Related Experiment Video
Updated: May 11, 2026
Pre-clinical Evaluation of Tyrosine Kinase Inhibitors for Treatment of Acute Leukemia
Published on: September 19, 2013
Results of therapy for acute lymphoblastic leukemia in black and white children
Ching-Hon Pui1, John T Sandlund, Deqing Pei
1Department of Hematology/Oncology, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA. ching-hon.pui@stjude.org
Insights
Black and white children with acute lymphoblastic leukemia (ALL) showed similar survival rates in a single-institution study. This suggests that equal access to effective treatment leads to comparable outcomes for pediatric ALL patients.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Trials
Background:
- Acute lymphoblastic leukemia (ALL) treatment has improved, yet disparities exist in outcomes between black and white children in national studies.
- This study addresses the need to understand racial differences in ALL treatment efficacy within a single institution.
Purpose of the Study:
- To compare the clinical outcomes of therapy for black and white children diagnosed with ALL.
- To investigate if racial disparities in ALL treatment persist at the institutional level.
Main Methods:
- Retrospective analysis of 412 children and adolescents with newly diagnosed ALL treated between 1991 and 1998.
- Patients received risk-directed, intensive therapy including chemotherapy and methotrexate.
- Survival rates were analyzed using Kaplan-Meier, Mantel-Haenszel tests, and Cox regression, adjusting for prognostic factors.
Main Results:
- Black children were more likely to present with higher-risk prognostic features than white children.
- Despite higher-risk features, 5-year event-free and overall survival rates were comparable between black (80.7% and 86.2%) and white (79.4% and 85.0%) children.
- Multivariate analysis confirmed no significant racial effect on long-term ALL treatment outcomes.
Conclusions:
- Equal access to effective antileukemic therapy can lead to similar high cure rates for black and white children with ALL.
- This institutional data suggests that standardized, risk-directed therapy mitigates racial disparities in ALL outcomes.
Context:
Treatment results for acute lymphoblastic leukemia (ALL) clearly have improved over the past decade, but black children have not fared as well as white children in large national trials.
Objective:
To compare the clinical outcomes of therapy for black and white children with ALL treated at a single institution.
Design, Setting, And Patients:
A retrospective analysis of 412 children and adolescents (68 black, 338 white, and 6 other race) with newly diagnosed ALL who were treated consecutively at a pediatric cancer center in Memphis, Tenn. Patients were enrolled from December 1991 to July 1998 in successive Total Therapy studies regardless of race, ethnicity, or ability to pay and received risk-directed therapy according to stringent criteria.
Interventions:
All patients received the same intensive, remission-induction therapy followed by 120 weeks of risk-assigned postremission therapy that included reinduction treatment, pulses of high-dose methotrexate, and early intensification of intrathecal chemotherapy.
Main Outcome Measures:
Event-free and overall survival rates for black and white children were estimated by the method of Kaplan and Meier and compared with the Mantel-Haenszel test and by Cox proportional hazards regression analysis, adjusting for known prognostic factors.
Results:
The 68 black children were significantly more likely than the 338 white children to have higher-risk prognostic features, including an initial leukocyte count greater than 100 x 10(3)/ microL, a T-cell immunophenotype, and the t(1;19) chromosomal translocation with E2A-PBX1 fusion, and were less likely to have hyperdiploid blast cells, a favorable prognostic factor in childhood ALL. However, the clinical outcomes for these 2 cohorts were not significantly different: 5-year event-free and overall survival rates were 80.7% (95% confidence interval [CI], 70.3%-91.1%) and 86.2% (95% CI, 77.2%-95.2%) for black children vs 79.4% (95% CI, 74.7%-84.1%) and 85.0% (95% CI, 80.9%-89.1%) for white children. Ten-year results also were comparable, but the CIs were wide because of the small numbers of patients who had been followed up for 10 years or more. The lack of a racial effect on the long-term outcome of therapy was still apparent in a multivariate Cox regression analysis, adjusting for sex, age, presenting leukocyte count, leukemic cell DNA index, immunophenotype, and central nervous system status.
Conclusion:
With equal access to effective antileukemic therapy, black and white children with ALL can expect the same high rate of cure.
More Related Videos
09:57Comprehensive Protocol to Sample and Process Bone Marrow for Measuring Measurable Residual Disease and Leukemic Stem Cells in Acute Myeloid Leukemia
Published on: March 5, 2018
08:31Murine Model of Leukemia Relapse to Induction Chemotherapy for Acute Lymphoblastic Leukemia
Published on: October 17, 2025
