Among adolescents and young adults (AYAs) with acute myeloid leukemia (AML), Black patients experience higher rates of early death and shorter overall survival than White patients, according to a study published in Blood Advances.
These disparities may be driven by delayed diagnosis and treatment as well as genetic differences, according to researchers.
The researchers evaluated data from 89 non-Hispanic Black and 566 non-Hispanic White AYA patients with AML treated on CLGB/Alliance clinical trial protocols between 1983 and 2016. Patients were treated with intensive chemotherapy induction followed by intensive consolidation chemotherapy or autologous hematopoietic stem cell transplant. Targeted sequencing and longitudinal genomic profiling were performed in a subset of patients.
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For all AYAs, the early death rate was significantly higher in Black patients than in White patients, at 11% and 2%, respectively (P <.001). Among patients aged 18 to 29 years, the early death rate was 16% and 3%, respectively (P =.002).
For all AYAs, the median overall survival (OS) was significantly shorter in Black patients than in White patients, at 1.5 months and 3.1 months, respectively (P =.002). The 5-year OS rate was 32% for Black patients and 46% for White patients in the overall cohort.
Among patients aged 18 to 29 years, the median OS was 1.3 months in Black patients and 10.2 months in White patients (P <.001). The 5-year OS rate was 22% for Black patients and 51% for White patients in this age group.
There was no significant difference in disease-free survival between the Black and White patients for AYAs overall or for the 18-29 age group.
Black patients aged 18 to 29 years did have a lower complete remission rate than White patients, at 66% and 83%, respectively (P =.01). For all AYAs, the complete remission rate was numerically lower among Black patients than among White patients, at 73% and 82%, respectively, but the difference did not reach significance (P =.06).
The researchers also found that genetic features of AML were different between the races. Black patients were less likely than White patients to have normal cytogenetics at diagnosis (19% and 40%, respectively; P <.001). Black patients were also less likely to have normal karyotypes, NPM1 mutations, and biallelic CEBP mutations. They were more likely to have CBF rearrangements and mutations in ASXL1, BCOR, and KRAS.
“We believe that these data and other data justify further prospective studies of Black AYA patients with AML, including evaluation of alternate frontline and/or consolidation treatment,” the researchers wrote. They added that efforts should also be made to collect data of “social determinants of health to try to assess nonclinical reasons for poor outcomes, as well as careful consideration and enhanced monitoring for the individual Black AYA patients with AML being treated in the clinic today.”
Disclosures: Some of the study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of disclosures.
Reference
Larkin KT, Nicolet D, Kelly BJ, et al. High early death rates, treatment resistance, and short survival of Black adolescents and young adults with AML. Blood Adv. 2022;6:5570-5581. doi: 10.1182/bloodadvances.2022007544
This article originally appeared on Hematology Advisor
