Poster Session I: Acute lymphoblastic leukemia - Clinical
Prolonged exposure and overexposure to depleted uranium (DU) is leukemogenic and genotoxic due to its radiological (alpha particle) and chemical (metal) components. The use of DU in the 1999 Kosovo War raised concern about the increase of new cases of leukemia.
The aim of this study was twofold: 1) to analyze the incidence rates of leukemia in Kosovo in the pre-war (1995-1998) and two post- war periods (2000-2003 and 2012-2015); and 2) to examine if there is any association between the use of DU rounds and incidence rates of leukemia in different regions of Kosovo.
Patients diagnosed with leukemia in the University Clinical Centre of Kosovo for the period 1995-2015 were subject of this study. Annual incidence crude rates per 100,000 persons/year were calculated for seven regions of Kosova in three periods (1995-1998, 2000-2003 and 2012-2015). The number of DU rounds by region was determined from accurate NATO records containing geographic coordinates. Regional distribution, difference in incidence between pre-war period and first and last post-war period were calculated. In addition, to examine possible links between the presence of DU ordnance and incidence rates of leukemia, we analyzed the correlation between rounds/km2 and average annual incidence rates in the 27 municipalities.
Difference of incidence rates between the pre-war (1995-1998) and the first post-war period (2000-2003) for the entire territory of Kosovo shows that leukemia increased by 12.63% whereas between pre-war and last post war period by 68.95% (Table 1). Region of Gjakova and Peja, the first and third most exposed regions to DU ordnance (7.73 rounds/km2 and 4.78 rounds/km2 respectively) ranked first and second in difference in leukemia incidence whereas Prishtina, Gjilan and Ferizaj, regions with the least number of rounds/km2, were characterized by declining in incidence rates of leukemia. After 15 years, still the difference in leukemia between pre-war period and the last post-war period remains larger in Gjakova and Peja.
In the first post-war period (2000-2003), significant moderate Spearman correlation was found between the DU rounds/km2 and cases of leukemia (Figure 1).
Figure 1. Correlation between rounds/km2 and annual average incidence rates by municipalities for leukemia in the period 2000-2003. Data was analysed using the Spearman correlation test and significance accepted when p < 0.05.
The rise in incidence of leukemia in Kosovo may be partially induced by the use of DU during the war, but further studies are needed to explore this.