{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T06:38:20Z","timestamp":1792478300522,"version":"4.5.0"},"reference-count":39,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2022,2,24]],"date-time":"2022-02-24T00:00:00Z","timestamp":1645660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["U10CA098413"],"award-info":[{"award-number":["U10CA098413"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["U10CA098543"],"award-info":[{"award-number":["U10CA098543"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["U10CA180886"],"award-info":[{"award-number":["U10CA180886"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["U10CA180899"],"award-info":[{"award-number":["U10CA180899"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100017012","name":"Children\u2019s Oncology Group","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100017012","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006058","name":"St. Baldrick's Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006058","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Boys with acute lymphoblastic leukemia (ALL) have historically experienced inferior survival compared to girls. This study determined whether sex\u2010based disparities persist with contemporary therapy and whether patterns of treatment failure vary by sex.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients 1 to 30.99\u00a0years old were enrolled on frontline Children\u2019s Oncology Group trials between 2004 and 2014. Boys received an additional year of maintenance therapy. Sex\u2010based differences in the distribution of various prognosticators, event\u2010free survival (EFS) and overall survival (OS), and subcategories of relapse by site were explored.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 8202 (54.4% male) B\u2010cell ALL (B\u2010ALL) and 1562 (74.3% male) T\u2010cell ALL (T\u2010ALL) patients were included. There was no sex\u2010based difference in central nervous system (CNS) status. Boys experienced inferior 5\u2010year EFS and OS (EFS, 84.6%\u00a0\u00b1\u00a00.5% vs 86.0%\u00a0\u00b1\u00a00.6%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.009; OS, 91.3%\u00a0\u00b1\u00a00.4% vs 92.5%\u00a0\u00b1\u00a00.4%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.02). This was attributable to boys with B\u2010ALL, who experienced inferior EFS (hazard ratio [HR], 1.2; 95% confidence interval [95% CI], 1.1\u20101.3; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.004) and OS (HR, 1.2; 95% CI, 1.0\u20101.4; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.046) after adjustment for prognosticators. Inferior B\u2010ALL outcomes in boys were attributable to more relapses (5\u2010year cumulative incidence 11.2%\u00a0\u00b1\u00a00.5% vs 9.6%\u00a0\u00b1\u00a00.5%; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.001), particularly involving the CNS (4.2%\u00a0\u00b1\u00a00.3% vs 2.5%\u00a0\u00b1\u00a00.3%; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.0001). There was no difference in isolated bone marrow relapses (5.4%\u00a0\u00b1\u00a00.4% vs 6.2%\u00a0\u00b1\u00a00.4%; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.49). There were no sex\u2010based differences in EFS or OS in T\u2010ALL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Sex\u2010based disparities in ALL persist, attributable to increased CNS relapses in boys with B\u2010ALL. Studies of potential mechanisms are warranted. Improved strategies to identify and modify treatment for patients at highest risk of CNS relapse may have particular benefit for boys.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.34150","type":"journal-article","created":{"date-parts":[[2022,2,24]],"date-time":"2022-02-24T12:01:19Z","timestamp":1645704079000},"page":"1863-1870","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Sex\u2010based disparities in outcome in pediatric acute lymphoblastic leukemia: a Children\u2019s Oncology Group report"],"prefix":"10.1002","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1334-3670","authenticated-orcid":false,"given":"Sumit","family":"Gupta","sequence":"first","affiliation":[{"name":"Division of Haematology\/Oncology The Hospital for Sick Children Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David T.","family":"Teachey","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Center for Childhood Cancer Research Children\u2019s Hospital of Philadelphia and Perelman School of Medicine University of Philadelphia Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiguo","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Colleges of Medicine, Public Health, and Health Professions University of Florida Gainesville Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4081-8195","authenticated-orcid":false,"given":"Karen R.","family":"Rabin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Baylor College of Medicine Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly P.","family":"Dunsmore","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Virginia School of Medicine Charlottesville Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric C.","family":"Larsen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Maine Children\u2019s Cancer Program Scarborough Maine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly W.","family":"Maloney","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Colorado and Children\u2019s Hospital Colorado Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Leonard A.","family":"Mattano","sequence":"additional","affiliation":[{"name":"HARP Pharma Consulting Mystic Connecticutt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart S.","family":"Winter","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospitals and Clinics of Minnesota Minneapolis Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Carroll","sequence":"additional","affiliation":[{"name":"Department of Genetics University of Alabama at Birmingham Birmingham Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nyla A.","family":"Heerema","sequence":"additional","affiliation":[{"name":"Department of Pathology The Ohio State University Wexner School of Medicine Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Borowitz","sequence":"additional","affiliation":[{"name":"Division of Hematologic Pathology Johns Hopkins University Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent L.","family":"Wood","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine Children\u2019s Hospital Los Angeles Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William L.","family":"Carroll","sequence":"additional","affiliation":[{"name":"Department of Pediatrics NYU Langone Health New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Raetz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics NYU Langone Health New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi J.","family":"Winick","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Harold C. 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