Among patients with acute myeloid leukemia, Black race has been found to be an independent prognostic factor for lower survival outcomes, regardless of cytogenetics, findings have shown.
Data from a 30-year retrospective analysis of clinical trials were presented at a press briefing at the 67th American Society of Hematology Oncology Annual Meeting and Exposition.
Data collected from 10 ECOG-ACRIN phase 2 and 3 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 Dr. Shella Saint Fleur-Lominy, 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.
Further, NPM1 mutations were linked with poorer overall survival (OS) in Black patients versus 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.
“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, 30-day mortality rates were also similar, at 7.1% and 8.9%, respectively. Notably, a significantly lower portion of Black patients (37.1%) underwent allogeneic stem cell transplant versus White patients (48.5%). Rates of bone marrow transplant were similar in Black patients (19%) and White patients (20.2%).
“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 and a 14% higher risk of disease recurrence or death 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.
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 2,162 White patients. Core binding factor AML was observed in a non-significantly higher percentage of Black patients (12.8%) versus White patients (8.3%).
Researchers identified no racial prevalence in FLT3-ITD, CEBPA, TP53 or NPM1 mutations in patients with available data on these mutations.
“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, 3,469 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 years versus 53.5 years in White patients. Also of statistical significance, 121 Black patients (65.8%) versus 1,901 White patients (54.8%) were younger than 60.
Reference
“Inferior survival in black AML patients treated with intensive chemotherapy in ECOGACRIN clinical trials is independent of cytogenetic profiles” by Dr. Shella Saint Fleur-Lominy et al., Blood.
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