Gender aspects in chronic myeloid leukemia: long-term results from randomized studies

Abstract

Gender-related aspects in chronic myeloid leukemia (CML) have not been studied well. We therefore analyzed 856 patients with Ph/BCR-ABL-positive CML from the German randomized CML-studies I (interferon a (IFN) vs hydroxyurea (HU) vs busulfan) and II (IFN þ HU vs HU alone). The median observation time was 8.6 years. A total of 503 patients (59%) were male. Female patients were older (51 vs 46 years; Po0.0001), presented with lower hemoglobin (11.7 vs 12.5 g/dl; Po0.0001), higher platelet counts (459 vs 355 Â 10 9 /l; Po0.0001), smaller spleen size (3 vs 4 cm below costal margin; P ¼ 0.0097), a lower rate of additional cytogenetic aberrations (9 vs 15%; P ¼ 0.018) and a less favorable risk profile (P ¼ 0.036). The transplantation rate was 14% for female (n ¼ 48) and 22% for male patients (n ¼ 113). Median survival was longer in female patients (58 vs 49 months; P ¼ 0.035) mainly attributable to better survival in the low-and intermediate-risk groups and, independent from risk groups, in the HU group. These results were confirmed by matched-pair analyses based on German population data (n ¼ 496, 59 vs 45 months; P ¼ 0.0006). This is the first analysis of gender aspects in CML using randomized trials. It demonstrates the relevance of analyses of gender differences in CML and in malignant disease at large.

Myeloma in patients younger than age 50 years presents with more favorable features and shows better survival: an analysis of 10 549 patients from the International Myeloma Working Group

“…21 Whether increased androgenic sex hormone levels in young males do account for the preponderance of multiple myeloma in very young male adults, however, remains speculative as yet. Overall survival, however, did not differ between male and female patients, which is in contrast to several other cancers such as chronic myeloid leukemia, 22 acute myeloid leukemia, 23 and others that show significantly longer survival in female patients.…”

Sex and Gender Differences in Hematology

“…59 Despite presenting with a less favorable risk profile, female patients have been shown to respond better to therapy than males and resulted with a significantly better overall survival in earlier trials and at least comparable outcomes in more recent studies. 59,60 In contrast, there is emerging evidence at least in a t(8;21)-positive subgroup of pediatric patients with acute myeloid leukemia (AML), that male gender is a positive prognostic factor for survival. 61 Other studies have not shown any gender difference concerning outcome in adult AML patients.…”

Gender Differences in UVB-Induced Skin Carcinogenesis, Inflammation, and DNA Damage

“…For example, recent studies suggest that women may be more susceptible to tobacco-induced lung cancer (26). There have also been reported gender differences in the development of chronic myeloid leukemia (27), colon cancer (28), multiple sclerosis (29), and diabetic cardiomyopathy (30). A report of the Surveillance, Epidemiology and End Results program of the National Cancer Institute revealed the cancer incidence for all sites to be greater in males compared with females, and the cancer mortality rate is similarly higher in males (31).…”