Adolescent and young adult (AYA) Black patients with acute myeloid leukemia (AML) experience higher rates of recurrence and lower rates of survival compared with White patients, which may be driven by delayed diagnosis and treatment, and genetic differences of the disease, according to the results of a retrospective study published in the journal Blood Advances.

“Higher death rates suggest a delay in diagnosis and treatment, calling for systemic changes to patient care,” the authors wrote in their report. AML survival has been associated with age, but it is unknown whether race can also affect outcomes.

This study evaluated data of 89 non-Hispanic Black and 566 non-Hispanic White patients with AML treated on CLGB/Alliance clinical trial protocols between 1983 and 2016. Patients were treated with intensive chemotherapy induction followed by intensive consolidation or autologous hematopoietic stem cell transplant (HSCT). Targeted sequencing and longitudinal genomic profiling were performed on a subset of patients.


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Clinical outcomes were worse among Black patients compared with White patients aged 18 to 29; outcomes were more similar for the age groups of 18 to 39 and 30 to 39. The early death rate was significantly higher among Black patients aged 18 to 29 at 16% compared with 3% among White patients who received similar treatment (odds ratio [OR], 16.23; 95% CI, 2.45-107.72; P =.002).

Overall survival was also lower in Black patients, with a median of 1.3 months compared with 10.2 months among White patients (hazard ratio [HR], 0.48; 95% CI, 0.28-0.81; P <.001). This translated to a with a 5-year rate of 22% and 51% among Black or White patients, respectively. Disease-free survival was similar between the groups.

Black patients aged 18 to 29 experienced lower complete remission rates at 66% compared with 83% among White patients (P =.01). “Reduced response rates to induction chemotherapy and leukemic clone persistence suggest a need for different treatment intensities and/or modalities in Black adolescent and young adult patients,” the authors wrote.

The genetic features of AML were different between the races, as 19% and 40% of Black or White patients, respectively, had normal cytogenetics (P <.001). Black patients demonstrating lower rates of normal karyotypes, NPM1 mutations, and biallelic CEBP mutations. There were also higher rates of CBF rearrangements, as well as mutations in ASXL1, BCOR, and KRAS.

The authors concluded that “we believe that these data and other data justify further prospective studies of Black AYA patients with AML, including evaluation of alternate frontline and/or consolidation treatment.” They added that efforts should also be made to collect data of “social determinants of health to try to assess nonclinical reasons for poor outcomes, as well as careful consideration and enhanced monitoring for the individual Black AYA patients with AML being treated in the clinic today.”

Disclosures: Some of the study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of disclosures.

Reference

Larkin KT, 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. 2022;6:5570-5581. doi: 10.1182/bloodadvances.2022007544