title: Racial differences in presentation, referral and treatment patterns and survival in adult patients with acute myeloid leukemia: a single-institution experience.
abstract: BACKGROUND
  Disease presentation and outcomes differ by race in a number of malignancies, but data in adult acute myeloid leukemia (AML) are limited.
  
  
  METHODS
  We conducted a retrospective analysis of pretreatment characteristics, referral and treatment patterns, and outcomes in 548 AML patients evaluated at the University of Maryland Greenebaum Cancer Center, a tertiary care referral center in Baltimore, MD, from 2000 through 2009. Cases were analyzed for time from diagnosis to referral, age, race, gender, socioeconomic status, antecedent hematologic disorder, cytotoxic or radiation therapy for prior malignancy, karyotype, fms-like tyrosine kinase receptor-3 (FLT3) mutations, intensive chemotherapy, clinical trial participation, hematopoietic stem cell transplantation (HSCT) and overall survival (OS).
  
  
  RESULTS
  Black patients (n=105) were younger than white patients (n=396) (54 vs. 61 years, p<0.001), were more commonly female (55% vs. 45%, p<0.001), and had a lower estimated median household income ($42,677 vs. $53,534 per year, p<0.001). Black patients more frequently had complex karyotypes (26% vs. 12%, p=0.002) and less frequently normal karyotypes (27% vs. 42%, p=0.02). FLT3 mutation frequency was similar. Time to referral and proportion of patients receiving intensive chemotherapy did not differ, but both clinical trial participation (43% vs. 54%, p=0.04) and HSCT (17% vs. 35% for patients ≤70 years old, p=0.001) were less frequent in blacks than whites. Nevertheless, OS was similar in all black and white patients (median 15 vs. 14 months, p=0.23), and when stratified by age, gender and karyotype risk classification.
  
  
  CONCLUSIONS
  AML presentation and treatment differed in black and white patients, but OS was similar. Black patients appear to have barriers to clinical trial participation and HSCT, and there may be barriers to tertiary care referral for black males.
authors: University of Maryland Greenebaum Cancer Center, Baltimore, MD 21201, USA.
authors: Jason
authors: J
authors: Bierenbaum
authors: Amy J
authors: AJ
authors: Davidoff
authors: Yi
authors: Y
authors: Ning
authors: Michael L
authors: ML
authors: Tidwell
authors: Ivana
authors: I
authors: Gojo
authors: Maria R
authors: MR
authors: Baer
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D015142:Baltimore; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007621:Karyotyping; D015470:Leukemia, Myeloid, Acute / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D059645:Mutation Rate; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D015996:Survival Rate; D044465:White People / Q000706:statistics & numerical data*; D051941:fms-Like Tyrosine Kinase 3 / Q000235:genetics
chemical_list: C497970:FLT3 protein, human; D051941:fms-Like Tyrosine Kinase 3