By Mary Ellen Schneider
Black patients with acute myeloid leukemia (AML) who are under age 60 had worse outcomes than their white counterparts, even when they received the same care, according to findings reported at the annual meeting of the American Society of Hematology.
In the study, researchers discovered that younger Black patients had a 27% higher likelihood of death than white patients, suggesting that Black patients are not benefiting from recent advances in the treatment of acute myeloid leukemia (Abstract 6).
“Although overall survival has actually improved across three decades for AML patients as a whole… the survival disparity between Black and white AML patients has actually widened,” said Bhavana Bhatnagar, DO, of the Ohio State University Comprehensive Cancer Center, who presented the study findings.
The multi-part study began with a retrospective look at Surveillance Epidemiology End Results (SEER) data for 25,523 adults aged 18-60 years who were diagnosed with AML between 1986 and 2015. When researchers looked specifically at 8,074 white patients and 1,356 Black patients from the SEER dataset, they found that the 3-year overall survival rates were 34% for younger Black patients and 43% for white patients (P less than 0.001).
When researchers examined the demographic and socioeconomic characteristics of younger Black and white AML patients, they found some key differences. Black patients were younger at the time of their AML diagnosis, there was a higher proportion of Black patients residing in metropolitan areas, and more Black patients were uninsured or on Medicaid. Additionally, a higher percentage of Black patients came from families who lived below the poverty line. However, researchers found that Black race was an independent predictor of poor overall survival in younger AML patients, with Black patients having a 27% higher risk of death, compared with white patients, even after adjustment for age, sex, metropolitan area of residence, measure of poverty, and decade of diagnosis.
Researchers next evaluated AML patients in the setting of clinical trials to see if access to treatment was affecting survival rates. They examined 1,339 AML patients treated on Cancer and Leukemia Group B/Alliance for Clinical Trials in Oncology protocols between 1986 and 2016. The researchers found no statistical differences in complete remission rates, early death rates, or relapse rates. However, both disease-free and overall survival were significantly worse for Black patients with AML, compared with white patients.
Finally, Dr. Bhatnagar and her colleagues looked at underlying molecular differences to help explain the survival differences they were seeing. One finding that stood out, Dr. Bhatnagar said, is that Black patients had a lower frequency of prognostically favorable NPM1 mutations (25% versus 38%, P=0.04).
“The NPM1 gene is a very common gene mutation in AML patients and in the absence of concurrent mutations in a separate gene – FLT3-ITD – associates with a favorable prognosis,” she explained
When the researchers analyzed outcomes for NPM1-mutated patients they found that disease-free survival and overall survival for Black patients who harbored this mutation were worse than survival in white NPM1-mutated patients.
Dr. Bhatnagar said the primary purpose of the study is raise awareness among clinicians and that larger, prospective studies are needed to confirm the findings and investigate the factors contributing to these survival differences.