title: Clinical characteristics, response to therapy, and survival of African American patients diagnosed with chronic lymphocytic leukemia: joint experience of the MD Anderson Cancer Center and Duke University Medical Center.
abstract: BACKGROUND
  Little is known regarding racial disparities in characteristics and outcomes among patients with chronic lymphocytic leukemia (CLL).
  
  
  METHODS
  The characteristics and outcomes of untreated African American (AA) patients with CLL (n = 84) were analyzed and compared with a reference nonblack (NB) patient population (n = 1571).
  
  
  RESULTS
  At the time of presentation, AA patients had lower median hemoglobin levels (12.9 g/dL vs 13.7 g/dL), higher β2 microglobulin levels (2.7 mg/dL vs 2.4 mg/dL), greater frequency of constitutional symptoms (27% vs 10%), unmutated immunoglobulin heavy-chain variable region (IGHV) mutation status (65% vs 47%), ζ-chain-associated protein kinase 70 (ZAP70) expression (58% vs 32%), and deletion of chromosome 17p or chromosome 11q (28% vs 17%; P ≤ 02 for each comparison). Fifty-one percent of AA patients and 39% of NB patients required first-line therapy and 91% and 88%, respectively, received chemoimmunotherapy. Overall response rates to treatment were 85% for AA patients and 94% for NB patients (P = .06); and the complete response rates were 56% and 58%, respectively (P = .87). The median survival of AA patients was shorter compared with that of NB patients (event-free survival: 36 months vs 61 months; P = .007; overall survival: 152 months vs not reached; P = .0001). AA race was an independent predictor of shorter event-free and overall survival in multivariable regression models.
  
  
  CONCLUSIONS
  The current results indicated that AA patients with CLL have more unfavorable prognostic characteristics and shorter survival compared with their NB counterparts.
authors.affiliation: Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Falchi
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Keating
authors.forename: Xuemei
authors.initials: X
authors.lastname: Wang
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Coombs
authors.forename: Mark C
authors.initials: MC
authors.lastname: Lanasa
authors.forename: Sara
authors.initials: S
authors.lastname: Strom
authors.forename: William G
authors.initials: WG
authors.lastname: Wierda
authors.forename: Alessandra
authors.initials: A
authors.lastname: Ferrajoli
mesh_terms: D051997:ADP-ribosyl Cyclase 1 / Q000032:analysis; D000046:Academic Medical Centers; D000328:Adult; D001741:Black or African American / Q000235:genetics* / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood / Q000235:genetics; D002886:Chromosomes, Human, Pair 17; D018572:Disease-Free Survival; D005260:Female; D017353:Gene Deletion; D015972:Gene Expression Regulation, Neoplastic; D054624:Health Status Disparities; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics; D007135:Immunoglobulin Variable Region / Q000235:genetics; D053208:Kaplan-Meier Estimate; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000235:genetics* / Q000276:immunology / Q000401:mortality* / Q000628:therapy; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D051746:ZAP-70 Protein-Tyrosine Kinase / Q000235:genetics; D001613:beta 2-Microglobulin / Q000097:blood
chemical_list: D014408:Biomarkers, Tumor; D007143:Immunoglobulin Heavy Chains; D007135:Immunoglobulin Variable Region; D001613:beta 2-Microglobulin; D051746:ZAP-70 Protein-Tyrosine Kinase; C497261:ZAP70 protein, human; D051997:ADP-ribosyl Cyclase 1
keywords: African Americans; Chemoimmunotherapy; Chronic Lymphocytic Leukemia; Prognostic Factors; Racial Disparities; Survival
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