Familial Patterns of Inheritance

There have been a few reports in the literature of a familial aggregation of childhood leukemia, although this is quite rare.74 Moreover, these associations cannot rule out shared environmental factors. One notable exception to these rare familial patterns is the risk of leukemia in twins, particularly monozygotic. The risk of leukemia in the unaffected twin is highest in infancy, and decreases with age.85 Molecular studies suggest that this high concordance is due to shared placental circulation, where the affected twin's leukemia cells migrate to the other twin.86 Studies of twin infants with leukemia have demonstrated identical rearrangements of chromosomes in their leukemia cells, with no evidence of these rearrangements in parental or remission blood, suggesting that the leukemia took place in utero.86,87 Finally, in a study of a common chromosomal translocation found in childhood ALL (TEL-AML1), the translocation was found in blood spots collected at birth of children who developed leukemia later in childhood, suggesting that the translocation is insufficient for clinical leukemia and that a postnatal event is also required.88 These molecular studies have important significance for pinpointing the timing of when the initiating event may have occurred.

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