Grant Number:	1R21CA317474-01 Interpret this number
Primary Investigator:	Schraw, Jeremy
Organization:	Baylor College Of Medicine
Project Title:	RHECALL: Radiation and Heat in Childhood Acute Lymphoblastic Leukemia
Fiscal Year:	2026

PROJECT SUMMARY Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy in the United States. While five- year survival rates improved dramatically during the last several decades, ALL remains a leading cause of death due to disease in children and the growing population of survivors are at substantially increased risk for second malignant neoplasms and debilitating chronic health conditions. The increasing incidence of ALL and the peak from 2-5 years of age suggest that environmental exposures occurring in early life play a significant role in its initiation and progression, yet these remain poorly understood. Understanding the etiology of ALL will be critical to developing prevention and screening programs that would reduce the impact of this devastating disease. Recent data suggest that exposure to extreme ambient heat or ultraviolet radiation (UV) are associated with ALL, and for UV with specific somatic mutational signatures. However, these studies had methodological limitations and did not directly evaluate whether heat or UV were associated with molecular changes in exposed people. The putative causal roles for these agents in ALL etiology remain matters of ongoing debate. Our objectives are to determine whether exposure to ambient heat or UV radiation are associated with childhood ALL and with specific molecular alterations in germline and somatic samples from children with ALL. We will characterize the associations of exposure to ambient heat and UV with childhood ALL using data on >1,750 cases with ALL and >100,000 controls without cancer identified through the Texas Cancer Registry and Texas Center for Health Statistics. We will identify exposure biomarkers using data and biospecimens collected from a cohort of >1,000 children with ALL. In accomplishing its objectives, our study will: provide robust evidence with which to evaluate whether heat and UV are associated with ALL; characterize the critical exposure period(s); directly evaluate whether heat and UV are associated with changes in the germline and somatic genomes for the first time; and inform future research into risk prediction (and perhaps, prevention) strategies for childhood ALL.





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