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Blood, 1 June 2004, Vol. 103, No. 11, pp. 4036-4042.
Prepublished online as a Blood First Edition Paper on February 19, 2004; DOI 10.1182/blood-2003-09-3118.
Submitted September 23, 2003
Accepted February 8, 2004
Differences in Prognostic Factors and Outcomes in African-Americans and Caucasians with Acute Myeloid Leukemia
Mikkael A Sekeres*, Bercedis Peterson, Richard K Dodge, Robert J Mayer, Joseph O Moore, Edward J Lee, Jonathan Kolitz, Maria R Baer, Charles A Schiffer, Andrew J Carroll, James W Vardiman, Frederick R Davey, Clara D Bloomfield, Richard A Larson, and Richard M Stone
Hematology and Medical Oncology, The Cleveland Clinic Foundation, Cleveland, OH, USA
The Cancer and Leukemia Group B Statistical Center, Durham, NC, USA
Adult Oncology, The Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
Duke University Medical Center, Durham, NC, USA
Sinai Hospital of Baltimore, Baltimore, MD, USA
North Shore University Hospital, New York University School of Medicine, Manhasset, NY, USA
Roswell Park Cancer Institute, Buffalo, NY, USA
Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
University of Alabama at Birmingham, Birmingham, AL, USA
University of Chicago, Chicago, IL, USA
SUNY Upstate Medical University, Syracuse, NY, USA
The Ohio State University, Columbus, OH, USA
* Corresponding author; email: sekerem{at}ccf.org.
Caucasians have a more favorable prognosis than African-Americans for a number of cancers. The relationship between race and outcome is less clear in acute myeloid leukemia (AML). Using data from seven Cancer and Leukemia Group B studies initiated from 1985 to 1997, we conducted a retrospective cross-sectional analysis of 2570 patients (270 African-American and 2300 Caucasian) with de novo AML who received induction chemotherapy. African-Americans were younger than Caucasians (48 vs. 54 years, P<0.001). African-Americans also had different cytogenetic risk group distributions than Caucasians (P<0.001): they were more commonly classified in the favorable (23% vs. 14%) and unfavorable (31% vs. 23%) groups, and less commonly classified in the intermediate group (47% vs. 63%). African-American males had a lower complete remission (CR) rate (54%, compared to 64% for Caucasian men, 65% for Caucasian women, and 70% for African-American women, P=0.001) and a worse overall survival compared to all other patients (P=0.004), taking into account known risk factors. African-Americans and Caucasians with AML differ with respect to important prognostic factors. African-American men have worse CR rates and overall survival than Caucasians and African-American women, and should be considered a poor-risk group.
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