Black Adolescent Young Adults With AML Have Worse Outcomes Vs White Population

Black adolescent young adult patients with acute myeloid leukemia appeared to have inferior outcomes compared with White patients.

Adolescent and young adult patients who are Black with acute myeloid leukemia (AML) between 18 and 29 years old reportedly have worse survival than White patients receiving similar therapy, according to a study published in Blood Advances.

A higher rate of early death was observed in Black patients between the ages of 18 to 29 (16%) vs 3% the White population (3%; P = .002). Moreover, Black patients had a lower complete remission (CR) rate at 66% vs 83% (P = .01) in White patients, as well as a lower 5-year overall survival (OS) rate at 22% vs 51% (P <.001), respectively. Disparities were also observed across different cytogenetic subgroups, including worse 5-year OS rates among Black patients with non-core binding factor AML (12% vs 44%; P <.001) and cytogenetically normal AML (13% vs 50%; P = .003) compared with White patients.

Patients who were Black compared with White had a higher rates of early death at 11% vs 2% (P <.001), lower CR rates at 73% vs 82% (P = .06), and shorter 5-year OS rates at 32% vs 46% (P = .002). However, the 5-year disease-free survival (DFS) rate was in 32% in Black patients vs 40% in White patients (P = .25).

Patient characteristics were almost the same in regard to age and sex, while there were no differences in clinical features were apparent at diagnosis. A total of 327 samples were collected from 50 Black patients and 277 White patients. At diagnosis, 40% of White patients were cytogenetically normal vs 19% of Black patients (P <.001), and 22% vs 37% of patients, respectively, had abnormal karyotypes with chromosome rearrangement that were associated with core-binding factor AML (P = .005).

Mutations of t(8;21)(q22;q22)/RUNX1::RUNX1T1 were observed in 22% of patients who were Black vs 10% of those who were White (P = .002), while there were similar rates of inv(16)(p13.1q22)/CBFB::MYH11 or t(16;16)(p13.1;q22)/CBFB::MYH11 mutationsincluding 15% in Black patients vs 12% in White patients (P = .49).

Gene variants including ASXL1 (12% vs 1%; P <.001), KRAS (16% vs 5%; P = .01), ZRSR2 (6% vs 0.4%; P = .01), BCOR (8% vs 2%; P = .05), and CALR (8% vs 2%; P = .05) were more prevalent in Black patients vs White patients. However, more White patients had gene alterations in NPM1 (29% vs 4%; P <.001) and bi-allelic CEBPA (17% vs 3%; P = .02) compared with Black patients.

Overall patients who were Black had higher early death rates in 16% vs 3% (P = .002). The median OS for patients who were Black and between the ages of 18 to 29 years was 1.3 years vs 10.2 years for patients who were White (P <.001). Investigators did not find any significant differences in survival between patients who were Black or White between the ages of 30 to 39.

A total of 15% of patients who were White and 4.5% of those who were Black received allogeneic hematopoietic stem cell transplantation (HSCT) during first CR. Of those who underwent allogeneic HSCT, a longer DFS was observed among White patients vs Black patients and did not undergo the treatment. There were no significant differences in OS between treatment groups (P = .21).

Patients who were Black and had core-binding factor AML had higher rates of early death at 12% vs 3% of patients who were White (P = .06), lower CR rates at 85% vs 95% (P = .06), and shorter 5-year OS rates in 54% vs 70% (P = .05), respectively. No differences in DFS and OS were observed between patient subgroups with non-core binding factor AML with t(8;21) alterations. However, OS but not DFS was shorter for patients who were Black between 18 to 29 years of age with inv(16)/t(16;16) vs 18 to 29 and 30 to 39 year-olds who were White.

Reference

Larkin K, Nicolet D, Kelly BJ, et al. High early death rates, treatment resistance, and short survival of Black adolescents and young adults with AML. Blood Adv. Published Online July 5, 2022. doi:10.1182/bloodadvances.2022007544