Survival is significantly lower for young black patients with AML than for their white counterparts

Despite similar treatment, black patients aged 18 to 29 with acute myeloid leukemia were twice as likely to die within 5 years as whites.

Despite similar treatment, black patients aged 18 to 29 with acute myeloid leukemia (AML) were twice as likely to die within 5 years as white patients, according to findings recently published in Blood Advances.

The investigators added that black patients in this age group were 5 times more likely to die within 30 days of treatment, defined as an early death, and only survived an average of 1.3 years compared to 10.2 years for white patients (P <.001 hr ci>

The investigators observed no significant differences in pretreatment clinical, demographic, or molecular characteristics between black and white adolescents and young adults (AYA) who died prematurely.

There were no such racial differences in survival among patients aged 30 to 39. Median overall survival (OS) was 2.2 years in both groups and 42% of patients in both groups were alive at 5 years.

There is an inverse relationship with age and survival for most cancers, including AML patients. Additionally, some types of cancer have demonstrated unique biology in AYA patients that may affect response to treatment, although this factor has not been sufficiently studied in AML.

Previous data demonstrated racial differences in LAM outcomes. Black patients have shorter disease-free survival (DFS) and overall survival (OS) than age-matched white patients.

It is unclear whether these survival disparities persist specifically in AYA patients, and whether AML has unique genetic characteristics in these patients.

Researchers from the Ohio State University Comprehensive Cancer Center–James, Duke University Medical Center, University of Chicago and others compared the survival of 89 non-Hispanic black patients to that of 566 non-Hispanic white patients aged 18 to 39 year olds treated in frontline Cancer and Leukemia Group B/Alliance for Clinical Trials in Oncology protocols from 1983 to 2016. Samples from 50 black patients and 277 white patients were analyzed by targeted sequencing, and researchers performed profiling integrated genomics on selected longitudinal samples.

All patients received intensive induction treatment, followed by intensive consolidation

chemotherapy or autologous hematopoietic stem cell transplantation at the first complete response (CR).

The age and sex distribution was nearly identical between the black and white patient groups. Investigators found no significant differences in clinical features at diagnosis.

Black patients aged 18 to 29 had worse results in all areas. These patients had higher early mortality rates (16% versus 3%; P = 0.002), lower CR rate (66% versus 83%; P = 0.01) and decrease in OS at 5 years (22% versus 51%; P <.001 compared to white patients.>

These survival disparities persisted across cytogenetic groups. Forty percent of white patients were cytogenetically normal (NC) at diagnosis, compared to only 19% of black patients. Thirty-seven percent of black patients had central binding factor (CBF)-AML, compared to 22% of white patients. Black patients accommodated t(8;21)(q22;q22)/RUNX1::RUNX1T1 twice as often as white patients (22% versus 10%; P = .002). The incidence of inv(16)(p13.1q22)/CBFB :: MYH11 or t(16;16)(p13.1;q22)/CBFB :: MYH11 was similar (15% versus 12%; P = 0.49). There were no significant differences in the frequency of recurrent cytogenetic abnormalities such as rearrangements of 11q23/KMT2At(6;9)(p23;q34), complex karyotype or only trisomy 8 between the 2 groups.

Black AYA patients with CBF AML had worse OS than their white counterparts at 5 years (54% vs 70%; P P = 0.06). The outcomes of younger black AYA patients with non-CBF AML were “significantly poorer” than those of white patients at 5 years for both DFS (14% vs. 34%; P P <.001 not a single black patient with lam-cn between the ages of and was disease-free years after diagnosis compared to for white patients. only in patients alive at versus>P = 0.003).

Black patients aged 18 to 29 with CBF-AML had better survival than black patients with non-CBF-AML, but the survival of black patients with CBF-AML was similar to that of white patients with CBF-AML. non-CBF-AML.

In the overall patient population, black patients had poorer outcomes than white patients, including a higher early mortality rate (11% vs. 2%; P P = 0.06) and lower 5-year OS (32% versus 46%; P = .002). Median OS was twice as long in white patients (1.5 vs 3.1 years). Black patients had comparable 5-year SSM (32% vs. 40%; P = 0.25) but the median DFS was similar (1.2 vs 1.4 years).

Reference

  1. Larkin K, Nicolet D, Kelly BJ, et al. High early mortality rates, treatment resistance, and short survival of black adolescents and young adults with AML. Adv of blood. Published online July 5, 2022. doi:10.1182/bloodadvances.2022007544

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