Neighborhood Factors and Treatment Outcomes in Pediatric Acute Lymphoblastic Leukemia: A REDIAL Consortium Report.

Abstract

Acute lymphoblastic leukemia (ALL) shows persistent outcome disparities among socioeconomically disadvantaged and Hispanic children. Neighborhood socioeconomic status (nSES) and residence in Hispanic enclaves may contribute to these disparities, yet their impact on pediatric ALL is unclear. We examined associations of nSES and Hispanic enclave residence with ALL treatment outcomes. We analyzed children (0-24 years) diagnosed with ALL between 2005 and 2017 and treated at REducing Disparities In Acute Leukemia (REDIAL) Consortium centers in Texas. Census-tract nSES (Yost) and Hispanic enclave indices were computed from US Census and American Community Survey (ACS) data, classifying tracts into low/high nSES and enclave/no enclave residence. Outcomes included end-of-induction (EOI) minimal residual disease (MRD) positivity (MRD ≥ 0.01%), relapse, event-free survival (EFS), and overall survival (OS). Associations were evaluated using multivariable logistic and Cox regression models adjusting for sex, age at diagnosis, race/ethnicity, EOI MRD, cytogenetic features, National Cancer Institute (NCI) risk group at diagnosis, ALL immunophenotype, and treating institutions. Among 1,348 patients, 41% resided in low-nSES tracts and 42% in Hispanic enclaves. Neither enclave residence nor low nSES was associated with EOI MRD positivity; similar null associations were observed for relapse, EFS, and OS. Although unadjusted analyses indicated slightly poorer 5-year EFS for low-nSES areas (81% vs. 85%, P = 0.04), this difference attenuated after adjustment. In this large, multicenter, and diverse cohort of children with ALL, neighborhood socioeconomic disadvantage and Hispanic enclave residence were not independently associated with treatment outcomes after accounting for clinical and cytogenetic features. Future studies should examine other social determinants and neighborhood influences on disease characteristics, survivorship, and late effects.

Significance: In this multicenter study, neither neighborhood socioeconomic disadvantage nor residence in a Hispanic/Latino enclave was associated with inferior outcomes among children with ALL after controlling for clinical and cytogenetic disease features. Disparities affecting economically disadvantaged or minoritized populations may be mediated by other factors.