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Year : 2013  |  Volume : 2  |  Issue : 1  |  Page : 14-26

Gender Disparity in Clinical Presentation, Immunophenotype, and Early Steroid Response in Pediatric Acute Lymphoblastic Leukemia Patients

1 Department of Pathology, College of Medicine/Al-Nahrain University, Al Kadhimya, Baghdad
2 Department of Histopathology, Al- Yarmook Teaching Hospital, Teaching Laboratories

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Background: Acute leukemia is the most common type of childhood cancer, of which acute lymphocytic leukemia (ALL) comprises 78% of cases. Incidence rate, prognosis and survival of childhood ALL patients differ according to gender. Despite overall improvements in survival of children with ALL, male children still experience poorer survival. Objective is to explore differences between male and female pediatric patients with newly diagnosed ALL regarding their presenting clinical features, ALL immunophenotype, and early steroid response. Methods: This study was prospectively designed to include 60 newly diagnosed pediatric ALL patients from April 2011 to March 2013. Each patient was assessed clinically at admission and at the end of a 7-day prednisone prophase to be classified as a prednisone-good responder (<1000/μL peripheral blood blasts on day 8) or a prednisone-poor responder (>1000/μL). Immunophenotype was determined by immunocytochemical staining of bone marrow aspirates for cCD79a (specific for B-cells) and cCD3 (specific for T-cells). Results: The study group consisted of 38 males and 22 females. The median age was 62.5 months for males and 41.5 months for females. Splenomegaly was found in 71% of males versus 63.6% of females, hepatomegaly in 68.4% of males versus 45.5% of females, mediastinal masses were detected in 6 males and 3 females, and CNS disease affected 5 patients, 3 males and 2 females (p>0.05). WBC mean count was 63.78±15.98 x109/L in males and 49.2±21.87 x109/L in females, the mean Hb was 8.75±0.53 g/dl in males and 7.91±0.34 g/dl in females (p>0.05). 75.8% of male patients were B-ALL and 24.3% were T-ALL, and 76.5% of females were B- ALL and 23.5% were T-ALL. 86.8% of male patients and 86.4% of female patients were good steroid responders (p > 0.05). Conclusions: Pediatric male patients were more frequent and older than females, and presented with clinical and hematological features considered to be of poor prognosis more than females. No significant difference was observed regarding ALL immunophenotypes and early steroid response.

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