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Prepublished online as a Blood First Edition Paper on May 17, 2002; DOI 10.1182/blood-2002-02-0395.
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Blood, 15 September 2002, Vol. 100, No. 6, pp. 1957-1964
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Racial and ethnic differences in survival of children
with acute lymphoblastic leukemia
Smita Bhatia,
Harland N. Sather,
Nyla A. Heerema,
Michael E. Trigg,
Paul S. Gaynon, and
Leslie L. Robison
From the City of Hope National Medical Center, Duarte,
CA; Keck School of Medicine, University of Southern California, Los
Angeles; The Ohio State University, Columbus; Alfred I Dupont Hospital
for Children, Wilmington, DE; Children's Hospital, Los Angeles, CA;
and University of Minnesota, Minneapolis.
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 pharmacogeneticsfor those differences.
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