Risk of adult acute and chronic myeloid leukemia with cigarette smoking and cessation

Abstract

Background: Cigarette smoking is an established risk factor for adult myeloid leukemia, particularly acute myeloid leukemia (AML), but less is known about the nature of this association and effects of smoking cessation on risk.

Methods: In a large population-based case-control study of myeloid leukemia that included 414 AML and 185 chronic myeloid leukemia (CML) cases and 692 controls ages 20-79 years, we evaluated risk associated with cigarette smoking and smoking cessation using unconditional logistic regression methods and cubic spline modeling.

Results: AML and CML risk increased with increasing cigarette smoking intensity in men and women. A monotonic decrease in AML risk was observed with increasing time since quitting, whereas for CML, the risk reduction was more gradual. For both AML and CML, among long-term quitters (≥30 years), risk was comparable to non-smokers.

Conclusions: Our study confirms the increased risk of myeloid leukemia with cigarette smoking and provides encouraging evidence of risk attenuation following cessation.

Fig. 1

A–D. Estimates of OR (solid lines) and 95% CI (dotted lines) of smoking pack-years and AML (A) and CML (B) risk, and smoking cessation (years since quitting) and AML (C) and CML (D) risk, using a restricted cubic spline regression model adjusted for age, sex, and BMI. Knot locations are marked by filled circles. Never smokers are the reference group for the model of smoking pack-years. Current smokers have aquit-time of zero and are the reference group for the model of smoking cessation; never smokers are excluded. The horizontal line represents a null association (OR = 1.00).