Klin Padiatr 2017; 229(03): 182-195
DOI: 10.1055/s-0037-1602193
Top 1 Acute and chronic leukaemias
Georg Thieme Verlag KG Stuttgart · New York

Prognostic Impact of Sex in Pediatric ALL in three consecutive ALL-BFM trials

A Claviez
1   Pediatrics, University Hospital Schleswig-Holstein, Kiel
,
N Brinkmeier
1   Pediatrics, University Hospital Schleswig-Holstein, Kiel
,
M Zimmermann
2   Ped. Hematology and Oncology, Medical School Hannover, Hannover
,
M Stanulla
2   Ped. Hematology and Oncology, Medical School Hannover, Hannover
,
M Schrappe
1   Pediatrics, University Hospital Schleswig-Holstein, Kiel
,
A Möricke
1   Pediatrics, University Hospital Schleswig-Holstein, Kiel
› Author Affiliations
Further Information

Publication History

Publication Date:
30 May 2017 (online)

Also available ateRef
 
 

    Introduction:

    Sex has early been recognized as prognostic factor in acute lymphoblastic leukemia (ALL) with inferior outcome for boys.

    Methods:

    8256 patients treated in the consecutive ALL trials ALL-BFM 90, 95 and 2000 were analyzed for the significance of sex with respect to clinical/biological features, response, relapses and toxicity.

    Results:

    The male/female ratio was 1.18 in 7115 pB-ALL and 2.67 in 1141 T-ALL patients. No sex-related differences were shown for initial patient characteristics (age, WBC, genetics), but a tendency to worse molecular treatment response was seen in boys among pB-ALL. Boys with pB-ALL had a significantly higher 6y-cumulative relapse incidence (CIR) than girls but a steady improvement over the 3 trials (20.1%, 17.6% and 14.3% in ALL-BFM 90, 95 and 2000) whereas girls did not (12.4%, 13.8% and 11.2% in ALL-BFM 90, 95 and 2000). Treatment-related mortality (TRM) was significantly higher in girls due to greater susceptibility to severe infections. Among T-ALL, CIR decreased significantly over the trials without difference between the sexes.

    Conclusions:

    Significant overall relapse reduction has been achieved over the 3 ALL-BFM trials, but no improvement was attained for girls with pB-ALL. Together with higher TRM in girls, this led to similar EFS rates of girls and boys in the most recent trial ALL-BFM 2000.


     

    No conflict of interest has been declared by the author(s).