Gender and treatment outcome in XXXX : report from the MRC UKALL trials.

@entity1 @entity981 @entity1778 @entity7555 @entity236
We have examined the factors influencing prognosis in over 4000 @entity1 with @entity981 ( @entity981 ) aged 1-14 who have been treated on consecutive MRC UKALL trials from 1972 to 1990. During this time the results of treatment have improved steadily but are consistently superior in @entity1 when compared with @entity1 ; the 5-year event-free survival in @entity1 improving from 51% to 71% and in @entity1 from 31% to 57%. These results were independent of age and presenting leucocyte count. @entity1 not only had a testicular relapse rate of 10% but an excess of @entity236 , particularly evident after 2 years from diagnosis. Other prognostic factors included @entity7555 and the morphology of leukaemic blast cells; immunophenotype of the @entity1778 , however, had no independent significance after allowance for age, sex and leucocyte count. The influence of sex on prognosis was reaffirmed when we examined various methods of identifying @entity1 at highest risk of treatment failure for whom alternative therapy such as bone marrow transplantation might be justified. In MRC UKALL X @entity1 had been deemed 'high risk' on the basis of leucocyte count alone, but with further follow-up it has become apparent that @entity1 with an initial leucocyte count of > 100 x 10(9)/l have a similar prognosis to @entity1 with a lower count. We therefore derived a risk score based on sex, age and count which has given better discrimination between standard risk (66% 5-year survival) and poor risk (39%) survival than other methods. This group of worse-risk @entity1 includes 16% of @entity1 but only 3% of all @entity1 . Gender remains an important prognostic factor in UKALL trials and there are very few @entity1 who are at highest risk of treatment failure. The reasons for this remain unclear, but the pattern of relapses suggests that @entity1 more often get inadequate systemic therapy. We postulate that the reasons for treatment failure may relate to sensitivity to continuing (maintenance) chemotherapy.
