Poorer Outcomes Observed for Black Patients Undergoing Chemotherapy for AML

Black race is an independent prognostic indicator of poorer outcomes, regardless of cytogenetics, among patients treated with intensive chemotherapy for acute myeloid leukemia (AML), according to data from a 30-year retrospective analysis presented during a press briefing at the 2025 American Society of Hematology (ASH) Annual Meeting and Exposition.¹

Data collected from 10 ECOG-ACRIN phase 2 and 3 clinical trials between 1984 and 2019 revealed that Black patients experienced 31.3% greater risk of disease recurrence or death and 21.2% greater risk of death than their White counterparts.

“In this large study, we saw that Black race was an independent predictor of inferior survival in patients with AML treated on clinical trials with intensive chemotherapy, and that poorer survival of Black patients was independent of cytogenetics,” said Shella Saint Fleur-Lominy, MD, PhD, a physician at The University of Maryland School of Medicine’s Marlene and Stewart Greenebaum Comprehensive Cancer Center in Baltimore, Maryland, who presented the data.

The hazard ratio for overall survival (OS) for Black patients vs White patients was 1.212 (95% CI, 1.01-1.453; P = .0383), and the hazard ratio for disease-free survival (DFS) was 1.313 (95% CI, 1.05-1.641; P = .017).

Further, NPM1 mutations were linked with poorer OS in Black patients vs White patients; Black patients with NPM1-mutated AML had an OS of 19.1 months compared with 8.9 months in White patients harboring NPM1 mutations (P = .0095).

“NPM1 failed to confer favorable outcomes for Black patients, suggesting race can modify the effect of certain somatic mutations,” said Saint Fleur-Lominy.

In general, complete remission rates were similar in Black (58.2%) and White (57.5%) patients (P = .55), 30-day mortality rates were also similar, at 7.1% and 8.9%, respectively (P = .504). Notably, a significantly lower portion of Black patients (37.1%) underwent allogeneic stem cell transplant vs White patients (48.5%; P <.001). Rates of bone marrow transplant were similar in Black patients (19.0%) and White patients (20.2%; P = .89)

“Access to allogeneic transplant is a persistent inequity, even in patients with sufficient social support, to be enrolled in clinical trials,” explained Saint Fleur-Lominy.

Patients in other racial groups besides Black and White were 6% higher risk of death (HR, 1.06; 95% CI, .87-1.30) and a 14% higher risk of disease recurrence or death (HR, 1.14; 95% CI, 0.87-1.50) compared with White patients.

Cytogenetic Profiles and Risk Prediction in Black and White Patients

While European LeukemiaNet (ELN) cytogenic risk score (RS) predicted OS in Black and White patients, ELN cytogenic RS predicted DFS in White patients but not for Black patients (P = .48 in Black patients vs P = <0.0001 in White patients).

OS for Black patients was 57.8 months in those with a favorable ELN cytogenic RS, 14.2 months for those with intermediate RS, and 5.8 months for those with an adverse RS. Likewise, OS for White patients with those risk profiles was 60.1 months, 15.2 months, and 7.1 months, respectively.

Complete cytogenetic profiles were available for 117 Black patients and 2162 White patients. Core binding factor AML was observed in a nonsignificantly higher percentage of Black patients (12.8%) vs White patients (8.3%).

No difference was observed for Black vs White patients in complex karyotype (CK); CK with -5/del(5q), -7/del(7q), or -17/del(17p); or AML with myelodysplasia-related changes including +8 and del(20q).

Researchers identified no racial prevalence in FLT3-ITD, CEBPA, TP53, or NPM1 mutations in patients with available data on these mutations (n=1218, n= 576, n = 572, and n = 683, respectively).

“There is a need for analysis of large representative AML data set with integration of ancestry, social factors, and comprehensive genomic profiling of AML,” said Fleur-Lominy, “in order to elucidate the interaction between race and outcome disparities in AML.”

Patients Characteristics and Statistical Analysis

The study aimed to compare outcomes in Black and White patients, and categorized the patient population as Black, White, or other. The study population included 184 Black patients, 3469 White patients, and 156 other patients.

In total, Black patients comprised 1.1% to 11% of respective trial populations. Investigators identified that Black patients were significantly younger at diagnosis, having a median age of 47.9 (SD, 18.8) years vs 53.5 (SD, 16.3) years in White patients (P <.001). Also of statistical significance, 121 Black patients (65.8%) vs 1901 White patients (54.8%) were younger than 60 (P = .0004).

Black and White racial groups were well-matched in gender (Female, 43.5% vs 45.6%, respectively; P = .595) and performance status (0 or 1, 86.4% vs 84.7%; P = .599).

Researchers used descriptive statistics to summarize baseline characteristics with the Wilcoxon rank-sum and Fisher’s exact tests. Further, multivariable Cox proportional hazards regression models were used to assess the association between race and survival outcomes adjusting for age, platelet count, white blood cell count, hemoglobin, blast percentage, ELN cytogenetic RS, and performance status. Cox models were also stratified by protocol.

Kaplan-Meier curves were used to perform subgroup analyses of OS and DFS, which were stratified by race via log-rank tests. All statistical test were 2-sided, and analysis only included patients with complete data for variables of interest.

Saint Fleur-Lominy disclosure: AstraZeneca, consultancy.

Reference

Saint Fleur-Lominy S, Chen L, Sun Z, et al. Inferior survival in black AML patients treated with intensive chemotherapy in ECOG-ACRIN clinical trials is independent of cytogenetic profiles. Blood. 2025;146(suppl 1):290.