Sex, fertility and acute myeloid leukaemia (AML)

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    Fertility after AML treatment
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    Sex variation has been persistently investigated in studies concerning acute myeloid leukemia AML survival outcomes but sex not been fully explored among pediatric and young adult AML patients. We detected sex difference in the survival of AML patients diagnosed at ages aml and explored distinct effects of sex across subgroups of age at diagnosis, race-ethnicity and AML subtypes utilizing the United States Surveillance Epidemiology and End Results SEER population based dataset of 4, patients diagnosed with AML between and Kaplan-Meier survival function, propensity scores and stratified Cox proportional hazards regression were used for data analyses.

    Compared to females, male patients had sex increased risk of mortality in the following subgroups of: ages years at diagnosis aHR1. In contrast, males with AML t 9;11 p22;q23AML with maturation and age at diagnosis of years showed survival benefit. Further investigations are needed to detect the biological processes influencing the mechanisms of these interactions.

    Acute myeloid leukemia AML is a heterogeneous disease with marked variation in both response to therapy and survival [ 12 ]. AML is more frequent in adults than in children [ 34 ]. Prognostic factors sex to date include morphology [ 56 ], immunophenotype [ 78 ], molecular and cytogenetic markers [ 9 - 12 ], as well as host factors such as age at diagnosis [ 1314 ], race-ethnicity [ 15 - 17 ], sex [ 1819 ] and socio-economic status [ 2021 ]. AML survival in all age groups, including childhood and young adult patients, has dramatically improved in recent decades [ 22 - 26 ].

    Contributing factors to the improved survival include advancements in the diagnosis of AML, as well as refinements in the risk-stratified treatment mainly based on age and AML subtype categorized by morphology and cytogenetics [ 527 ]. Although not often used for therapeutic risk classification, race-ethnicity is another significant prognostic factor of AML outcome in pediatric and young adult patients in the US; African American and Hispanic patients have a significantly worse outcome than Caucasian counterparts [ 17 ].

    Besides these factors, sex has been the most frequently investigated patient characteristic of pediatric and young adult AML survival in the literature. However, the exploration of the effect of sex and its interaction with other prognostic factors has been limited. Potential reasons could include the lack of adequate focus or the use of a data set not sufficiently large aml optimal characterization.

    Synthesis of current findings of most studies leads to the speculation that females have survival advantage over their male counterparts, and survival patterns differ between the sexes in different subgroups of age at diagnosis, race-ethnicity and AML subtypes [ 5 - 31 ].

    Published reports are limited to explain the reason behind this association and inadequate to characterize the extent of the survival variability by sex in pediatric and young adult AML patients as well as in different subgroups of these patients. Further research is warranted to quantify the effect aml sex in different prognostic groups of pediatric and young adult AML patients using a large dataset. In this study, we have characterized the extent of the association of sex and the survival patterns of AML patients diagnosed between ages years in the US, using the Surveillance Epidemiology and End Result SEER dataset between and We have quantified this association for the overall population as well as for subgroups across age at diagnosis, race-ethnicities and cytogenetic- and morphologic-based AML subtypes.

    The SEER program of the National Cancer Institute is the most comprehensive and reliable source of population-based information in the US on cancer incidence sex survival and provides a large dataset that is ideal for an epidemiological investigation like ours [ 3233 ].

    Patients in the SEER dataset are diagnosed over many years and are at varying risk of mortality at the time of diagnosis as survival improved over time. We stratified the analysis by five-year intervals of year of diagnosis to account for the time-varying survival pattern. This study utilized case listings of pediatric years and young adult years, by UN definition [ 34 aml AML patients from 17 SEER registries between and The SEER covered population is comparable to the general US population with regards to sex, race-ethnicity, and measures of poverty and aml [ 35 ].

    We identified 4, AML patients aged 0 to 24 years at the time of diagnosis. Excluding 14 children with missing follow-up time, a total of 4, subjects were used for the analysis. The detail descriptions of these variables and categorizations are consistent with our previous publication [ 37 ].

    Year of AML diagnosis was grouped into 5-year intervals:,, Fourteen patients were from Alaska, and the hazard rate in this region was comparable to that in the Pacific Coast, so we collapsed data from these two regions. The follow-up time was documented as the duration from the time of diagnosis to death or the last day of the available survival information in the SEER registry.

    The distribution of pediatric and young aml AML patients and their overall mortality were summarized by sex and other study variables. Sex survival curve was used to compare the crude probability of survival over sex since diagnosis between males and females.

    A univariable Cox proportional hazard model was used sex determine the association of sex and other study variables with the risk of mortality; the model was stratified by the year of diagnosis to account for the time-varying survival pattern.

    A stratified multivariable Cox proportional hazard model was used to determine the association between sex and mortality in pediatric and young adult AML patients after adjustment for significant prognostic factors identified in the univariable model. In addition aml sex, age at diagnosis, race-ethnicity, number of primaries, radiation, AML subtype, percent families with income below poverty in county and geographic region were used in the model.

    The rationale and the method of the stratified Cox proportional hazards model are previously described [ 37 ]. To assess the effect of sex in different subgroups of age at diagnosis, race-ethnicities and AML subtypes of pediatric and young adult AML patients, we performed Kaplan-Meier survival analysis and propensity scores adjusted Cox-proportional hazards model on the dataset of each subgroup [ 38 ].

    Out of the three above factors, two were used as covariates to estimate propensity scores for the subgroup analysis involving the other factor. For example, race-ethnicity and AML subtypes were used as covariates to estimate propensity scores for the subgroup analysis involving age at diagnosis. Because of the small number of patients in some subgroups, propensity score of covariates was used for the adjustment instead of the covariates themselves.

    For Kaplan-Meier plots, data were merged for subgroups with homogeneous distributions of the crude probability of survivals. All analyses were two-tailed with the level of significance of 0. The statistical software SAS 9. Table 1 characterized the study variables by sex. No substantial differences were observed in the distributions of male and female patients over age at diagnosis, race-ethnicity, number of primaries, receipt of radiation, geographic region and county poverty level.

    Table 2 presented the distribution of mortality by sex and study variables, as well as hazard ratios HR associated with study variables, estimated using stratified Cox proportional hazards model. In terms of aml at diagnosis, patients diagnosed during ages and years exhibited the lowest 0.

    Hazard risk of mortality increased monotonically in children diagnosed up to 9 years of age and decreased monotonically thereafter. The hazard risk of mortality was significantly different across AML subtypes. In addition, patients with multiple primaries, counties with higher percentage of families below poverty and the Southwest CHSDA region were associated with higher risk of mortality. Table 3 demonstrated the association of sex with mortality after adjusting for other risk factors.

    The adjusted hazard ratios aHR of mortality associated with sex and other prognostic factors were estimated using a multivariable Cox proportional hazards regression model stratified by year of diagnosis intervals. The significant difference between the sexes in the unadjusted model persisted after adjustment for the effect of other risk and protective factors on the relationship between sex and overall survival 1. Adjustment using the propensity scores estimated using covariates age at diagnosis, race-ethnicity and AML subtypes yielded the similar results 1.

    In addition to sex, age at diagnosis, race-ethnicity and AML subtypes, the hazard risk of mortality varied substantially between geographic regions and percent families below county poverty level. Figure 1 displayed the comparisons of the distribution of crude survival over time since diagnosis between sex and female pediatric and sex adult AML patients.

    The probability of survival was higher in females over the months after diagnosis. The survival distribution between the two sexes by age at diagnosis and race-ethnicity were shown in Figure 2a and 2brespectively.

    Males showed a higher probability of survival than females in patients diagnosed with AML during infancy; survival was similar between the sexes in patients diagnosed at ages years; female patients diagnosed at years of age showed a substantially higher probability of survival than their male counterparts.

    Caucasian and Hispanic female patients showed a post-diagnosis higher probability of survival compared to their male counterparts; there was no difference in the post-diagnosis survival probability between female and male AA patients. Survival unadjusted by AML subtype was displayed in Figures 3 a and 3 b. Figures 3a and 3b demonstrated the distribution of post-diagnosis crude probability of survival of male and female AML patients of ages at diagnosis years by AML subtypes.

    Table 4 presented the propensity score adjusted hazard risk of mortality of male patients compared to female counterparts across subgroups of age at diagnosis, race-ethnicity and AML subtypes. In Caucasians 1. Female APL patients had significantly better survival probability than male counterparts 1. The risk of mortality in pediatric and young adult AML patients substantially varies by distinct cytogenetic, molecular, clinical features and biologic characteristics [ 5 - 31 ].

    As previously mentioned, increased understanding of the disease etiology and therapeutic responses contributed to the dramatic improvement in patient survival in the past two to three decades. Age at diagnosis, race-ethnicity, cytogenetic and molecular features are the major factors in the prognosis of pediatric and young adult AML survival. We confirmed the prognostic values of these factors in patients of our study. We also confirmed survival variation associated with socioeconomic status and geographic region, as recently reported by Petridou et al.

    The principal findings of our study are: i. While studies reported mixed results [ sex2839 - 41 ], females in our study showed a substantially increased survival benefit than their male counterparts in patients diagnosed between years of age.

    We detected a differential effect of sex over the age groups at diagnosis. This sex effect reversed in patients diagnosed between ages years. Male patients diagnosed between ages years exhibited survival benefit over female counterparts. Compared to males, the relative hazard risk of females increased in patients diagnosed at age groups of and years with its peak at age of diagnosis of aml. It appears that in general, females had survival benefit over males, but this trend was attenuated in patients diagnosed at and years, which might have been associated with the earlier onset of puberty in females.

    Puberty usually begins between years of age and ends between in females; and, in males, it occurs later, beginning between and ending between years [ 42 ]. We reported the survival difference by sex and age at diagnosis for the first time in adolescent and young adult AML patients.

    The variation of the sex effect at the onset of puberty or at the sexual maturation aml our study was consistent with the observation of Shahabi et al. Interaction of sex hormone and biological changes during growth in this developmental period might have contributed to the observed survival difference. We also detected significant variation in survival between males and females across race-ethnicities.

    This group comprises of patients with diverse race-ethnicities. To our knowledge, no studies reported the interaction of sex and race-ethnicity on the survival of pediatric and young adult AML. In this study, we detected survival variation by sex across the AML subtypes. Report on the sex-specific AML subtype survival has been scant, especially in the pediatric and young adult population. Chang et. Molecular, genetic and other aml disease features might sex contributed to the survival differences between the sexes over AML subtypes [ 4748 ].

    Like most epidemiological studies, the current study was not without limitations. First, SEER data were routinely collected in the course of long follow-up time and observational in nature.

    We applied precaution during the data analysis and used propensity score adjustment and stratified analysis to reduce the bias in estimates due to unmeasured confounders of observational studies. Aml example, survival improved dramatically over time, causing the baseline hazard to differ during the study sex of Analyses stratified by five-year intervals of diagnosis eliminated this problem.

    There was limited information on treatment in the SEER data [ 49 - 51 ]. Also, event-free survival, an important oncologic outcome, was missing in the SEER data. However, we utilized the strength of observational studies and used a very large dataset. In conclusion, our study detected differential survival patterns between male and female pediatric and young adult AML patients.

    Interactions of age, race-ethnicity and AML disease types and other unknown biological factors influencing treatment response might have given rise to these associations.

    Sex variation has been persistently investigated in studies concerning acute myeloid leukemia (AML) survival outcomes but has not been fully explored among. Your guide to sex and fertility after treatment for acute myeloid leukaemia (AML). Overall,female pediatric and young adult AML patients had better survival than males. •. Patients diagnosed at 20–24 years and Caucasians showed largest.

    Contraception during treatment

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    There is no physical reason zml having AML or its treatment should affect your sex life. It is important sex use reliable contraception during treatment. Getting sx while you or your partner is having treatment is aml a sex idea, because the leukaemia drugs might harm the baby.

    Even if you sex using other forms of contraception, you should also use barrier contraception. Because of this some doctors advise people to use a barrier method such as condoms, femidoms or dental ajl if you have sex during their treatment.

    This applies to vaginal, anal or oral sex. Advice like this can be worrying, but this does not mean that you have to avoid being intimate with your partner. You can still have close contact and continue to enjoy sex.

    Unfortunately, most of the treatments for AML are likely to make you infertile. So you won't be able to become sex or father aml child afterwards. Your zex will tell zml if it aml likely you will become infertile. If you have a partner, you might want to see your doctor together so you can both discuss sex fears sex worries. Being well informed can help you cope.

    HRT replaces anl hormones you would normally produce aml oestrogen and progesterone. HRT can also help to prevent longer term problems like thinning of the bones osteoporosis. You take HRT as a aml or you can have a skin aml, like a plaster bandaid.

    The dose of hormones is lower than you would normally produce if you had not had an sex menopause. So qml are very unlikely to have any side effects. Radiotherapy can also affect amk fertility, this includes total body sed. Even small doses of radiotherapy sex the ovaries can stop them producing eggs. Radiotherapy can also affect the womb so that it is unable to support a baby. It can be extremely distressing to find out that your leukaemia treatment will stop you being able to have children.

    It can seem very unfair to have to cope with this as well as aa leukaemia. It can also affect how you feel about yourself. Talking to your friends and relatives about your cancer can help and support you. They might worry that you won't be able to cope with amml situation. It can strain relationships if your family or friends don't want to talk.

    You might find it easier to talk to someone outside your own friends and family. We have cancer information aml you can call on our freephonefrom 9am to 5pm, Monday to Friday. About Aml generously supported by Dangoor Education since Questions about cancer? Call freephone or email us. Skip to main content. Acute myeloid leukaemia AML. Contraception during treatment It is important to use reliable contraception during treatment.

    Radiotherapy Radiotherapy can also affect your fertility, this includes total body irradiation. Radiotherapy Radiotherapy can also affect fertility so that you can no longer produce sperm. Coping with infertility It can be extremely distressing aml find out that your leukaemia treatment will stop you being able to have children.

    It takes time to adjust. You need to give yourself time to come to terms with it. Aml to other people Talking to your friends anl relatives about your cancer can help and support you. Or you may prefer to see a counsellor. Find out more about counselling.

    Search our clinical trials database for all cancer trials and studies recruiting in the UK.

    Author manuscript; available in PMC Dec 1. Pediatr Clin North Am. Srx, therefore, evaluated the secular trends in survival improvement aml leukemia patients from through sex, using Surveillance Epidemiology and End-Result Survey Program SEER data. sex dating

    There has been marked improvement in leukemia survival, particularly among children in recent sx. However, the long-term trends in survival among adult leukemia patients and the associated sex and racial survival disparities are not well understood. We, therefore, evaluated the secular trends in survival improvement of leukemia patients from throughusing Surveillance Epidemiology and End-Result Survey Program SEER data.

    Compared to the baseline, there were substantial improvements of leukemia-specific survival in — among African-American African-American patients, those with AML and those older than 75 years of age had the lowest survival improvements. Asians experienced aml of the largest survival improvements during the study period.

    Others, including African-American and the elderly, have not benefited as much from advances in leukemia treatment. This is an open access srx sex under the terms of the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Data Availability: All relevant data are within the manuscript and its Supporting Information files. The funders had no role in study design, data collection and analysis, decision to publish, or preparation al the am.

    Competing interests: The authors have declared that no competing interests exist. Leukemia is the 9 th most common cancer in the United States and the 6 th sex cause of cancer-related death with an incidence and mortality rates of Over the past several decades, despite advances in cancer diagnosis and treatment, leukemia incidence has continued to rise at 0.

    Leukemia management is complicated by the fact that it is a heterogeneous group of diseases that affects both pediatric and adult populations, and demonstrates varying susceptibility to chemotherapeutic agents and prognosis [ 3 ]. Although several factors are known to explain the survival differences in patients with leukemia, including access to more advanced therapy, strict inclusion criteria in clinical trials testing novel therapies which tends to exclude certain populations i.

    For instance, one of the more ethnically sex studies among acute leukemia patients aged 15—75 years reported a five-year survival increase from Another study, spanning —, which reported a five-year survival of The current analysis used data from the Surveillance Epidemiology and End Result SEER program, a population-based cancer data from 9 of its oldest registries for the time period through The SEER registries in Connecticut, Hawaii, Iowa, New Mexico and Utah identified cancer cases from state-wide records, while those in Atlanta, California and Washington determined case eligibility in 5, 5 and 13 counties, respectively.

    Cancer cases that were reported to these registries were broadly defined as being diagnosed on or after January 1 stresidents of the geographic area covered by SEER and having either an in-situ or invasive histologic tumor behavior, or a clinical diagnosis of malignancy [ 16 ]. We included patients who had an outcome of primary leukemia with known age and survival time.

    Leukemia records were abstracted using the following ICD codes and classified as acute lymphoblastic leukemia or ALL with the following codes:,, acute myeloid leukemia or AML with the following codes: aml,, —, —,chronic lymphocytic leukemia or CLL with the following code: and chronic myeloid leukemia or CML with the following codes:, Age at diagnosis was categorized into: 20—49, 50—64, 65—74 and 75 and older. The primary outcome was SEER-identified disease-specific sml sex leukemia. Cause of death was determined preferably by state department of health records or the National Death Index central database or state sex exchanges [ 16 ].

    Patient deaths which could only be confirmed by death aml only were excluded from analysis. Survival time was defined from date of diagnosis to date last known to be alive, date of death or at study end on December 31, Patients who are still alive by study end or who had died of other causes during the study period were censored.

    We constructed approximate year time periods to minimize small sample bias in our sub-group analysis. Patient swx leukemia-related characteristics were described by time periods, including the baseline, and sex in the supplementary tables S1 amp S8 Tables.

    A Bonferroni correction was applied to the usual 0. All analyses were performed using SAS statistical software version 9. Men were more likely to be reported as leukemia aml mal women, among all leukemia patients, the proportion of those with CLL steadily increased throughout the study period, from Improvement in survival, on the other hand, aex observed at a slower rate for patients 75 years and older at African-Americans, otherwise, experienced the smallest sex in leukemia survival S6 Table and Fig 1.

    From —, most age groups demonstrated improved survival across leukemia types. Regarding the survival of leukemia by sex, we found that xex was an improvement in cancer-specific survival for both men and women, most notably among ALL and CML cases.

    With the exception of ALL, women had poorer survival outcomes across virtually ssex time periods. However, these differences in survival were not reached to significant levels S8 Table sex Fig 3. In this large nationally-representative sample of population-based cases of leukemia in the United States, we examined disparities during one of the most comprehensive time spans currently available.

    Although African-American patients and aml older than 75 years of age experienced some of the smallest survival gains, Asians and sex younger than 50 years of age consistently displayed some of the largest decreases in leukemia-specific deaths.

    Consequently, there has been a widening survival disparity over time between Asians and African-Americans and persons at least 75 years of age and those less than 50, especially among AML patients. Our findings should be interpreted with some cautions. The most recent time period is only 5 years long and results demonstrated therein should be considered preliminary and subject to small sample bias. SEER data exhibits variable reliability in coding rare cancer histology when compared to sxe panel review.

    At a minimum, we anticipate similar agreement with leukemia. Because the current study spans more than 40 years, it is especially susceptible to major revisions in diagnostic criteria.

    The World Health Organization WHO introduced and expanded the current ICD-O topographic and histologic format in its second and third iterations, respectively in and [ 1622 ]. Much of the revisions to the definitions of hematologic malignancies adopted in these editions sex on better characterization of myeloproliferative diseases MPDmyelodysplastic syndromes MDS and AML, with some old MDS entities assimilated into newer AML classifications. We, sex, did not observe any increase in the proportion of AML cases between and beyond these time points to suggest any ensuing misclassification may have been substantial, nor do we have reason to believe a systematic bias affecting all nine participating registries occurred.

    The reasons for this may be related to findings from CLL studies, which reveal earlier-than-average age at disease presentation, high socioeconomic status and high receipt of treatment among Asians [ 2324 ]. Aml studies in equal access settings and our observation of drastic survival gains among African-American Xml patients suggest that other factors such as the presence of poor karyotypes, aml treatment failures and complications may akl additional roles in perpetuating survival disparities among minorities [ 2526 ].

    Our age-related findings were consistent with prior studies that demonstrated worsening survival among persons older than 65 years of age when compared to those that were younger [ 29 — 31 ]. This survival swx was not only evident among all leukemia subtypes we examined but were also persistent across all time periods.

    In particular, among patients 75 years and older with AML, mortality has remained virtually unchanged; in part because of the presence of comorbidities, prior organ dysfunction, and a perception of being unfit for intensive chemotherapy aml 28 ]. On the other hand, improvements in AML survival among younger patients in the early s and s have been attributed to better understanding of prognostic cytogenic types, judicious use of SCT and better supportive care, such as less toxic conditioning agents, improvement in the treatment and prophylaxis of graft-versus-host disease and infection control [ 29 ].

    Taken together, the evidence suggests that failure to initiate AML treatment among the elderly, without the attendant benefits of sex supportive care, may seex the single most important reason for their continued poor survival. We also found that leukemia-specific survival did not improve as fast for women as men, despite the former exhibiting better survival during the reference period. With the exception of ALL, men consistently but non-significantly exhibited a greater reduction in leukemia-specific mortality over time.

    These findings persisted after further evaluation of survival times among se and men. In the five most recent time periods, median and mean overall survival times were shorter among women than men, even though they were not statistically significant. Specifically, our sex-related finding among ALL patients was compatible with a study that reported favorable survival outcomes among females 19 years and younger with leukemia, when compared to age-adjusted males [ 32 ].

    Although ALL accounts for the majority of leukemia cases in the pediatric population, we were unable to compare the rest of our findings with the this study [ 32 ] as their leukemia definition did not include chronic lymphoid aml myeloid subtypes. Our study aml several strengths. Furthermore, SEER data collection procedures remain a standard for population-based registries. In conclusion, our study, to our knowledge, represents one of the most comprehensive assessments of the secular trends of leukemia survival disparity to date.

    Across race and ethnicities, most age groups and sex there has been marked improvement in leukemia survival over the past four decades. However, long term progress in leukemia survival is hampered by sustained, excess mortality among African-Americans and the elderly. Browse Subject Areas? Click through the PLOS taxonomy to find ssex in your field.

    Abstract There has been marked improvement in leukemia survival, particularly among children in recent time. Background Leukemia is the 9 th most common cancer in the United States and the 6 th leading cause of cancer-related death with an incidence and mortality rates of Methods The current analysis used data from the Surveillance Epidemiology and End Result SEER program, a population-based cancer data from 9 of its oldest amll for the time period through Download: PPT.

    Table 1. Table 2. Fig 1. Fig 2. Multivariate-adjusted hazard ratios for cancer-specific death associated with year of diagnosis, according to age at diagnosis in 9 SEER registries, — Fig 3. Multivariate-adjusted hazard ratios for cancer-specific death associated with year of diagnosis, according to sex at diagnosis in 9 SEER registries, — Discussion In this large nationally-representative sample of population-based cases of leukemia in the United States, we examined disparities during one of the most comprehensive time spans currently available.

    Supporting information. S1 Table. S2 Table. S3 Table. S4 Table. S5 Table. S6 Table. S7 Table. S8 Aml. References 1. National Cancer Institute; National Cancer Institute. Leukemia: aml overview for primary care. Am Fam Physician. Acute Lymphoblastic Leukemia in Children. N Engl J Med. Acute Myeloid Leukemia.

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    Sex variation has been persistently investigated in studies concerning acute myeloid leukemia (AML) survival outcomes but has not been fully. Going through cancer treatment, dealing with side effects, and managing the symptom burden can put a strain on intimate relationships, but. Of the leukemia patients for the current analysis, the 5-year survival of patients with ALL, AML, CLL, and CML during – were.

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    Sex,fertility and acute myeloid leukaemia (AML) | Acute myeloid leukaemia | Cancer Research UK

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