PF473 PEDIATRIC HODGKIN LYMPHOMA: DISPARITIES IN SURVIVAL BY RACE

Abstract

Background:The association between race and survival has not been well established for patients with pediatric Hodgkin Lymphoma (HL).Aims:The purpose of this study was to examine the disparities in overall survival (OS) by race in a large cohort of patients with pediatric HL.Methods:We evaluated clinical features and survival outcomes among patients ≤21 years of age diagnosed with stage I‐IV HL from 2004 to 2015 from the prospectively collected National Cancer DataBase (NCDB). The association between patient‐reported race and OS was assessed in a multivariable Cox proportional hazards model.Results:Among 11,546 patients with pediatric HL ≤21 years of age within the NCDB, a total of 9,285 patients with stage I‐IV disease were eligible for this study, with a median follow‐up of 5 years. The race status was as follows: 7,722 (83%) White; 1,136 (12%) Black, and 427 (5%) other. Black patients were found to be younger (<15), lower stage at diagnosis, more commonly with “B” symptoms, less likely to have nodular‐sclerosis histology, more likely to be lower income and education quartiles, and under/uninsured (all p < 0.01). Treatment interventions among races was similar (use of chemotherapy, radiation therapy, or combined modality therapy). Patients of Black race experienced a 5‐year OS of 91.5% vs. 95.9% compared to their White counterparts (p < 0.01). This difference in OS persisted across all stratified stages (I‐IV). When adjusting for all co‐variates, Black race was associated with significantly decreased OS (HR = 1.50; 95% CI, 1.12–1.99, p < 0.01). In risk factor stratification by race,age <15, stage IV disease, presence of B symptoms, use of radiation, and income were prognostic factors for OS in White patients, but not for Black patients. Effect measure modification was also utilized to assess the interaction between socioeconomic parameters (education/income/insurance status) and race and no significant interaction was found. In sensitivity analysis including age groups of ≤15 years, 16–18 years, and >18 years of age, Black race was associated with poorer OS among all age groups compared to Whites with rates of 95.4% vs 97.7%, 87.1% vs 96.1%, and 91.6% vs 94.6% respectively.Summary/Conclusion:Our study reveals that among pediatric patients with HL, Black race was associated with lower overall survival, across all disease stages and pediatric age groups. To our knowledge, this study represents the largest dataset examining the role of race on survival for pediatric patients with HL. Further studies are necessary to elucidate the causes of these differences in order to facilitate optimal treatment of pediatric HL patients in the era of risk‐stratified, response‐based treatment.image