Racial disparities in the survival of American children, adolescents, and young adults with acute lymphoblastic leukemia, acute myelogenous leukemia, and Hodgkin lymphoma.
BACKGROUND
Race-based survival in children and adolescents with hematologic malignancies has been a national challenge for decades. Large-scale investigations of age- and race-based survival trends over time in these patients have not previously been reported. The objective of this study was to investigate whether race- and age-related differences in pediatric and adolescent and young adult (AYA) leukemia and lymphoma survival persist and to what extent these differences have changed over time.


METHODS
Using the Surveillance, Epidemiology, and End Results program, this study investigated the outcomes of black and white (1975-2012; n = 27,369) and white and Hispanic (1992-2012; n = 20,574) children (0-14 years old) and AYAs (15-39 years old) with acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML), and Hodgkin lymphoma (HL). Estimates of 5- and 10-year relative survival were compared over time.


RESULTS
Trends showed a convergence of survival for white and black children with ALL but a divergence in survival for AYA patients. Hispanic children and AYAs both suffered inferior outcomes. Trends for AML revealed persistent survival differences between black and white children and suggested worsening disparities for AYAs. Survival trends in HL revealed sustained survival differences between black and white AYA patients, whereas no differences were found in Hispanic and white patient outcomes for AML or HL.


CONCLUSIONS
Although survival for children and AYAs with ALL, AML, and HL has improved over the past 4 decades, differences persist between black, white, and Hispanic children and AYAs; survival disparities between black and white children with ALL have been nearly eliminated. Strategies aimed at identifying causality and reducing disparities are warranted. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2723-2730. © 2016 American Cancer Society.
Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Medical Center, New York, New York.
Justine M
JM
Kahn
Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California.
Theresa H M
TH
Keegan
Cancer Prevention Institute of California, Fremont, California.
Li
L
Tao
Cancer Prevention Institute of California, Fremont, California.|Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Renata
R
Abrahão
Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon.
Archie
A
Bleyer
Human Oncology & Pathogenesis Program and Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
Aaron D
AD
Viny
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006689:Hodgkin Disease / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015470:Leukemia, Myeloid, Acute / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D008297:Male; D009367:Neoplasm Staging; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
Epidemiology; Surveillance; adolescent; adolescent and young adult (AYA); and End Results (SEER); disparities; leukemia; lymphoma; pediatric; race; survival