Estimation of the exposure response relation between benzene and acute myeloid leukemia by combining epidemiological, human biomarker, and animal data

Background Chemical risk assessment can benefit from integrating data across multiple evidence bases, especially in exposure-response cure (ERC) modelling when data across the exposure range is sparse. Methods We estimated the ERC for benzene and acute myeloid leukemia (AML), by fitting linear and spline-based Bayesian meta-regression models that included summary risk estimates from non-AML and non-human studies as prior information. Our complete dataset included six human AML studies, three human leukemia studies, ten human biomarker studies, and four experimental animal studies. Results A linear meta-regression model with intercept best predicted AML risks after cross-validation, both for the full dataset and AML studies only. Risk estimates in the low exposure range (<40 ppm yrs) from this model were comparable, but more precise, when the ERC was derived using all available data than when using AML data only. Allowing for between-study heterogeneity, RRs and 95% prediction intervals [95%PI] at 5 ppm years were 1.58 [1.01, 3.22]) and 1.44 [0.85, 3.42], respectively. Conclusions Integrating the available epidemiological, biomarker, and animal data resulted in more precise risk estimates for benzene exposure and AML, although the large between-study heterogeneity hampers interpretation of these results. The harmonization steps required to fit the Bayesian meta-regression model involve a range of assumptions that need to be critically evaluated, as they seem crucial for successful implementation. Impact By describing a framework for data-integration and explicitly describing the necessary data harmonization steps, we hope to enable risk assessors to better understand the advantages and assumptions underlying a data integration approach.