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Prepublished online as a Blood First Edition Paper on May 17, 2002; DOI 10.1182/blood-2002-02-0395.
Submitted February 6, 2002
Accepted April 16, 2002
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
Keck School of Medicine, University of Southern California, Los Angeles, California, USA
The Ohio State University, Columbus, Ohio, USA; Department of Pediatric Hematology/Oncology, City of Hope National Medical Center, Duarte, California, USA
Alfred I. Dupont Hospital for Children, Wilmington, Delaware, USA
Childrens Hospital Los Angeles, Los Angeles, California, USA
University of Minnesota, Minneapolis, Minnesota, USA
* Corresponding author; email: sbhatia{at}coh.org.
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. 8,447 children [whites (n=6,703), Hispanics (n=1071), blacks (n=506), and Asians (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 and event-free survival (EFS) and 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<0.001). Five-year EFS rates were: Asians:75.1±3.5%; whites:72.8±0.6%; Hispanics:65.9±1.5%; and blacks:61.5±2.2%. Multivariate analysis revealed that when compared with whites, blacks and Hispanics had worse outcomes and Asians better outcomes, after adjusting for known risk factors. The poorer outcomes among black children were most apparent among patients with standard-risk features (RR=2.0, 95% CI, 1.6-2.5), whereas poorer outcomes in Hispanics (RR=1.4, 95% CI,1.2-1.6) were most evident among patients with high-risk features. Asians 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%). There continue to be racial and ethnic differences in overall and event-free survival among children with ALL who receive contemporary risk-based therapy. Future studies should focus upon reasons for those differences, such as compliance and pharmacogenetics.
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