Race and age disparities in randomized trials of acute myeloid leukemia: a systematic review and meta-analysis

Blood Neoplasia Pub Date : 2025-01-22 DOI:10.1016/j.bneo.2025.100070

Nathalie Loeb , Olivia Katsnelson , Anshika Jain , Parsa Tahvildar , Daniel Teitelbaum , Alejandro Garcia-Horton

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Abstract

There are significant racial and ethnic disparities in the incidence and survival of patients with acute myeloid leukemia (AML). Understanding the discrepancies in enrollment in randomized controlled trials (RCTs) is important for better informing access to care and clinical trial conduct. We systematically reviewed the literature on the enrollment of racial/ethnic minorities and older adults into RCTs of AML. MEDLINE was searched from inception through June 2023 for RCTs on disease-modifying therapy for AML in adults. The proportion of trials reporting racial and ethnic subgroups, the enrollment proportions for each race, and age ≥65 years were determined, which were stratified by year, trial phase, and geographic location. A meta-analysis of enrollment incidence ratios (EIRs), the ratio of trial proportions of members of a racial and ethnic subgroup divided by the US population–based incidence, was conducted. A total of 7759 titles and abstracts and 157 full texts were screened, yielding 90 studies. Up to 23.3% of trials reported race or ethnicity, and 28.9% reported age ≥65 years. Of the trials reporting race, 4.7% of participants were Black, 9.8% Asian/Pacific Islander, 0.5% Native American/Alaska Native, 80.8% White, and 3.4% Hispanic. Hispanic patients (EIR, 0.28), and Asian patients (EIR, 0.16) were significantly underrepresented, whereas White patients (EIR, 1.23) were significantly overrepresented. When stratifying by year, we found an increase in the proportion of trials reporting on race in the last 10 years (46.2% vs 19.5%) and an increase in the last 20 years in the proportion of racial minorities enrolled.

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摘要急性髓性白血病（AML）患者在发病率和存活率方面存在明显的种族和民族差异。了解随机对照试验（RCT）的入组情况差异对于更好地提供医疗服务和开展临床试验非常重要。我们系统地回顾了有关AML随机对照试验中少数民族和老年人入组情况的文献。我们检索了 MEDLINE 从开始到 2023 年 6 月有关成人急性髓细胞性白血病改良疗法的 RCT 文献。根据年份、试验阶段和地理位置进行分层，确定了报告种族和民族亚群的试验比例、各民族的入组比例以及年龄≥65岁的患者比例。对入组发生率（EIRs）进行了荟萃分析，即种族和民族亚群成员的试验比例除以美国人口发病率的比值。共筛选了 7759 篇标题和摘要以及 157 篇全文，得出 90 项研究结果。多达 23.3% 的试验报告了种族或民族，28.9% 的试验报告了年龄≥65 岁。在报告种族的试验中，4.7%的参与者为黑人，9.8%为亚太岛民，0.5%为美洲原住民/阿拉斯加原住民，80.8%为白人，3.4%为西班牙裔。西班牙裔患者（EIR，0.28）和亚裔患者（EIR，0.16）的比例明显偏低，而白人患者（EIR，1.23）的比例明显偏高。按年份分层后，我们发现过去 10 年中报告种族的试验比例有所上升（46.2% 对 19.5%），过去 20 年中少数种族的入选比例也有所上升。

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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Blood Neoplasia

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