Alexandra Walsh1, Joseph Chewning2, Xuelin Li3, Chen Dai4, Kimberly Whelan2, Avi Madan-Swain2, John Waterbor3, Monica L Baskin4, Frederick D Goldman2. 1. Department of Pediatric Hematology and Oncology, Children's Specialty Center of Nevada, Las Vegas, Nevada. 2. Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama. 3. Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama. 4. Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Abstract
BACKGROUND: While significant improvements have been made for children with acute lymphoblastic leukemia (ALL) in the United States over the past 20 years, black patients continue to have inferior outcomes. The full impact of socioeconomic variables on outcomes in this minority population is not entirely understood. PROCEDURE: Disease characteristics, demographic, and socioeconomic status (SES) variables were collected on black (n = 44) and white (n = 178) patients diagnosed at the University of Alabama at Birmingham. Cox proportional hazard regression was used to evaluate the influence of SES and insurance status on survival. RESULTS: As a cohort, 5-year overall survival (OS) was 87% (82-91%), with a median follow-up of 99 months. In univariable analysis, black race was not significantly associated with a higher risk of death or relapse and death. White and black patients with standard-risk leukemia had excellent outcomes, with 97% (91-99%) and 96% (75-99%) 5-year OS, respectively. In contrast, for high-risk disease, white patients had a statistically significant improved 5-year OS rates compared with black patients (79% [68-87%] vs. 52% [28-72%]). Black children were more likely to have public insurance, and, in multivariable analysis, this was associated with a trend toward an improved outcome. Black patients also had poorer census tract-level SES parameters, but these variables were not associated with survival. CONCLUSION: Our study demonstrates significantly inferior outcomes for black children with high-risk leukemia. These outcome disparities were not related to SES variables, including poverty or private insurance coverage, suggesting the involvement of other factors and highlighting the need for a prospective investigative analysis.
BACKGROUND: While significant improvements have been made for children with acute lymphoblastic leukemia (ALL) in the United States over the past 20 years, black patients continue to have inferior outcomes. The full impact of socioeconomic variables on outcomes in this minority population is not entirely understood. PROCEDURE: Disease characteristics, demographic, and socioeconomic status (SES) variables were collected on black (n = 44) and white (n = 178) patients diagnosed at the University of Alabama at Birmingham. Cox proportional hazard regression was used to evaluate the influence of SES and insurance status on survival. RESULTS: As a cohort, 5-year overall survival (OS) was 87% (82-91%), with a median follow-up of 99 months. In univariable analysis, black race was not significantly associated with a higher risk of death or relapse and death. White and black patients with standard-risk leukemia had excellent outcomes, with 97% (91-99%) and 96% (75-99%) 5-year OS, respectively. In contrast, for high-risk disease, whitepatients had a statistically significant improved 5-year OS rates compared with black patients (79% [68-87%] vs. 52% [28-72%]). Black children were more likely to have public insurance, and, in multivariable analysis, this was associated with a trend toward an improved outcome. Black patients also had poorer census tract-level SES parameters, but these variables were not associated with survival. CONCLUSION: Our study demonstrates significantly inferior outcomes for black children with high-risk leukemia. These outcome disparities were not related to SES variables, including poverty or private insurance coverage, suggesting the involvement of other factors and highlighting the need for a prospective investigative analysis.
Authors: Staci D Arnold; Ruta Brazauskas; Naya He; Yimei Li; Matt Hall; Yoshiko Atsuta; Jignesh Dalal; Theresa Hahn; Nandita Khera; Carmem Bonfim; Shahrukh Hashmi; Susan Parsons; William A Wood; Amir Steinberg; César O Freytes; Christopher E Dandoy; David I Marks; Hillard M Lazarus; Hisham Abdel-Azim; Menachem Bitan; Miguel Angel Diaz; Richard F Olsson; Usama Gergis; Adriana Seber; Baldeep Wirk; C Fred LeMaistre; Celalettin Ustun; Christine Duncan; David Rizzieri; David Szwajcer; Franca Fagioli; Haydar Frangoul; Jennifer M Knight; Rammurti T Kamble; Paulette Mehta; Raquel Schears; Prakash Satwani; Michael A Pulsipher; Richard Aplenc; Wael Saber Journal: Biol Blood Marrow Transplant Date: 2020-05-25 Impact factor: 5.742
Authors: Olga A Taylor; Austin L Brown; Julienne Brackett; ZoAnn E Dreyer; Ida Ki Moore; Pauline Mitby; Mary C Hooke; Marilyn J Hockenberry; Philip J Lupo; Michael E Scheurer Journal: Clin Cancer Res Date: 2018-09-11 Impact factor: 12.531