An aggressive leukemia is much more deadly for black patients than for whites – why?

THURSDAY, July 7, 2022 (HealthDay News) — Getting a blood cancer diagnosis is devastating for young people, but it’s also much more deadly if the patient is black, new research shows.

The new study, which looked at outcomes for patients with acute myeloid leukemia (AML), highlights the urgent need to understand racial and ethnic differences, as well as the disparities in diagnosis, treatment and care between black and white patients. It was published on July 5 in Blood Progress†

“We found that in young black and white patients who received similar intensive therapy in clinical trials, outcomes were dramatically worse for black patients compared to white patients — and this disparity occurred mainly in patients ages 18 to 29,” said lead author dr. Karlyn Larkin, a hematologist with the Ohio State University Comprehensive Cancer Center.

“To our knowledge, this is the first study to examine how molecular genetic changes contribute to outcomes in young black people with AML compared to their white counterparts,” Larkin said in a journal press release.

According to the findings, young black people with AML were five times more likely to die within 30 days of starting treatment than their white counterparts and twice as likely to die within five years, even with comparable advanced treatment.

Black patients are underrepresented in clinical trials, so there are critical knowledge gaps, the researchers say, despite decades of research investigating the influence of many acquired genetic variants in AML. Most of those studies focused on data from patients of European descent.

AML is a cancer of the blood and bone marrow. It progresses very quickly and people are often advised to start chemotherapy within days of diagnosis.

The study identified clear differences in molecular genetic profiles for treatment among young black and white patients that may contribute to these widely differing outcomes, the authors said.

“From a genetic perspective, we are underserving these patients, on top of all the other health care inequalities facing this historically undervalued population,” Larkin said.

The researchers analyzed data for 566 white patients and 89 black patients, a percentage representative of that of the general US population. The patients were all newly diagnosed with AML. They were treated in clinical trials between 1983 and 2016, led by a research group at the US National Cancer Institute that is now alliance†

The research team also performed analyzes of bone marrow and blood cell samples collected from the patients before treatment and again after they were in remission.

Approximately 11% of Black patients died within 30 days of starting treatment, compared to 2% of Caucasian patients. The five-year survival rate was 46% for white patients, but 32% for black patients. The early death rate for black patients ages 18 to 29 was 16% compared to 3% for white patients.

In this younger age group, Black patients survived on average only 1.3 years, compared to 10.2 years for white patients. There were no significant differences by race in survival in an older segment of the study population.

The researchers also looked at a type of AML called core binding factor AML† Among those patients, black people had a higher rate of premature death at 12%, compared to 3% for their white counterparts. Their five-year survival rate was 54% compared to 70% for white patients.

The team said they could not identify any clear clinical differences between the two groups.

Reasons for the poorer outcomes in black patients may be treatment delays or suboptimal care, which may reflect historical cultural biases and structural racism, other pre-existing health problems or more aggressive disease, Larkin said.

The findings require more research, she said, and “raise the question of why these young patients, who we assume are healthy enough to tolerate intensive therapy, do not survive.”

More information

The US National Cancer Institute has more on: acute myeloid leukemia†

SOURCE: Blood Progresspress release, 5 July 2022