Survival disparities in patients with acute lymphoblastic leukemia: A focus on young adult and adolescent patients.

Abstract

e18529 Background: Acute lymphoblastic leukemia (ALL) in the pediatric population has a 5-year overall survival that exceeds 90%, however, the survival rate drops significantly in the adolescent and young adult (AYA) population. 80% of ALL-related deaths occur in AYA patients, despite AYA patients representing less than one-fourth of total ALL cases. In addition, there is an increasing incidence of ALL among minority AYAs in the United States. Although worse survival in Hispanic and non-Hispanic Black ALL patients have been reported, there is paucity of data on the AYA population specifically. In this study, we sought to investigate the impact of racial/ethnic and sociodemographic disparities on recent overall survival of adolescent and young adult patients with ALL, using the Surveillance, Epidemiology, and End Results (SEER) database. Methods: The SEER database was utilized to extract data on patients with a histological diagnosis of ALL between 2000-2021. Patients between the ages of 15-39 were included in our AYA cohort, as defined by the National Cancer Institute. Our primary outcome of interest was overall survival (OS), defined as the time from ALL diagnosis to death from any cause. Kaplan-Meier methods were used to estimate 5-year survival rates. Cox proportional hazards regression was used for multi-variable modelling of the survival database. The difference between the observed number of events between each group was compared using a log-rank statistical test and hazard ratios reflecting 5-year OS between groups. Results: Our data captured 6,655 AYA patients with ALL from 2000 to 2021. Races were categorized into non-Hispanic Black (n=439, 6.6%), non-Hispanic White (n=2517, 37.8%), Hispanic (n=3076, 46.2%), non-Hispanic Asian or Pacific Islander (NHAPI) (n=551, 8.3%), and non-Hispanic American Indian/Alaska Native (NHAIAN) (n=72, 1.1%). The estimated 5-year OS was 64% for non-Hispanic White patients, 65% for NHAPI, 51% for NHAIAN, 56% for Hispanic, and 50.5% for non-Hispanic Black patients. Compared to non-Hispanic White patients, a statistically significant worse overall survival was seen in non-Hispanic Black patients [HR 1.6 (95% CI 1.38-1.9, p<0.001)] and Hispanic patients [HR 1.4 (95% CI 1.31-1.5, p<0.001)]. There were no statistically significant differences in OS when stratified by income, gender, or urban vs rural location. Conclusions: From 2000 to 2021, race among AYA ALL predicted worse overall survival in Black and Hispanic AYA patients. It is important to better understand the disparities that impact the AYA population, whom may be particularly vulnerable to social factors impacting their care.