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Racial and ethnic differences in survival of children with acute lymphoblastic leukemia
Open accessAbstract
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.
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“Similarly, ancestry, which is known to alter both pediatric ALL incidence and survival (Abrahão et al., 2015; Goggins & Lo, 2012; Linabery, Johnson, & Ross, 2012), is likely to also impact the risk and severity of late effects (Bhatia et al., 2002; Dores, Devesa, Curtis, Linet, & Morton, 2012; Lim, Bhatia, Robison, & Yang, 2014; Yang et al., 2010).”
From Brain structure, working memory and response inhibition in childhood leukemia survivors (2017) · cites this paper as Bhatia et al., 2002
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Cancer health disparities in racial/ethnic minorities in the United States
Zavala, V. A., Bracci, P. M., Carethers, J. M., Carvajal‐Carmona, L. G., Halmai, N. B., Cruz-Correa, M. R., Davis, M. B., de Smith, A. J., Dutil, J., Figueiredo, J. C., et al. (2020) · British Journal of Cancer · doi:10.1038/s41416-020-01038-6 · Cited by 952
Pediatric acute lymphoblastic leukemia
Inaba, H., & Mullighan, C. G. (2020) · Haematologica · doi:10.3324/haematol.2020.247031 · Cited by 765
Cancer statistics for Hispanics/Latinos, 2015
Siegel, R. L., Fedewa, S. A., Miller, K. D., Sauer, A. G., Pinheiro, P. S., Martinez‐Tyson, D., & Jemal, A. (2015) · CA A Cancer Journal for Clinicians · doi:10.3322/caac.21314 · Cited by 474
Cancer Statistics for Hispanics/Latinos, 2018
Miller, K. D., Sauer, A. G., Ortiz, A. P., Fedewa, S. A., Pinheiro, P. S., Tortolero‐Luna, G., Martinez‐Tyson, D., Jemal, A., & Siegel, R. L. (2018) · CA A Cancer Journal for Clinicians · doi:10.3322/caac.21494 · Cited by 448
Cancer statistics for the US Hispanic/Latino population, 2021
Miller, K. D., Ortiz, A. P., Pinheiro, P. S., Bandi, P., Minihan, A. K., Fuchs, H. E., Tyson, D. M., Tortolero‐Luna, G., Fedewa, S. A., Jemal, A., et al. (2021) · CA A Cancer Journal for Clinicians · doi:10.3322/caac.21695 · Cited by 405
Metadata
- Authors
- Bhatia, S., Sather, H. N., Heerema, N. A., Trigg, M. E., Gaynon, P. S., & Robison, L. L.
- Affiliations
- University of Southern California (US)
- Corresponding author
- Bhatia, Smita
- Venue
- Blood
- Publisher
- American Society of Hematology
- Published
- 2002-09-15
- Volume
- 100
- Issue
- 6
- Pages
- 1957-1964
- ISSN
- 0006-4971 (ISSN-L)
- 1528-0020
- OpenAlex
- W1995246501
- Cited by
- 270
- References
- 47
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 9 · 2023: 11 · 2022: 15 · 2021: 14 · 2020: 25 · 2019: 12 · 2018: 11 · 2017: 12 · 2016: 13 · 2015: 12 · 2014: 18 · 2013: 10 · 2012: 17
- FWCI
- 8.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Blood (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Cancer Institute (U10CA013539, 5U10 CA 13539-2652)
- Topics
- Health Sciences › Medicine › Hematology › Acute Lymphoblastic Leukemia research
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Pathology and Forensic Medicine › Lymphoma Diagnosis and Treatment
- Keywords
- acute lymphoblastic leukemia, racial disparities, ethnic differences, children, overall survival, event-free survival, Hispanic children, Black children, Asian children, socioeconomic status, pharmacogenetics, medication adherence
- MeSH terms
- Adolescent, Child, Child, Preschool, Chromosome Aberrations, Ethnicity, Female, Follow-Up Studies, Humans, Infant, Male, Prospective Studies, Retrospective Studies, Risk Factors, Social Class, Survival Analysis, Treatment Outcome, Disease-Free Survival, Racial Groups, Precursor Cell Lymphoblastic Leukemia-Lymphoma
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