Young Black patients with leukemia have worse outcomes than whites

A recent study from Ohio State University shows that Young adult Black patients with acute myeloid leukemia (AML) are five times more likely than comparable white patients to die within 30 days of beginning treatment, and twice as likely to die within five years, despite receiving similar state-of-the-art treatment.

AML is an aggressive and fast-growing form of blood cancer diagnosed in about 20,000 U.S. patients annually. The majority of people receive their diagnosis within a few weeks after developing symptoms. People who have been diagnosed are often advised to start chemotherapy immediately, within days of diagnosis.

The study was published in the July 5, 2022 issue of the Blood Advances online only, an open access journal of the American Society of Hematology (ASH). ASH is the world’s largest professional society concerned with the causes and treatment of blood disorders.

The research was performed by The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James).

“To our knowledge, this is the first study to examine how molecular genetic alterations contribute to outcomes in young Black people with AML compared with their white counterparts,” said Dr. Karilyn Larkin, a hematologist with the OSUCCC – James and lead author of the study. 

Danielle Parker, far right, Simulation Center coordinator, gives a lesson on ventilating a patient — represented here by a mannequin — to, from left, Murrah High School students Benjamin Knott and Myron Evans and Tevin Tillman, a University of Southern Mississippi student. (umc.edu)

Study shows vast disparities among young Leukemia patients based on race

The study found that among young Black and white patients who received similar intensive therapy on clinical trials, the outcomes were dramatically inferior for Black patients when compared to white patients. “This disparity occurred predominantly among patients aged 18 to 29 years,” said Larkin.

The study analyzed data for 566 white patients and 89 Black patients, a proportion representative to that of the general U.S. population. All patients were between the ages of 18 and 39 with newly diagnosed AML and were treated in clinical trials run by the National Cancer Institute between 1983 and 2016.

They found that about 11% of Black patients died within 30 days of starting treatment, compared to 2% of white patients. Five-year survival was 46% for white patients, but 32% for Black patients. The rate of early death for Black patients ages 18 to 29 was 16% compared to 3% for white patients.

Dr. Sophia Tolliver (left) examines a patient at The Ohio State University Wexner Medical Center after discussing ways to preserve her hairstyle during exercise. She led a study that found few primary care providers acknowledge hair care as a barrier to exercise for African American women.

Black patients in the 18 to 29 age group survived for a median of just 1.3 years compared with a median of 10.2 years for white patients aged 18 to 29. By contrast, among patients in the 30 to 39 age group, there were no significant differences in survival between Black and white participants.

Larkin notes that because Black patients continue to be underrepresented in cancer clinical trials, a critical knowledge gap remains, despite decades of research about the influence of many acquired genetic variants in AML. Most of those studies were focused on data from patients of European ancestry.

“Understanding how these disease-specific genetic variants, which are acquired during a lifetime, differ between patients can help doctors identify effective treatment options on an individual or population basis,” Larkin said.

More research needed

The study also identified clear differences in pretreatment molecular genetic profiles between young Black and white Americans with AML that may contribute to these widely varying outcomes. The study did not address how structural racism and health care disparities may contribute to different outcomes among Black patients with AML however.

“From a genetic perspective, we are underserving these patients, on top of all of the other health care inequities this historically underserved population faces,” Larkin said.

The researchers also looked at a type of acute myeloid leukemia called core-binding factor AML. Among those patients, Black people had a higher rate of early death at 12%, compared to 3% for their white counterparts. Their five-year survival was 54% compared to 70% for white patients.

The team said they could not identify any obvious clinical differences between the two groups.

“Reasons for the poorer outcomes among Black patients may include treatment delays or suboptimal care, which may reflect historical cultural biases and structural racism, other existing health conditions, or more aggressive disease,” Larkin said.

Larkin says that their findings on leukemia “raise the question of why these young patients, who we would assume are healthy enough to tolerate intensive therapy, don’t survive,” and that further research is required.