Effect of race on outcome of white and black children with acute myeloid leukemia: the St. Jude experience

Abstract

Background: The association between race and outcome of treatment for childhood acute myeloid leukemia (AML) has not been adequately studied.

Procedure: We compared the clinical characteristics, biological features, and outcomes between white and black children with AML who were treated on five consecutive clinical protocols (1980-2002) at St. Jude Children's Research Hospital. We used proportional hazards modeling to investigate the relation between race and outcome.

Results: We observed no statistically significant differences between the 229 white and 58 black patients in clinical characteristics, FAB subtype, cytogenetic features, or outcome. There were no significant differences in event-free survival (EFS) or overall survival (OS) between the two race groups in individual clinical trials or in all studies combined. For the study group as a whole, the 5-year survival estimate was 39.2% +/- 3.6% for white patients and 33.8% +/- 6.5% for black patients. However, on our most recent trial (AML-97), there was a trend towards inferior outcome among black patients: the 5-year survival estimates were 55.6% +/- 12.3% and 27.3% +/- 13.5% for whites and blacks, respectively.

Conclusions: Although we detected no differences in treatment outcome between white and black children with AML over the entire study period, black children appear to have worse outcomes than white children during more recent studies. Improved treatment is needed for all children with AML.