Disparities in Acute Lymphocytic Leukemia Outcomes Among Young Adults.

IF 1.3 Q4 HEMATOLOGY
Journal of hematology Pub Date : 2024-08-01 Epub Date: 2024-08-15 DOI:10.14740/jh1282
Zoe McKinnell, Daniel Tuerff, Mustafa Hammudi, Colleen Hamilton, Martha Antonio, Ramesh Subrahmanyam, Joao Ascensao, Maneesh Rajiv Jain
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引用次数: 0

Abstract

Background: Age is a strong prognostic factor in acute lymphocytic leukemia (ALL), with children doing better than adults with the same disease. One hypothesis for this age-based disparity is differences in treatment regimens. Optimizing care for adolescents and young adults (AYA) with ALL has not been well defined and disparities in care exist. We conducted a retrospective study of all veterans with ALL diagnosed between the ages of 18 and 45 since the year 2000 to evaluate disparities among prognostication methods, treatment regimens, and accrual to clinical trials with regard to age and race/ethnicity and how these factors influence overall survival.

Methods: Electronic medical record data from the VA Informatics and Computing Infrastructure (VINCI) were used to identify 6,724 patients with an ICD-9 or 10 code for ALL. All patients were chart checked to confirm an ALL diagnosis between the ages of 18 and 45 and excluded if they were diagnosed before 2000, had childhood ALL, or if induction protocol was not recorded. A total of 252 patients were included in the final analysis. Multivariate analysis was performed with controls for age, ALL subtype (B, T, mixed phenotype), Ph status, cytogenetic risk (based on modified Medical Research Council-Eastern Cooperative Oncology Group (MRC-ECOG) study), obesity (body mass index (BMI) > 30), and race.

Results: Patients treated with pediatric regimens, including pediatric-inspired regimens, have statistically significant (P = 0.009) survival gains, with a hazard ratio (HR) of 0.52 after controlling for age, obesity, ALL subtype, cytogenetic risk and race. White patients had significantly improved OS compared to people of color (HR 0.57, P = 0.02) after controlling for the aforementioned covariates. Black patients were far less likely (23%) to receive a transplant than non-Black patients (46%). Only 7% of patients were treated on a clinical trial.

Conclusions: These data demonstrate that treatment with a pediatric regimen significantly improves overall survival in patients up to the age of 45 and suggests ongoing shortcomings in treatment for young adults with ALL, especially 30 to 45 years old, including persistently high use of adult induction regimens, low rates of referral to clinical trials, and significant racial disparities in bone marrow transplants for Black patients.

年轻人急性淋巴细胞白血病治疗结果的差异。
背景:年龄是急性淋巴细胞白血病(ALL)的一个重要预后因素,患同样疾病的儿童比成人的预后要好。造成这种年龄差异的一个假设是治疗方案的不同。青少年和年轻成人(AYA)急性淋巴细胞白血病患者的最佳治疗方案尚未得到很好的定义,而且在治疗方面也存在差异。我们对 2000 年以来所有年龄在 18 岁至 45 岁之间确诊为 ALL 的退伍军人进行了一项回顾性研究,以评估预后方法、治疗方案和临床试验的加入在年龄和种族/族裔方面的差异,以及这些因素如何影响总体生存率:通过退伍军人信息学和计算基础设施(VINCI)的电子病历数据,确定了6724名ICD-9或10编码为ALL的患者。对所有患者进行病历检查,以确认其年龄在18至45岁之间的ALL诊断,如果患者在2000年之前确诊、患有儿童ALL或没有记录诱导方案,则将其排除在外。共有 252 名患者被纳入最终分析。在对年龄、ALL亚型(B、T、混合表型)、Ph状态、细胞遗传风险(基于修改后的医学研究委员会-东部合作肿瘤学组(MRC-ECOG)研究)、肥胖(体重指数(BMI)>30)和种族进行对照的基础上进行了多变量分析:在控制了年龄、肥胖、ALL亚型、细胞遗传风险和种族因素后,采用儿科方案(包括儿科启发方案)治疗的患者生存率有显著统计学意义(P = 0.009),危险比(HR)为0.52。与有色人种相比,白人患者在控制了上述协变量后,生存率明显提高(HR 0.57,P = 0.02)。黑人患者接受移植的几率(23%)远低于非黑人患者(46%)。只有 7% 的患者接受了临床试验治疗:这些数据表明,采用儿科方案治疗可显著提高45岁以下患者的总生存率,同时也表明年轻成人 ALL 患者(尤其是 30 至 45 岁患者)的治疗仍存在不足,包括成人诱导方案的使用率居高不下、临床试验转诊率低以及黑人患者骨髓移植的种族差异显著。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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Journal of hematology
Journal of hematology HEMATOLOGY-
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