Poorer outcomes in young adult Black patients with acute myeloid leukemia.

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Young adult Black patients with acute myeloid leukemia (AML) have significantly lower survival rates than White patients with AML despite similar intensive treatment. Results of a study by Karilyn T. Larkin, MD, and her colleagues at The Ohio State University in Columbus show that young Black patients with AML are five times more likely to die within 30 days of beginning treatment and twice as likely to die within 5 years in comparison with White patients.1 The results are based on an analysis of 566 White patients and 89 Black patients aged 18–39 years with newly diagnosed AML treated in National Cancer Institute clinical trials between 1983 and 2016. Specifically, the outcome disparity was found in patients aged 18–29 years. Black patients in this age group had a significantly higher early death rate than White patients (16% vs. 3%; p = .002), a lower complete remission rate (66% vs. 83%; p = .01), and decreased overall 5-year survival (22% vs. 51%; p < .001). No differences were found in patients aged 30–39 years. Cytogenetic and molecular analyses performed on select longitudinal bone marrow and blood cell specimens collected from 327 patients (50 Black and 277 White) before treatment and after the achievement of remission showed that the survival differences persisted across cytogenetic groups. Black patients with non–core-binding factor (CBF) AML had significantly lower overall 5-year survival rates than White patients (12% vs. 44%; p < .001). The lower survival included patients with cytogenetically normal AML. Although the investigators found that the cytogenetic and molecular mutations were different between young Black patients and White patients, these differences alone did not account for the differences in outcomes. The study also found that Black patients had lower frequencies of some mutations (normal karyotypes, NPM1, and biallelic CEBPA) and higher frequencies of others (CBF rearrangements and ASXL1, BCOR, and KRAS) in comparison with White patients. The type of treatment also did not account for the survival differences, as all patients received similar therapy consisting of intensive induction treatment followed by intensive consolidation chemotherapy or autologous hematopoietic stem cell transplantation. To better understand and validate the findings, lead author Dr Larkin, a hematologist with The Ohio State University Comprehensive Cancer Center–Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, says that prospective studies incorporating more patient data, such as social determinants of health, comorbidities, and co-occurring complications, are needed. Noting in a press release that most data on AML come from patients of European ancestry, she underscored the need for additional prospective studies of young Black adult patients with AML to better understand what is driving their poorer outcomes. “They [the findings] also raise the question of why these young patients, who we would assume are healthy enough to tolerate intensive therapy, don’t survive,” she said in the release.2 Dr Larkin emphasizes the need for extra vigilance when one is treating young Black patients with AML, including a referral for allogeneic stem cell transplantation as soon as possible. “AML is already a heterogenous disease with treatments that are changing and newer strategies for monitoring,” she says. “To best serve this patient population, [oncologists] should be encouraged to consult with centers of expertise, which may open the door to clinical trials, novel therapies, measurable residual disease monitoring and interpretation, and earlier transplantation.”