Premium
Comparative Toxicity by Sex Among Children Treated for Acute Lymphoblastic Leukemia: A Report From the Children's Oncology Group
Author(s) -
Meeske Kathleen A.,
Ji Lingyun,
Freyer David R.,
Gay Paul,
Ruccione Kathleen,
Butturini Anna,
Avramis Vassilios I.,
Siegel Stuart,
Matloub Yousif,
Seibel Nita L.,
Sposto Richard
Publication year - 2015
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.25628
Subject(s) - medicine , incidence (geometry) , hazard ratio , lymphoblastic leukemia , cumulative incidence , survivorship curve , cancer , toxicity , acute lymphocytic leukemia , pediatrics , leukemia , confidence interval , cohort , physics , optics
Background Epidemiologic studies find sex‐based differences in incidence, survival, and long‐term outcomes for children with cancer. The purpose of this study was to determine whether male and female patients differ with regard to acute treatment‐related toxicities. Procedures We reviewed data collected on the Children's cancer group (CCG) high‐risk acute lymphoblastic leukemia (ALL‐HR) study (CCG‐1961), and compared male and female patients' toxicity incidence and related variables in the first four phases of treatment. Similar analyses were performed with standard‐risk ALL (ALL‐SR) patients enrolled in CCG‐1991. Results Among ALL‐HR patients, females had significantly more hospital days, delays in therapy, grade 3 or 4 toxicities (e.g., gastrointestinal, liver), and supportive care interventions (e.g., transfusions, intravenous antibiotics) than males. Females were significantly more likely to have died of treatment‐related causes than males (Hazard ratio = 2.8, 95%CI = 1.5–5.3, P = 0.002). Five months after beginning the treatment, the cumulative incidence of treatment‐related deaths was 2.6% for females and 1.2% for males. Similar disparities were found among ALL‐SR patients, with females experiencing significantly more hospital days and treatment‐related toxicities than males. Conclusions This study complements cancer survivorship studies that also report an increase in treatment‐related late effects among females. Risk profiles appear to be different for male and female patients, with females having greater risk of developing both acute and long‐term treatment‐related toxicities. The underlying biological mechanisms for these sex differences are poorly understood and warrant further study in order to determine how sex‐based outcome disparities can be addressed in future clinical trials and practice. Pediatr Blood Cancer 2015;9999:1–10. © 2015 Wiley Periodicals, Inc.