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. 2021 Dec 14;5(23):4992-5001.
doi: 10.1182/bloodadvances.2021004735.

Association of race and ethnicity with clinical phenotype, genetics, and survival in pediatric acute myeloid leukemia

Shannon E Conneely  1 , Casey L McAtee  1 , Rohit Gupta  1 , Joseph Lubega  1 , Michael E Scheurer  1 , Rachel E Rau  1
Affiliations

Association of race and ethnicity with clinical phenotype, genetics, and survival in pediatric acute myeloid leukemia

Shannon E Conneely et al. Blood Adv. .

Abstract

Black and Hispanic children with acute myeloid leukemia (AML) have worse outcomes compared with White children. AML is a heterogeneous disease with numerous genetic subtypes in which these disparities have not been specifically investigated. In this study, we used the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) database to examine the association of race-ethnicity with leukemia cytogenetics, clinical features, and survival outcomes within major cytogenetic subgroups of pediatric AML. Compared with White non-Hispanic patients, t(8;21) AML was more prevalent among Black (odds ratio [OR], 2.22; 95% confidence interval [CI], 1.28-3.74) and Hispanic patients (OR, 1.74; 95% CI, 1.05-2.83). The poor prognosis KMT2A rearrangement t(6;11)(q27;q23) was more prevalent among Black patients (OR, 6.12; 95% CI, 1.81-21.59). Among those with KMT2Ar AML, Black race was associated with inferior event-free survival (EFS) (hazard ratio [HR], 2.31; 95% CI, 1.41-3.79) and overall survival (OS) (HR, 2.54; 1.43-4.51). Hispanic patients with KMT2Ar AML also had inferior EFS (HR, 2.20; 95% CI, 1.27-3.80) and OS (HR, 2.07; 95% CI, 1.09-3.93). Similarly, among patients with t(8;21) or inv(16) AML (ie, core-binding factor [CBF] AML), Black patients had inferior outcomes (EFS HR, 1.93; 95% CI, 1.14-3.28 and OS HR, 3.24; 95% CI, 1.60-6.57). This disparity was not detected among patients receiving gemtuzumab ozogamicin (GO). In conclusion, racial-ethnic disparities in survival outcomes among young people with AML are prominent and vary across cytogenetic subclasses. Future studies should explore the socioeconomic and biologic determinants of these disparities.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
Primary cytogenetic lesions by race-ethnicity. Data represent 525 White non-Hispanic, 143 Hispanic, and 108 Black patients with cytogenetic data available. (A) Proportion of patients with t(8;21) cytogenetics by race-ethnicity. (B) Proportion of patients with monosomy 5, 5q deletion, monosomy 7, or 7q deletion by race/ethnicity. (C) Proportion of patients with t(6;11)(q27;q23) by race-ethnicity.
Figure 2.
Figure 2.
Survival in patients with AML by race-ethnicity within the TARGET cohort. (A) EFS across entire TARGET cohort by race-ethnicity. (B) OS across entire TARGET cohort by race-ethnicity. (C) EFS among patients with KMT2Ar AML by race-ethnicity. (D) OS among patients with KMT2Ar AML by race-ethnicity. (E) EFS among patients with CBF AML by race-ethnicity. (F) OS among patients with CBF AML by race-ethnicity.
Figure 3.
Figure 3.
EFS by receipt of gemtuzumab in Black vs non-Black patients with CBF AML. (A) Non-Black patients. (B) Black patients.
See this image and copyright information in PMC

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