Benzene-contaminated toluene and acute myeloid leukemia: a case series and review of literature

Case-Control Study of Occupational Acute Myeloid Leukemia in the Republic of Korea

Background

We conducted a case-control study to identify high-risk occupations and exposure to occupational hazards for acute myeloid leukemia (AML).

Methods

When patients with AML admitted to the Department of Hematology in the study hospital for the first time are referred to the Department of Occupational and Environmental Medicine, data on occupation are collected by investigators to evaluate work-relatedness. Community-based controls were recruited through an online survey agency, and four controls per case were matched. Occupational information was estimated using structured questionnaires covering 27 specific occupations and 32 exposure agents. Conditional logistic regression analysis was performed by pairing cases and controls.

Results

In the analysis of the risk of AML according to occupational classification, a significant association was found in paint manufacturing or painting work (OR = 2.22, 95% CI: 1.03-4.81) and aircrew (OR = 6.00, 95% CI: 1.00-35.91) in males, and in pesticide industry (OR = 6.89, 95% CI: 1.69-28.07) and cokes and steel industry (OR = 2.00, 95% CI: 1.18-22.06) in ≥60 years old. Moreover, the risk of AML increased significantly as the cumulative exposure to thinners increased. In the analyses stratified by sex and age, the association between pesticide exposure and AML was significant in males (OR = 3.28, 95% CI: 1.10-9.77) and in ≥60 years old (OR = 6.22, 95% CI: 1.48-26.08).

Conclusion

This case-control study identified high-risk occupational groups in the Republic of Korea including paint manufacturers and painters, aircrew, and those who are occupationally exposed to pesticides or paint thinners.

Actividades económicas, laborales, ambientales y aditivas con exposición a benceno y el desarrollo de leucemia mieloide aguda

Introducción: el benceno es un hidrocarburo aromático obtenido por destilación del alquitrán utilizado en gasolineras y como solvente industrial, clasificado como cancerígeno por exposición ocupacional o ambiental. Está relacionado con el desarrollo de leucemia mieloide aguda (LMA) por su absorción principal por vía inhalatoria, y su metabolismo hepático con producción de benzoquinona de alta liposolubilidad que le permite depositarse en la médula ósea y tejido graso. Objetivo: analizar la asociación de las formas de exposición por actividades económicas, oficios, cargos, exposición ambiental y aditiva con el desarrollo de   LMA. Materiales y métodos: revisión sistemática de la literatura en las bases de datos Medline, Embase, Lilacs, Cochrane Library, Toxnet y OpenGrey, en inglés y español con los términos benzene, cancer, leukemia, occupational and enviromental exposition. Resultados: la mayoría de los estudios muestran una relación causal entre la exposición a benceno y el desarrollo de LMA, con predominio en ambientes laborales, seguidos de factores ambientales y aditivos como el humo del cigarrillo. Conclusiones: se encontró evidencia de asociación entre la exposición a benceno ocupacional y/o ambiental con el desarrollo de leucemia mieloide aguda, debido a que altera el estrés oxidativo y la desregulación del aryl hidrocarburo generando efectos citogenéticos, mutación genética y alteraciones epigenéticas que se expresan en hematotoxicidad y desarrollo de leucemia.

Ongoing risk of bladder cancer among former workers at the last benzidine manufacturing facility in the USA

OBJECTIVE

To determine whether there is an ongoing risk of developing bladder cancer in a previously studied cohort of workers exposed to both benzidine and dichlorobenzidine or dichlorobenzidine only in the last benzidine manufacturing plant in the USA.

METHODS

Workers (n=488) were identified from the quarterly 941 forms the employer was required to submit to the Social Security Administration from 1960 to 1977. Exposures were assigned based on dates worked and known benzidine/dichlorobenzidine production schedules. Incidence, vital status and cause of death were determined through 2014. Analyses were restricted to white men.

RESULTS

Bladder cancer incidence and mortality were significantly increased (25 incident cases, standardised incidence ratio (SIR) 2.19, 95% CI 1.42 to 3.23, and 5 deaths, standardised mortality ratio (SMR) 3.79, 95% CI 1.23 to 8.84). There were significant increases in incidence and mortality in those exposed to both benzidine and dichlorobenzidine (SIR 3.11, 95% CI 1.97 to 4.67, SMR 4.10, 95% CI 1.12 to 10.50), but not among workers exposed to dichlorobenzidine only (two incident cases, SIR 0.89, 95% CI 0.11 to 3.23 and one death, SMR 2.90, 95% CI 0.07 to 16.15). Bladder cancer incidence and mortality were increased in individuals with >20 years since last exposure with >5 years worked (six observed, SIR 5.94, 95% CI 2.18 to 12.92 and two deaths, SMR 7.93, 95% CI 0.96 to 28.65).

CONCLUSIONS

Incidence and mortality due to bladder cancer increased among workers exposed to benzidine but not among workers exposed only to dichlorobenzidine. The risk of incidence and death from bladder cancer remain elevated more than 20 years after last exposure to benzidine in those who worked >5 years.

Technical note: Residues of gaseous air pollutants in rabbit (Oryctolagus cuniculus) tissues

The modern consumer is concerned not only for meat quality, but also about animal welfare and the environment. Studies were conducted to determine the concentration of gaseous residues in the tissues of rabbits. For this purpose, gaseous air pollutants were measured at the height of rabbit cages. Immediately after slaughter, samples were taken for analysis to determine the level of residual pollutants in the tissues (blood, perirenal fat and lung). Headspace gas chromatography was performed on the tissue samples to test for volatile toxic substances. Gas residues of 11 compounds were determined in the samples of blood, perirenal fat and lungs. The same chemicals were present in the air of the farm and the animal tissues, which may indicate their capacity for bioaccumulation. We recommend that the results should be used to develop guidelines regarding the welfare of meat rabbits and requirements for laboratory rabbits.

Exposure to Mixtures of Pollutants in Mexican Children from Marginalized Urban Areas

Background:

Exposure to contaminant mixtures in developing countries is an important public health issue. Children are identified as the most susceptible group to adverse health effects due to the exposure.

Objective:

The aim of this study was to conduct a screening for mixture pollutants in Mexican children in urban marginalized communities.

Methods:

We analyzed children (aged 6–12 years old) who resided in four urban marginalized communities in San Luis Potosi, Mexico: i) Bellas Lomas (BEL), a site with vehicular traffic; ii) Tercera Chica (TC), a site with brick kilns; Iii) Rincon de San Jose (SJR), a site with a hazardous waste landfill; and (iv) Morales (MOR) a metallurgical zone with copper-arsenic and electrolytic zinc smelters. Polycyclic Aromatic Hydrocarbons (1-hydroxypyrene (1-OHP)), benzene (trans, trans-muconic acid (t,t-MA), manganese, arsenic and fluoride were quantified in urine and lead in blood samples.

Findings:

Our results indicate that median exposures to manganese were 4.4, 5.2, 5.8 and 6.3 µg/L for BEL, TC, SJR and MOR, respectively. For BEL, fluoride was present at a higher concentration with 2.3 mg/L followed by MOR, TC and SJR with 1.7, 1.5 and 1.2 mg/L respectively. The highest concentrations of arsenic that were found were 11 µg/L in MOR and lead concentration was reported between 4.2 and 6.8 µg/dL, in BEL, TC and MOR. 1-OHP and t,t-MA were higher in TC (0.23 µmol/mol creatinine (cr), 429.7 µg/g cr, respectively) followed by SJR (0.09 µmol/mol cr, 427.4 µg/g cr), MOR (0.03 µmol/mol cr, 258.6 µg/g cr) and BEL (0.06 µmol/mol cr, 220.6 µg/g cr).

Conclusion:

Considering the large number of people, especially children, exposed to multiple pollutants, it is important to design effective intervention programs that reduce exposure and the resultant risk in the numerous urban marginalized communities in Mexico.

Aberrant promoter methylation in genes related to hematopoietic malignancy in workers exposed to a VOC mixture

Occupational exposure to volatile organic compounds (VOCs) may cause hematopoietic malignancy, either by single exposure to benzene or possibly due to a concomitant exposure to several VOCs. Since oxidative stress, inflammation and DNA repair pathways are closely involved in cancer development, the effect of VOC exposure on expression of proteins involved in these pathways has been studied, but epigenetic changes have not been well described. Here, DNA methylation status following occupational exposure to a VOC mixture was assessed by bisulfite sequencing of the promoter regions of seven genes involved in the mentioned pathways. Peripheral blood samples and individual-level VOC exposure data were obtained from healthy leather shoe factory workers (LS, n=40) and gas station attendants (GS, n=36), as well as a reference group of university employees (C, n=66). Exposure levels for acetone, ethylbenzene, methyl ethyl ketone, n-hexane, toluene and xylene were higher in LS (p<0.001); benzene and methyl acetate levels were higher in GS (p<0.001). TOP2A, SOD1, and TNF-α promoter methylation status was increased in LS (p<0.05). In LS, we also found significant correlations between GSTP1 promoter methylation and both iNOS (r=0.37, p=0.008) and COX-2 (r=-0.38, p=0.007) methylation. In exposed groups, ethylbenzene exposure levels showed a significant correlation with TOP2A methylation (β=0.33). Our results show early, toxic effects at the epigenetic level caused by occupational exposure to high levels of a VOC mixture. These subcellular modifications may represent the initial mechanism of toxicity leading to hematopoietic malignancy, possibly due to a synergistic, hematotoxic effect of VOC mixtures.