Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
J Hematol Oncol. 2009 Jul 24;2:30. doi: 10.1186/1756-8722-2-30.
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.
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 109/l), and significant leukocytosis (WBC >50 x 109/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.
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.
在过去的十年中，人们已经认识到种族、社会经济和性别差异在疾病发病率、诊断和预后方面的重要性。这些领域的差异已成为美国主要的卫生政策重点。我们的研究旨在检查在洛杉矶加大医疗中心就诊的慢性髓细胞白血病（CML）患者的人口统计学和临床特征，该中心服务的人群种族多样。
患者的性别分布均匀，绝大多数为西班牙裔（60.9%），年龄相对较轻（中位数年龄 39 岁，范围 17-65 岁），与之前报道的 CML 患者人群相比。以前的 CML 研究确定了显著贫血（Hgb<12g/dl）、显著血小板增多症（血小板>450x109/L）和显著白细胞增多症（WBC>50x109/L）是显著的不良预处理预后因素。使用这些指标，以及经过验证的 Hasford 和 Sokal 评分，我们按性别和种族对患者进行分层和分析。与男性相比，女性显著贫血（p=0.019，Fisher 确切检验）和显著血小板增多症（p=0.041，Fisher 确切检验）的比例显著更高，尽管在风险分层或治疗反应方面没有差异。女性的 MCV 值显著低于男性（p=0.02，2 样本 t 检验），表明缺铁性贫血。关注种族，总体而言，西班牙裔的 Hasford 风险分层显著较低（p=0.046，Fisher 确切检验），在洛杉矶加大医疗中心，他们获得 3 个月完全血液学缓解（CHR）的可能性显著更大（p=0.016，Fisher 确切检验），而非西班牙裔患者的可能性显著更大，尽管在分析限制为接受一线伊马替尼治疗的患者时，治疗结果的差异不再显著。
与男性相比，洛杉矶加大医疗中心的女性 CML 患者就诊时存在更多显著的不良预处理预后因素，但获得了相当的治疗效果。总体而言，与非西班牙裔患者相比，西班牙裔患者的 CML 具有较低的风险特征，并且对治疗的反应更好；当统计分析仅限于给予伊马替尼作为一线治疗的患者时，这些种族差异不再显著。我们的患者的反应率低于大规模的全国性研究。以前的研究没有报道过这种组合发现，这可能反映了一个独特的患者群体。
