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. 2014 Jun;99(6):1088-94.
doi: 10.3324/haematol.2013.101378. Epub 2014 Mar 21.

The clinical significance of patients' sex in chronic lymphocytic leukemia

Daniel Catovsky  1 , Rachel Wade  2 , Monica Else  3
Affiliations

The clinical significance of patients' sex in chronic lymphocytic leukemia

Daniel Catovsky et al. Haematologica. 2014 Jun.

Abstract

We examined the prognostic influence of gender in chronic lymphocytic leukemia. Data from four randomized trials (involving 1821 patients) and three registration studies of stage-A disease (involving 1299 patients) were analyzed. Overall survival at 10 years was better for women than men in all trials (27% versus 15%; P=0.0001) and in the registration series (55% versus 43%; P<0.0001). More women than men in the trials were Binet stage A-progressive (26% versus 15%), but gender was an independent predictor of survival in multivariate analysis of clinical variables (P<0.0001). Women responded better to treatment (overall response 83%) than men (71%; P<0.0001), within each stage and age group, although fewer women than men received the full treatment dose (79% versus 85%; P=0.01). Women were more likely than men to experience toxicity (85% versus 78%, P=0.01), particularly gastro-intestinal toxicity (57% versus 42%, P<0.0001). Laboratory markers in the LRF CLL4 trial showed a significantly lower incidence in women than men of unmutated IGHV genes, raised beta-2 microglobulin, CD38 and Zap-70 positivity and TP53 deletions/mutations and/or 11q deletions. We also highlight the higher male:female ratios in randomized trials versus studies of early chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis. Chronic lymphocytic leukemia in women runs a more benign clinical course than in men. Gender was also an independent predictor of response, suggesting that pharmacokinetic differences between the sexes and a possible effect of estrogens may contribute to the better outcome. Understanding the reasons for the different outcome by gender may improve patients' management. (LRF CLL4 controlled-trials.com identifier: ISRCTN58585610).

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Figures

Figure 1.
Figure 1.
Analysis of the clinical significance of gender in four randomized trials: CONSORT flow diagram.
Figure 2.
Figure 2.
Overall survival by sex. (A) In all four randomized trials. (B) In the registration series.
Figure 3.
Figure 3.
Overall survival by sex and IGHV mutation status in the LRF CLL4 trial.
See this image and copyright information in PMC

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