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Racial and ethnic differences in survival of children with acute lymphoblastic leukemia
Smita Bhatia1, Harland N Sather, Nyla A Heerema
1Children's Oncology Group, City of Hope National Medical Center, PO Box 60012, Arcadia, CA 91006-6012, USA. sbhatia@coh.org
Insights
Racial and ethnic disparities persist in acute lymphoblastic leukemia (ALL) outcomes for children. Black and Hispanic children experienced worse survival, while Asian children had better outcomes, even with modern risk-based therapy.
Area of Science:
- Pediatric Oncology
- Hematology
- Epidemiology
Background:
- Black children with acute lymphoblastic leukemia (ALL) have poorer outcomes.
- Limited data exists on outcomes for Hispanic and Asian children with ALL.
- Understanding racial and ethnic disparities is crucial for equitable cancer care.
Purpose of the Study:
- To determine outcomes for children with ALL across different racial and ethnic backgrounds.
- To analyze survival rates adjusted for known prognostic factors.
- To identify specific disparities in treatment response by ethnicity.
Main Methods:
- Retrospective cohort study of 8447 children with newly diagnosed ALL (1983-1995).
- Analysis of overall survival (OS) and event-free survival (EFS).
- Multivariate analysis adjusting for clinical features, disease biology, socioeconomic status, and treatment era.
Main Results:
- Significant differences in survival by ethnicity (P <.001).
- Five-year EFS rates: Asian (75.1%), White (72.8%), Hispanic (65.9%), Black (61.5%).
- Black and Hispanic children had worse outcomes; Asian children had better outcomes compared to White children, after adjustment.
Conclusions:
- Racial and ethnic disparities in pediatric ALL outcomes persist despite contemporary risk-based therapy.
- Poorer outcomes for Black children were most evident in standard-risk groups; for Hispanic children, in high-risk groups.
- Asian children showed superior outcomes, particularly in high-risk and recent treatment eras, suggesting potential areas for further investigation into compliance or pharmacogenetics.
Abstract:
Black children with acute lymphoblastic leukemia (ALL) have poor outcomes, but limited information is available for children from other racial and ethnic backgrounds, such as Hispanic and Asian. We undertook a retrospective cohort study of children with ALL treated on Children's Cancer Group therapeutic protocols to determine outcomes by racial and ethnic backgrounds of patients treated with contemporary risk-based therapy. In total, 8447 children (white, n = 6703; Hispanic, n = 1071; black, n = 506; and Asian, n = 167) with newly diagnosed ALL between 1983 and 1995 were observed for a median of 6.5 years. Analysis of disease outcome was measured as overall survival (OS) and event-free survival (EFS) and was adjusted for known predictors of outcome including clinical features, disease biology, socioeconomic status, and treatment era (1983-1989 vs 1989-1995). There was a statistically significant difference in survival by ethnicity (P <.001). Five-year EFS rates were: Asian, 75.1% +/- 3.5%; white, 72.8% +/- 0.6%; Hispanic, 65.9% +/- 1.5%; and black, 61.5% +/- 2.2%. Multivariate analysis revealed that when compared with white children, black and Hispanic children had worse outcomes and Asian children had better outcomes after adjusting for known risk factors. The poorer outcomes among black children were most apparent among patients with standard-risk features (relative risk [RR], 2.0; 95% confidence interval [CI], 1.6-2.5), whereas poorer outcomes in Hispanic children (RR, 1.4; 95% CI, 1.2-1.6) were most evident among patients with high-risk features. Asian children had better outcomes than all racial and ethnic groups among high-risk patients, particularly in the recent era (5-year EFS, 90.9% +/- 6.1%). Racial and ethnic differences in OS and EFS persist among children with ALL who receive contemporary risk-based therapy. Future studies should focus on reasons-perhaps compliance or pharmacogenetics-for those differences.