Sex differences in adults with acute myeloid leukemia and the impact of sex on overall survival

• Published in: Cancer medicine (Malden, MA) MA), 2023-03, Vol.12 (6), p.6711-6721
• Main Authors: Stabellini, Nickolas, Tomlinson, Benjamin, Cullen, Jennifer, Shanahan, John, Waite, Kristin, Montero, Alberto J., Barnholtz‐Sloan, Jill S., Hamerschlak, Nelson
• Format: Article
• Language: English
• Subjects: Acute myeloid leukemia; Adult; AML; Bone marrow; Cancer therapies; Chemotherapy; Death; Dementia; Demographics; Electronic health records; Ethnicity; Female; Gender differences; Hospitalization; Hospitals; Humans; Immunotherapy; Incidence; Leukemia; Leukemia, Myeloid, Acute - epidemiology; Leukemia, Myeloid, Acute - genetics; Leukemia, Myeloid, Acute - therapy; Lymphoma; Male; Males; Medical diagnosis; Medical prognosis; Mortality; Mutation; Patients; Population; Sensitivity analysis; Sex Characteristics; Sex differences; Sexes; Software; Survival; Transplants & implants; treatment; treatment adverse events; Variables
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.5461

Background There is a male predominance of acute myeloid leukemia (AML) incidence, but survival data are conflicting. The objective of this study is to carry out a comprehensive analysis of sex differences in AML, and to investigate the impact of sex disparities in survival. Methods The cohort included patients ≥18 years diagnosed with AML (2010–2022). Demographics, treatment patterns, treatment adverse events, and survival were analyzed. The population was described and compared by sex, and sex‐based risks and associations were obtained via Cox proportional‐hazards regression. Results In total, 1020 AML patients were analyzed (57.4% males), with lower risk of death for females (aHR = 0.41, 95% CI 0.26–0.66). Among females, BMT (aHR = 0.51, 95% CI 0.27–0.97), hospitalization record (aHR = 0.65, 95%CI 0.45–0.93), and higher appointment completion rates (aHR = 0.98, 95% CI 0.98–0.98) were associated with lower risk of death. Overall, and similarly in males, higher age at diagnosis (aHR = 1.03, 95% CI 1.02–1.04) and a TP53 mutation (aHR = 2.24, 95% CI 1.69–2.97) were associated with higher risk of death. Conclusion Sex differences exist in both AML incidence and overall survival. Treatment and health care factors should be addressed by caregivers and public policies developed to reduce mortality rates and mitigate existing sex differences. This study, focused on sex differences in acute myeloid leukemia, reported a 1.34 male:female ratio with a later start of treatment and lower treatment adherence rates in females. Bone marrow transplant, hospitalization, and higher treatment completion rates were associated with lower risk of death in females. In patients with a hospitalization record, females were 39% less likely to receive chemotherapy, 160% more likely to have a chemotherapy adverse event, and had a 59% lower risk of death.