Gender and ethnic differences in chronic myelogenous leukemia prognosis and treatment response: a single-institution retrospective study

Journal of Hematology & Oncology, Jul 2009

Background In the last decade the importance of ethnicity, socio-economic and gender differences in relation to disease incidence, diagnosis, and prognosis has been realized. Differences in these areas have become a major health policy focus in the United States. Our study was undertaken to examine the demographic and clinical features of chronic myelogenous leukemia (CML) patients presenting initially at the LAC+USC Medical Center, which serves an ethnically diverse population. Results Patients were evenly split by gender, overwhelmingly Hispanic (60.9%), and quite young (median age 39, range 17–65) compared with previously reported CML patient populations. Previous CML studies identified significant anemia (Hgb <12 g/dl), significant thrombocytosis (platelets >450 × 109/l), and significant leukocytosis (WBC >50 × 109/l) as significant adverse pretreatment prognostic factors. Using these indicators, in addition to the validated Hasford and Sokal scores, patients were stratified and analyzed via gender and ethnicity. A significantly greater proportion of women presented with significant anemia (p = 0.019, Fisher's exact test) and significant thrombocytosis (p = 0.041, Fisher's exact test) compared to men, although no differences were found in risk stratification or treatment response. MCV values for women were significantly (p = 0.02, 2-sample t-test) lower than those for men, suggesting iron deficiency anemia. Focusing on ethnicity, Hispanics as a whole had significantly lower Hasford risk stratification (p = 0.046, Fisher's exact test), and significantly greater likelihood (p = 0.016, Fisher's exact test) of achieving 3-month complete haematological remission (CHR) compared with non-Hispanics at LAC+USC Medical Center, though differences in treatment outcome were no longer significant with analysis limited to patients treated with first-line imatinib. Conclusion Female CML patients at LAC+USC Medical Center present with more significant adverse pre-treatment prognostic factors compared to men, but achieve comparable outcomes. Hispanic patients present with lower risk profile CML and achieve better treatment responses compared to non-Hispanic patients as a whole; these ethnic differences are no longer significant when statistical analysis is limited to patients given imatinib as first-line therapy. Our patients achieve response rates inferior to those of large-scale national studies. This constellation of findings has not been reported in previous studies, and is likely reflective of a unique patient population.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

http://www.jhoonline.org/content/pdf/1756-8722-2-30.pdf

Gender and ethnic differences in chronic myelogenous leukemia prognosis and treatment response: a single-institution retrospective study

Journal of Hematology & Oncology Gender and ethnic differences in chronic myelogenous leukemia prognosis and treatment response: a single-institution retrospective study Justin P Lee 2 Elliott Birnstein 2 David Masiello 0 1 Dongyun Yang 3 Allen S Yang 0 1 0 The Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases , USC, Los Angeles, California , USA 1 Norris Comprehensive Cancer Center, USC , Los Angeles, California , USA 2 Keck School of Medicine, University of Southern California , Los Angeles, California , USA 3 Department of Preventive Medicine, USC/Norris Comprehensive Cancer Center , Los Angeles, California , USA Background: In the last decade the importance of ethnicity, socio-economic and gender differences in relation to disease incidence, diagnosis, and prognosis has been realized. Differences in these areas have become a major health policy focus in the United States. Our study was undertaken to examine the demographic and clinical features of chronic myelogenous leukemia (CML) patients presenting initially at the LAC+USC Medical Center, which serves an ethnically diverse population. Results: Patients were evenly split by gender, overwhelmingly Hispanic (60.9%), and quite young (median age 39, range 17-65) compared with previously reported CML patient populations. Previous CML studies identified significant anemia (Hgb <12 g/dl), significant thrombocytosis (platelets >450 109/l), and significant leukocytosis (WBC >50 109/l) as significant adverse pretreatment prognostic factors. Using these indicators, in addition to the validated Hasford and Sokal scores, patients were stratified and analyzed via gender and ethnicity. A significantly greater proportion of women presented with significant anemia (p = 0.019, Fisher's exact test) and significant thrombocytosis (p = 0.041, Fisher's exact test) compared to men, although no differences were found in risk stratification or treatment response. MCV values for women were significantly (p = 0.02, 2-sample t-test) lower than those for men, suggesting iron deficiency anemia. Focusing on ethnicity, Hispanics as a whole had significantly lower Hasford risk stratification (p = 0.046, Fisher's exact test), and significantly greater likelihood (p = 0.016, Fisher's exact test) of achieving 3-month complete haematological remission (CHR) compared with nonHispanics at LAC+USC Medical Center, though differences in treatment outcome were no longer significant with analysis limited to patients treated with first-line imatinib. Conclusion: Female CML patients at LAC+USC Medical Center present with more significant adverse pretreatment prognostic factors compared to men, but achieve comparable outcomes. Hispanic patients present with lower risk profile CML and achieve better treatment responses compared to non-Hispanic patients as a whole; these ethnic differences are no longer significant when statistical analysis is limited to patients given imatinib as first-line therapy. Our patients achieve response rates inferior to those of large-scale national studies. This constellation of findings has not been reported in previous studies, and is likely reflective of a unique patient population. - Background In the last decade the importance of ethnicity, socio-economic and gender differences in relation to disease incidence, diagnosis, and prognosis has been realized. Differences in these areas have become a major health policy focus in the United States. Several studies have addressed ethnic differences in the behavior and mortality of prostate cancer and breast cancer and have been able to demonstrate a trend toward more aggressive disease in an African-American population when compared to a Caucasian-non Hispanic population [1-6]. Studies have also shown that uninsured and poorer patients are far more likely to have advanced disease when diagnosed with cancer compared to those with private coverage [1]. Using SEER registry data, there is a known higher incidence of ALL among the Hispanic population, while there is a lower incidence of acute myelogenous leukaemia (AML) and chronic myelogenous leukaemia (CML) in the Hispanic population [7]. Additionally it has been shown that there is a higher incidence of acute promyelocytic leukaemia (APL) in the Hispanic population when compared to a non-Hispanic population [8]. CML is a clonal myeloproliferative malignancy caused by a specific chromosomal translocation involving chromosomes 9 and 22, giving rise to the "Philadelphia Chromosome," which fuses the two genes bcr and abl [9-14]. There are approximately 4500 patients diagnosed with CML every year in the United States, accounting for 15% of all new leukemias [14]. The median age of patients at presentation is 4555 years old, with a slight male predominance [14]. The disease historically was characterized by an ordered progression from a chronic phase, to accelerated phase, to finally an acute "blastic" phase followed by death. Key breakthro (...truncated)


This is a preview of a remote PDF: http://www.jhoonline.org/content/pdf/1756-8722-2-30.pdf

Justin P Lee, Elliott Birnstein, David Masiello, Dongyun Yang, Allen S Yang. Gender and ethnic differences in chronic myelogenous leukemia prognosis and treatment response: a single-institution retrospective study, Journal of Hematology & Oncology, 2009, pp. 30, 2, DOI: 10.1186/1756-8722-2-30