Role of race and ethnicity in survival among children/young adults with relapsed ALL: a Children’s Oncology Group report

Pediatric Hispanic and Black patients with newly diagnosed B-cell acute lymphoblastic leukemia (B-ALL) experience worse overall survival (OS). We hypothesized that differential outcomes by race and ethnicity following relapse may contribute to disparities. We examined 2053 patients with ALL enrolled in frontline Children's Oncology Group trials from 1996 to 2014 who relapsed. We assessed the association of race and ethnicity, disease characteristics, and socioeconomic status with relapse survival predictors and postrelapse OS. For noninfant B-ALL, postrelapse OS (P = .002) and disease-related prognosticators such as time to relapse (P = .0002) differed by race and ethnicity. After adjusting for disease and patient characteristics, the OS association with overall race and ethnicity was attenuated, and lost statistical significance; Hispanic ethnicity specifically remained associated with worse OS (hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.01-1.41). Patients from highest annual median household income ZIP codes (>$85 000, approximately the highest quartile of patients) had better 5-year OS than those from the lowest (<$50 000; HR, 0.79; 95% CI, 0.63-0.99). Non-Hispanic Black and Hispanic patients more commonly lived in lower-income ZIP codes. For T-cell ALL, race, ethnicity, and socioeconomic status were not associated with OS. Worse postrelapse outcomes among racial and ethnic minority patients are largely driven by the prevalence of adverse disease-related factors at time of relapse, with a persistent disparity observed in Hispanic patients. The greatest impact in decreasing racial and ethnic B-ALL outcome disparities may be achieved by targeting frontline treatment interventions to address increased relapse among Black and Hispanic patients, and by developing and enabling equitable access to effective relapse treatments such as novel immunotherapies.

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Publication Details

Journal
Blood Advances
Published
2025-08-15
DOI
https://doi.org/10.1182/bloodadvances.2025016670
Primary Topic
Acute Lymphoblastic Leukemia research
Type
article
Field-Weighted Citation Impact
0.00

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article

Role of race and ethnicity in survival among children/young adults with relapsed ALL: a Children’s Oncology Group report

Mignon L. Loh, Lingyun Ji, Brent Lee Wood, Stephen P. Hunger et al.
Blood Advances
Acute Lymphoblastic Leukemia research
article

Role of race and ethnicity in survival among children/young adults with relapsed ALL: a Children’s Oncology Group report

Mignon L. Loh, Lingyun Ji, Brent Lee Wood, Stephen P. Hunger, Elizabeth A. Raetz, John A. Kairalla, Mary Shago, Susan R. Rheingold, John A. Ligon, Lena E. Winestone, Naomi Joan Winick, Alice Dang, Deepa Bhojwani, Andrew J. Carroll, Sumit Gupta, William L. Carroll, Meenakshi Devidas, Michael J. Borowitz, Nyla A. Heerema, Xinxin Xu
article en

Abstract

Pediatric Hispanic and Black patients with newly diagnosed B-cell acute lymphoblastic leukemia (B-ALL) experience worse overall survival (OS). We hypothesized that differential outcomes by race and ethnicity following relapse may contribute to disparities. We examined 2053 patients with ALL enrolled in frontline Children's Oncology Group trials from 1996 to 2014 who relapsed. We assessed the association of race and ethnicity, disease characteristics, and socioeconomic status with relapse survival predictors and postrelapse OS. For noninfant B-ALL, postrelapse OS (P = .002) and disease-related prognosticators such as time to relapse (P = .0002) differed by race and ethnicity. After adjusting for disease and patient characteristics, the OS association with overall race and ethnicity was attenuated, and lost statistical significance; Hispanic ethnicity specifically remained associated with worse OS (hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.01-1.41). Patients from highest annual median household income ZIP codes (>$85 000, approximately the highest quartile of patients) had better 5-year OS than those from the lowest (<$50 000; HR, 0.79; 95% CI, 0.63-0.99). Non-Hispanic Black and Hispanic patients more commonly lived in lower-income ZIP codes. For T-cell ALL, race, ethnicity, and socioeconomic status were not associated with OS. Worse postrelapse outcomes among racial and ethnic minority patients are largely driven by the prevalence of adverse disease-related factors at time of relapse, with a persistent disparity observed in Hispanic patients. The greatest impact in decreasing racial and ethnic B-ALL outcome disparities may be achieved by targeting frontline treatment interventions to address increased relapse among Black and Hispanic patients, and by developing and enabling equitable access to effective relapse treatments such as novel immunotherapies.

Blood AdvancesVol. 9(22)
Children's Oncology Group (CH), University of Southern California (US), Seattle Children's Hospital (US), St. Jude Children's Research Hospital (US), Children's Hospital of Philadelphia (US), Children's Hospital of Los Angeles (US), Johns Hopkins University (US), University of California, San Francisco (US), University of Toronto (CA), University of Washington (US), University of Florida Health (US), Hospital for Sick Children (CA), Johns Hopkins Bayview Medical Center (US), University of Alabama at Birmingham (US), University of Florida (US), NYU Langone Health (US), Seattle Children's Hospital (US), Center for Cancer and Blood Disorders (US), Children's Oncology Group (US), UCSF Benioff Children's Hospital (US), Institute for Work & Health (CA), UCSF Helen Diller Family Comprehensive Cancer Center (US), The Ohio State University (US), New York University (US), The University of Texas Southwestern Medical Center (US)
Children's Cancer Research Fund, York University, National Institutes of Health, National Cancer Institute
No poverty
Openalex Percentile: Top 71%
Acute Lymphoblastic Leukemia research
DOIOpen Access PDFOpenAlex
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