Gender and ethnic differences in chronic myelogenous leukemia prognosis and treatment response: a single-institution retrospective study
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 x 10^9/l), and significant leukocytosis (WBC >50 x 10^9/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.
Conclusions: 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.
Author: Justin LeeElliott BirnsteinDavid MasielloDongyun YangAllen Yang
Credits/Source: Journal of Hematology &Oncology 2009, 2:30
Published on: 2009-07-24
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
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