Can Decrease in Smoking Incidence Reduce Leukemia Mortality

Abstract Smoking is the leading preventable cause of death in the Western world. There is substantial evidence that smokers are approximately 1.5 times more likely to develop acute myeloid leukemia (AML) than non smokers. We were interested to know if there is a relationship between smoking and treatment outcome in AML. We searched the Centers for Disease Control and Prevention (CDC) and Surveillance Epidemiology and End Results (SEER) databases for data about smoking incidence and AML mortality. We collected AML mortality data for the United States (US) from SEER and state leukemia mortality data from CDC. CDC data are lumped for all types of leukemia. Since AML is the most common leukemia, and no significant improvement in AML treatment, as compared to chronic myeloid leukemia, occurred in the last two decades, we used the collective leukemia data. We compared smoking incidence and age-adjusted leukemia mortality between overall US and states with either a high (Alabama, Indiana, Ohio, Oklahoma, Kentucky) or a low (California, Connecticut, New York, Utah, Rhode Island) smoking incidence. SEER data revealed a statistically significant correlation (r=0.88) between smoking incidence and AML mortality for the different US regions (Figure 1). The correlation was significant whether we included a 10-year lag period (r= 0.75) for leukemia mortality or not. The correlation between smoking incidence and mortality rates for individual states was much more variable; data from two representative states, California (CA) with low smoking incidence (r=0.74) and Indiana (IN) with high smoking incidence (r=0.03) are shown (Figure 2). Possible causes for decreased mortality can include less pulmonary infections, less aggressive leukemia [reports of more frequent chromosomal aberrations involving chromosome 5, 7 and 8 in smokers] and better transplant outcome in non-smokers. To date, we did not find any data on association between leukemia incidence and smoking prevalence. These data suggest a possible association between smoking and leukemia mortality, and additional research is needed to determine if smoking cessation can be a tool to decrease leukemia mortality. Figure 1 Figure 1. Figure 2: Figure 2:.