Disparities in early death and survival in children, adolescents, and young adults with acute promyelocytic leukemia in California.
BACKGROUND
Findings from clinical trials and population-based studies have differed with regard to whether mortality within 30 days of diagnosis (early death) of acute promyelocytic leukemia (APL) has decreased in the era of all-trans retinoic acid and anthracycline-based chemotherapy.


METHODS
Using data from the California Cancer Registry, the authors investigated 7-day and 30-day mortality and survival in 772 patients who were aged birth to 39 years when they were diagnosed with APL during 1988 to 2011. Logistic regression and Cox proportional models were used to examine the association of early death and survival, respectively, with sociodemographic and clinical factors.


RESULTS
The overall 30-day mortality decreased significantly over time, from 26% (1988-1995) to 14% (2004-2011) (P =.004). On multivariable analysis, the odds of 30-day mortality were 3 times as high during 1988 through 1995 than 2004 through 2011 (P =.001). However, 7-day mortality did not improve over time (P =.229). When patients who died within 7 days of diagnosis were excluded, the 30-day mortality during 1996 to 2011 was 3% to 8%, which is similar to levels reported in clinical trials. Higher early death and lower survival were associated with a lack of health insurance (1996-2011) (early death odds ratio, 2.67; P =.031) and Hispanic race/ethnicity (early death odds ratio, 2.13; P =.014). Early death was not found to be associated with age, sex, socioeconomic status, or hospital type. Black patients also experienced worse survival.


CONCLUSIONS
The findings of the current study revealed a decreased 30-day mortality during the all-trans retinoic acid era, but 7-day mortality remained high. Efforts to achieve equal outcomes in young patients with APL should focus on improving access to effective treatment, mainly among uninsured patients and those of Hispanic and black race/ethnicity.
Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.|Cancer Prevention Institute of California, Fremont, California.
Renata
R
Abrahão
Leukemia and Lymphoma Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Raul C
RC
Ribeiro
Division of Hematology, Stanford University School of Medicine, Stanford, California.
Bruno C
BC
Medeiros
Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Ruth H
RH
Keogh
Cancer Prevention Institute of California, Fremont, California.|Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.
Theresa H M
TH
Keegan
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015473:Leukemia, Promyelocytic, Acute / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D016016:Proportional Hazards Models; D055815:Young Adult
acute promyelocytic leukemia; adolescents; all-trans retinoic acid (ATRA); children; early death; health disparities; health insurance; survival; young adults