The Institute of Cancer Research, London; The Royal Marsden Hospital, London.
Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds.
Clin Lymphoma Myeloma Leuk. 2021 Oct;21(10):667-675. doi: 10.1016/j.clml.2021.04.013. Epub 2021 Apr 24.
Sex differences in the incidence and outcomes of several cancers are well established. Multiple myeloma (MM) is a malignant plasma cell dyscrasia accounting for 2% of all new cancer cases in the UK. There is a clear sex disparity in MM incidence, with 57% of cases in males and 43% in females. The mechanisms behind this are not well understood and the impact of sex on patient outcomes has not been thoroughly explored.
We investigated the association of sex with baseline disease characteristics and outcome in 3894 patients recruited to the phase III UK NCRI Myeloma XI trial, in which treatment exposure to lenalidomide predominated.
Females were significantly more likely to have the molecular lesions t(14;16) and del(17p) and were more likely to meet the cytogenetic classification of high-risk (HiR) or ultra-high-risk disease (UHiR). There was no difference in progression-free survival (PFS) or overall survival (OS) between the sexes in the overall population.
Our data suggest that the genetic lesions involved in the initiation and progression of MM may be different between the sexes. Although females were more likely to have the poor prognosis lesions t(14;16) and del(17p), and were more likely to be assessed as having HiR or UHiR disease, this was not associated with reduced PFS or OS. In female patients the trial treatment may have been able to overcome some of the adverse effects of high-risk cytogenetic lesions. MicroAbstract Multiple myeloma (MM) is more common in males compared to females but the reasons behind this are not well understood and the impact of sex on patient outcomes is unclear. This study demonstrates fundamental differences in genetic lesions underlying the biology of MM between males and females. However, we found that progression-free survival and overall survival were the same in both sexes.
几种癌症的发病率和结局存在明显的性别差异已得到证实。多发性骨髓瘤（MM）是一种恶性浆细胞异常，占英国所有新发癌症病例的 2%。男性 MM 发病率明显高于女性，为 57%，女性为 43%。其背后的机制尚不清楚，性别对患者结局的影响也未得到充分探讨。
我们研究了 3894 例参加 UK NCRI Myeloma XI 三期临床试验的患者的性别与基线疾病特征和结局的关系，该试验中主要暴露于来那度胺治疗。
女性更有可能具有分子病变 t(14;16)和 del(17p)，更有可能符合高危（HiR）或超高危疾病（UHiR）的细胞遗传学分类。在总体人群中，男女之间无无进展生存期（PFS）或总生存期（OS）差异。
我们的数据表明，MM 起始和进展过程中涉及的遗传病变可能存在性别差异。尽管女性更有可能具有预后不良的病变 t(14;16)和 del(17p)，更有可能被评估为具有 HiR 或 UHiR 疾病，但这与降低 PFS 或 OS 无关。在女性患者中，试验治疗可能能够克服高危细胞遗传学病变的一些不良影响。
