Racial/Ethnic Outcome Disparities Identified in Pediatric AML

A new study identified that racial/ethnic disparities in survival outcomes for young people with acute myeloid leukemia (AML) were prominent and varied across cytogenetic subclasses. These disparities included higher rates of specific poor prognosis lesions among Black children with AML.

The retrospective study used the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) database to look at the cytogenetics, clinical features, and survival outcomes of a pediatric population with AML. Data from 552 White non-Hispanic, 154 Hispanic, and 108 Black non-Hispanic patients were included. The median age at diagnosis was 10.1 years.

Compared with White non-Hispanic patients, t(8;21) AML was more prevalent among Black (odds ratio [OR] = 2.22; 95% CI, 1.28 to 3.74) and Hispanic patients (OR = 1.74; 95% CI, 1.05 to 2.83). Despite this higher prevalence of this favorably prognostic subtype, the 3-year overall survival among Black patients with t(8;21) was lower than in White non-Hispanic patients.

Additionally, the poor prognosis KMT2A rearrangement was also more prevalent among Black patients (OR = 6.12; 95% CI, 1.81 to 21.59).

Looking specifically at patients with KMT2Ar, those patients of Black race had inferior event-free survival (hazard ratio [HR] = 2.31; 95% CI, 1.41 to 3.79) and overall survival (HR = 2.54; 95% CI, 1.27 to 3.80). The same was true for Hispanic patients with KMT2Ar for event-free survival (HR = 2.20; 95% CI, 1.27 to 3.80) and overall survival (HR = 2.07; 95% CI, 1.09 to 3.93).

Inferior survival outcomes were also seen for Black patients with t(8;21) or inv(16) AML.

The researchers noted that one striking finding of this study was preferential improvement with gemtuzumab ozogamicin therapy among Black patients with CBF AML. Black patients had the greatest improvement in event-free survival and overall survival with this treatment.

“These findings suggest biologic differences may exist which influence GO responsiveness within certain AML subtypes, or that other factors contributing to care of patients receiving an investigational agent may be at play,” the researchers wrote.