Wylie Burke1, Kenneth Thummel2. 1. Department of Bioethics and Humanities, University of Washington, Seattle, WA. Electronic address: wburke@uw.edu. 2. Department of Pharmaceutics, University of Washington, Seattle, WA.
Abstract
BACKGROUND: Precision medicine has uncertain potential to address population health disparities. PURPOSE: Case study of disparities in pediatric acute lymphoblastic leukemia (ALL). METHOD: Literature-based evaluation of ALL in African American (AA) and European American (EA) children. FINDINGS: AA children have a lower incidence of ALL than EA children, experience higher relapse rates, and are more likely to be diagnosed with poor prognostic indicators. Environmental risk exposures for ALL have small effect sizes; data are insufficient to determine their contribution to differences in incidence and prognosis. Differences in prevalence of gene variants associated with treatment response contribute to higher relapse rates in AA children. However, higher relapse rates were not seen in a care setting that eliminated out of pocket costs, used risk-directed therapy, and included rigorous case management. DISCUSSION: Unequal access to effective treatment contributes to ALL disparities. Precision medicine can help to define effective treatment for diverse patient populations.
BACKGROUND: Precision medicine has uncertain potential to address population health disparities. PURPOSE: Case study of disparities in pediatric acute lymphoblastic leukemia (ALL). METHOD: Literature-based evaluation of ALL in African American (AA) and European American (EA) children. FINDINGS: AA children have a lower incidence of ALL than EA children, experience higher relapse rates, and are more likely to be diagnosed with poor prognostic indicators. Environmental risk exposures for ALL have small effect sizes; data are insufficient to determine their contribution to differences in incidence and prognosis. Differences in prevalence of gene variants associated with treatment response contribute to higher relapse rates in AA children. However, higher relapse rates were not seen in a care setting that eliminated out of pocket costs, used risk-directed therapy, and included rigorous case management. DISCUSSION: Unequal access to effective treatment contributes to ALL disparities. Precision medicine can help to define effective treatment for diverse patient populations.
Authors: Jun J Yang; Cheng Cheng; Meenakshi Devidas; Xueyuan Cao; Yiping Fan; Dario Campana; Wenjian Yang; Geoff Neale; Nancy J Cox; Paul Scheet; Michael J Borowitz; Naomi J Winick; Paul L Martin; Cheryl L Willman; W Paul Bowman; Bruce M Camitta; Andrew Carroll; Gregory H Reaman; William L Carroll; Mignon Loh; Stephen P Hunger; Ching-Hon Pui; William E Evans; Mary V Relling Journal: Nat Genet Date: 2011-02-06 Impact factor: 38.330
Authors: Ching-Hon Pui; John T Sandlund; Deqing Pei; Gaston K Rivera; Scott C Howard; Raul C Ribeiro; Jeffrey E Rubnitz; Bassem I Razzouk; Melissa M Hudson; Cheng Cheng; Susana C Raimondi; Frederick G Behm; James R Downing; Mary V Relling; William E Evans Journal: JAMA Date: 2003-10-15 Impact factor: 56.272