Racial differences in the survival of childhood B-precursor acute lymphoblastic leukemia

A Pediatric Oncology Group study

Bradley H Pollock, Michael R. DeBaun, Bruce M. Camitta, Jonathan J. Shuster, Yaddanapudi Ravindranath, D. Jeanette Pullen, Vita J. Land, Donald H. Mahoney, Stephen J. Lauer, Sharon B. Murphy

Research output: Contribution to journalArticle

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Abstract

Purpose: We conducted a historic cohort study to test the hypothesis that, after adjustment for biologic factors, African-American (AA) children and Spanish surname (SS) children with newly diagnosed B-precursor acute lymphoblastic leukemia had lower survival than did comparable white children. Patients and Methods: From 1981 to 1994, 4,061 white, 518 AA, and 507 SS children aged 1 to 20 years were treated on three successive Pediatric Oncology Group multicenter randomized clinical trials. Results: AA and SS patients were more likely to have adverse prognostic features at diagnosis and lower survival than were white patients. The 5-year cumulative survival rates were (probability ± SE) 81.9% ± 0.6%, 68.6% ± 2.1%, and 74.9% ± 2.0% for white, AA, and SS children, respectively. Adjusting for age, leukocyte count, sex, era of treatment, and leukemia blast cell ploidy, we found that AA children had a 42% excess mortality rate compared with white children (proportional hazards ratio [PHR] = 1.42; 95% confidence interval [CI], 1.12 to 1.80), and SS children had a 33% excess mortality rate compared with white children (PHR = 1.33; 95% CI, 1.19 to 1.49). Conclusion: Clinical presentation, tumor biology, and deviations from prescribed therapy did not explain the differences in survival and event-free survival that we observed, although differences seem to be diminishing over time with improvements in therapy. The disparity in outcome for AA and SS children is most likely related to variations in chemotherapeutic response to therapy and not to compliance. Further improvements in outcome may require individualized dosing based on specific pharmacogenetic profiles, especially far AA and SS children. (C) 2000 American Society of Clinical Oncology.

Original languageEnglish (US)
Pages (from-to)813-823
Number of pages11
JournalJournal of Clinical Oncology
Volume18
Issue number4
StatePublished - Feb 2000
Externally publishedYes

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Pediatrics
African Americans
Survival
Mortality
Confidence Intervals
Ploidies
Pharmacogenetics
Biological Factors
Therapeutics
Leukocyte Count
Compliance
Disease-Free Survival
Leukemia
Cohort Studies
Survival Rate
Randomized Controlled Trials

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Pollock, B. H., DeBaun, M. R., Camitta, B. M., Shuster, J. J., Ravindranath, Y., Pullen, D. J., ... Murphy, S. B. (2000). Racial differences in the survival of childhood B-precursor acute lymphoblastic leukemia: A Pediatric Oncology Group study. Journal of Clinical Oncology, 18(4), 813-823.

Racial differences in the survival of childhood B-precursor acute lymphoblastic leukemia : A Pediatric Oncology Group study. / Pollock, Bradley H; DeBaun, Michael R.; Camitta, Bruce M.; Shuster, Jonathan J.; Ravindranath, Yaddanapudi; Pullen, D. Jeanette; Land, Vita J.; Mahoney, Donald H.; Lauer, Stephen J.; Murphy, Sharon B.

In: Journal of Clinical Oncology, Vol. 18, No. 4, 02.2000, p. 813-823.

Research output: Contribution to journalArticle

Pollock, BH, DeBaun, MR, Camitta, BM, Shuster, JJ, Ravindranath, Y, Pullen, DJ, Land, VJ, Mahoney, DH, Lauer, SJ & Murphy, SB 2000, 'Racial differences in the survival of childhood B-precursor acute lymphoblastic leukemia: A Pediatric Oncology Group study', Journal of Clinical Oncology, vol. 18, no. 4, pp. 813-823.
Pollock, Bradley H ; DeBaun, Michael R. ; Camitta, Bruce M. ; Shuster, Jonathan J. ; Ravindranath, Yaddanapudi ; Pullen, D. Jeanette ; Land, Vita J. ; Mahoney, Donald H. ; Lauer, Stephen J. ; Murphy, Sharon B. / Racial differences in the survival of childhood B-precursor acute lymphoblastic leukemia : A Pediatric Oncology Group study. In: Journal of Clinical Oncology. 2000 ; Vol. 18, No. 4. pp. 813-823.
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abstract = "Purpose: We conducted a historic cohort study to test the hypothesis that, after adjustment for biologic factors, African-American (AA) children and Spanish surname (SS) children with newly diagnosed B-precursor acute lymphoblastic leukemia had lower survival than did comparable white children. Patients and Methods: From 1981 to 1994, 4,061 white, 518 AA, and 507 SS children aged 1 to 20 years were treated on three successive Pediatric Oncology Group multicenter randomized clinical trials. Results: AA and SS patients were more likely to have adverse prognostic features at diagnosis and lower survival than were white patients. The 5-year cumulative survival rates were (probability ± SE) 81.9{\%} ± 0.6{\%}, 68.6{\%} ± 2.1{\%}, and 74.9{\%} ± 2.0{\%} for white, AA, and SS children, respectively. Adjusting for age, leukocyte count, sex, era of treatment, and leukemia blast cell ploidy, we found that AA children had a 42{\%} excess mortality rate compared with white children (proportional hazards ratio [PHR] = 1.42; 95{\%} confidence interval [CI], 1.12 to 1.80), and SS children had a 33{\%} excess mortality rate compared with white children (PHR = 1.33; 95{\%} CI, 1.19 to 1.49). Conclusion: Clinical presentation, tumor biology, and deviations from prescribed therapy did not explain the differences in survival and event-free survival that we observed, although differences seem to be diminishing over time with improvements in therapy. The disparity in outcome for AA and SS children is most likely related to variations in chemotherapeutic response to therapy and not to compliance. Further improvements in outcome may require individualized dosing based on specific pharmacogenetic profiles, especially far AA and SS children. (C) 2000 American Society of Clinical Oncology.",
author = "Pollock, {Bradley H} and DeBaun, {Michael R.} and Camitta, {Bruce M.} and Shuster, {Jonathan J.} and Yaddanapudi Ravindranath and Pullen, {D. Jeanette} and Land, {Vita J.} and Mahoney, {Donald H.} and Lauer, {Stephen J.} and Murphy, {Sharon B.}",
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T1 - Racial differences in the survival of childhood B-precursor acute lymphoblastic leukemia

T2 - A Pediatric Oncology Group study

AU - Pollock, Bradley H

AU - DeBaun, Michael R.

AU - Camitta, Bruce M.

AU - Shuster, Jonathan J.

AU - Ravindranath, Yaddanapudi

AU - Pullen, D. Jeanette

AU - Land, Vita J.

AU - Mahoney, Donald H.

AU - Lauer, Stephen J.

AU - Murphy, Sharon B.

PY - 2000/2

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N2 - Purpose: We conducted a historic cohort study to test the hypothesis that, after adjustment for biologic factors, African-American (AA) children and Spanish surname (SS) children with newly diagnosed B-precursor acute lymphoblastic leukemia had lower survival than did comparable white children. Patients and Methods: From 1981 to 1994, 4,061 white, 518 AA, and 507 SS children aged 1 to 20 years were treated on three successive Pediatric Oncology Group multicenter randomized clinical trials. Results: AA and SS patients were more likely to have adverse prognostic features at diagnosis and lower survival than were white patients. The 5-year cumulative survival rates were (probability ± SE) 81.9% ± 0.6%, 68.6% ± 2.1%, and 74.9% ± 2.0% for white, AA, and SS children, respectively. Adjusting for age, leukocyte count, sex, era of treatment, and leukemia blast cell ploidy, we found that AA children had a 42% excess mortality rate compared with white children (proportional hazards ratio [PHR] = 1.42; 95% confidence interval [CI], 1.12 to 1.80), and SS children had a 33% excess mortality rate compared with white children (PHR = 1.33; 95% CI, 1.19 to 1.49). Conclusion: Clinical presentation, tumor biology, and deviations from prescribed therapy did not explain the differences in survival and event-free survival that we observed, although differences seem to be diminishing over time with improvements in therapy. The disparity in outcome for AA and SS children is most likely related to variations in chemotherapeutic response to therapy and not to compliance. Further improvements in outcome may require individualized dosing based on specific pharmacogenetic profiles, especially far AA and SS children. (C) 2000 American Society of Clinical Oncology.

AB - Purpose: We conducted a historic cohort study to test the hypothesis that, after adjustment for biologic factors, African-American (AA) children and Spanish surname (SS) children with newly diagnosed B-precursor acute lymphoblastic leukemia had lower survival than did comparable white children. Patients and Methods: From 1981 to 1994, 4,061 white, 518 AA, and 507 SS children aged 1 to 20 years were treated on three successive Pediatric Oncology Group multicenter randomized clinical trials. Results: AA and SS patients were more likely to have adverse prognostic features at diagnosis and lower survival than were white patients. The 5-year cumulative survival rates were (probability ± SE) 81.9% ± 0.6%, 68.6% ± 2.1%, and 74.9% ± 2.0% for white, AA, and SS children, respectively. Adjusting for age, leukocyte count, sex, era of treatment, and leukemia blast cell ploidy, we found that AA children had a 42% excess mortality rate compared with white children (proportional hazards ratio [PHR] = 1.42; 95% confidence interval [CI], 1.12 to 1.80), and SS children had a 33% excess mortality rate compared with white children (PHR = 1.33; 95% CI, 1.19 to 1.49). Conclusion: Clinical presentation, tumor biology, and deviations from prescribed therapy did not explain the differences in survival and event-free survival that we observed, although differences seem to be diminishing over time with improvements in therapy. The disparity in outcome for AA and SS children is most likely related to variations in chemotherapeutic response to therapy and not to compliance. Further improvements in outcome may require individualized dosing based on specific pharmacogenetic profiles, especially far AA and SS children. (C) 2000 American Society of Clinical Oncology.

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