Sex Variability in Pediatric Leukemia Survival: Large Cohort Evidence

Abstract

<jats:p><jats:italic>Purpose</jats:italic>. Sex disparities in pediatric leukemia have been previously reported, and male children continue to present with poorer survival. However, the observed disparities are not fully understood. This current study sought to examine disparities in survival by the sex, and to determine if tumor prognostic factors impact on these disparities.<jats:italic>Patients and Methods</jats:italic>. We used the Surveillance Epidemiology and End Results dataset of pediatric leukemia patients (ages 0–19 years) diagnosed in the United States from 1973 to 2006. There were 15,215 patients of whom 8,622 (65.7%) were boys and 6,593 (43.3%) were girls. The Kaplan-Meier survival estimates, log rank test, and Cox proportional hazard methods were used to assess the data.<jats:italic>Results</jats:italic>. The overall (both sexes) five-year survival rate was 67.9%. Girls had a survival rate of 70.1%, while the rate was 66.3% in boys. Girls had a significant 14% decreased risk of dying relative to boys, hazard ratio (HR) = 0.86, 99% CI = 0.80–0.93. There were significant differences between boys and girls with respect to tumor cell type, race, age at diagnosis, year of diagnosis, and number of primaries,<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mi>P</mml:mi><mml:mo>&lt;</mml:mo><mml:mn>0.001</mml:mn></mml:mrow></mml:math>. After controlling for these factors, the sex differences in survival persisted, with girls still less likely to die from leukemia compared to boys, adjusted HR (AHR) = 0.85, 99% CI = 0.72–1.00,<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mi>P</mml:mi><mml:mo>&lt;</mml:mo><mml:mn>0.01</mml:mn></mml:mrow></mml:math>.<jats:italic>Conclusion</jats:italic>. In a large population-based pediatric leukemia study, boys continued to show poorer survival. These disparities were not completely explained by treatment received, tumor prognostic or socio-demographic factors.</jats:p>

Survival among children diagnosed with acute lymphoblastic leukemia in the United States, by race and age, 2001 to 2009: Findings from the CONCORD‐2 study

“…The current finding that survival differences in race were most pronounced at age <1 year or >4 years needs further study. 37 We also observed that, as previously reported, 38 boys have lower survival from ALL than girls. This sex difference was more marked in infants, for whom survival was the lowest, and it remained in the most recent period (2004-2009).…”

Clinical, hematological, and laboratory presentation of acute lymphoblastic leukemia of children in Diyala province/Eastern Iraq

“…16,18,19 In this study, ALL incidence was observed more in male gender (M: F= 1.3:1) matching the finding of further studies, whereas it reached 1.84:1 in others. 11,15,[20][21][22] The commonest complaint of the study patients was fever, followed by bone pain, weight loss, and fatigability, these were consistent with findings by other studies. 23,24 Bone pain was presented in 22 patients (40%), it was variably reported by many studies (19-67%), Joint pain was present in one (1.8%) patient only (ankle joint), whereas it was presented more (6-9.3%) by other studies.…”

Improving outcome of acute lymphoblastic leukemia with a simplified protocol: report from a tertiary care center in north India

“…Females had a 1.46 higher chance of dying ( P = 0.04) in our cohort. Conflicting reports are available regarding association of gender and mortality . Meeske et al.…”