vaccine. We also evaluated if immunizations were complete versus incomplete. We examined selected infections including chickenpox, mumps, pneumonia, scarlet fever, rubella, rubeola, pertussis, mononucleosis, and lung infections. Conditional logistic regression models were used to calculate an odds ratio (OR) and 95% confidence interval (CI) for each exposure, adjusted for maternal education and total annual income.
  
  
  
  Incomplete immunization schedules (OR = 5.30, 95% CI: 2.47-11.33) and incomplete DPT immunization (OR = 1.56, 95% CI: 1.06-2.29) were positively associated with childhood RMS. However, infections did not appear to be associated with childhood RMS.
  
  
  
  This is the largest study of RMS to date demonstrating a possible protective effect of immunizations against the development of childhood RMS. Further studies are needed to validate our findings. Our findings add to the growing body of literature, suggesting a protective role of routine vaccinations in childhood cancer and specifically in childhood RMS.
authors.affiliation: Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas.
authors.forename: Hari
authors.initials: H
authors.lastname: Sankaran
authors.affiliation: Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas.
authors.forename: Heather E
authors.initials: HE
authors.lastname: Danysh
authors.affiliation: Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Scheurer
authors.affiliation: Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas.
authors.forename: M Fatih
authors.initials: MF
authors.lastname: Okcu
authors.affiliation: Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Stephen X
authors.initials: SX
authors.lastname: Skapek
authors.affiliation: Seattle Children's Hospital, University of Washington, and Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Hawkins
authors.affiliation: Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Logan G
authors.initials: LG
authors.lastname: Spector
authors.affiliation: Department of Mathematics and Statistics, University of New Mexico, Albuquerque, New Mexico.
authors.forename: Erik B
authors.initials: EB
authors.lastname: Erhardt
authors.affiliation: Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico.
authors.forename: Seymour
authors.initials: S
authors.lastname: Grufferman
authors.affiliation: Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Lupo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007239:Infections / Q000150:complications*; D008297:Male; D012208:Rhabdomyosarcoma / Q000209:etiology / Q000517:prevention & control*; D014611:Vaccination
keywords: epidemiology; immunizations; infections; rhabdomyosarcoma; soft tissue sarcoma