成人急性髓系白血病患者在表现、转介和治疗模式及生存方面的种族差异：单机构经验。
Racial differences in presentation, referral and treatment patterns and survival in adult patients with acute myeloid leukemia: a single-institution experience.
机构信息
University of Maryland Greenebaum Cancer Center, Baltimore, MD 21201, USA.
出版信息
Leuk Res. 2012 Feb;36(2):140-5. doi: 10.1016/j.leukres.2011.10.018. Epub 2011 Nov 21.
BACKGROUND
Disease presentation and outcomes differ by race in a number of malignancies, but data in adult acute myeloid leukemia (AML) are limited.
MATERIALS AND METHODS
We conducted a retrospective analysis of pretreatment characteristics, referral and treatment patterns, and outcomes in 548 AML patients evaluated at the University of Maryland Greenebaum Cancer Center, a tertiary care referral center in Baltimore, MD, from 2000 through 2009. Cases were analyzed for time from diagnosis to referral, age, race, gender, socioeconomic status, antecedent hematologic disorder, cytotoxic or radiation therapy for prior malignancy, karyotype, fms-like tyrosine kinase receptor-3 (FLT3) mutations, intensive chemotherapy, clinical trial participation, hematopoietic stem cell transplantation (HSCT) and overall survival (OS).
RESULTS
Black patients (n=105) were younger than white patients (n=396) (54 vs. 61 years, p<0.001), were more commonly female (55% vs. 45%, p<0.001), and had a lower estimated median household income ($42,677 vs. $53,534 per year, p<0.001). Black patients more frequently had complex karyotypes (26% vs. 12%, p=0.002) and less frequently normal karyotypes (27% vs. 42%, p=0.02). FLT3 mutation frequency was similar. Time to referral and proportion of patients receiving intensive chemotherapy did not differ, but both clinical trial participation (43% vs. 54%, p=0.04) and HSCT (17% vs. 35% for patients ≤70 years old, p=0.001) were less frequent in blacks than whites. Nevertheless, OS was similar in all black and white patients (median 15 vs. 14 months, p=0.23), and when stratified by age, gender and karyotype risk classification.
CONCLUSION
AML presentation and treatment differed in black and white patients, but OS was similar. Black patients appear to have barriers to clinical trial participation and HSCT, and there may be barriers to tertiary care referral for black males.
背景
在许多恶性肿瘤中，疾病的表现和结局因种族而异，但成人急性髓系白血病（AML）的数据有限。
材料与方法
我们对 2000 年至 2009 年在马里兰大学格林贝癌症中心（巴尔的摩的一家三级转诊中心）接受评估的 548 例 AML 患者的预处理特征、转诊和治疗模式以及结局进行了回顾性分析。对这些病例进行了从诊断到转诊的时间、年龄、种族、性别、社会经济地位、既往血液学疾病、先前恶性肿瘤的细胞毒性或放射治疗、核型、fms 样酪氨酸激酶受体-3（FLT3）突变、强化化疗、临床试验参与、造血干细胞移植（HSCT）和总生存期（OS）的分析。
结果
黑人患者（n=105）比白人患者（n=396）年轻（54 岁比 61 岁，p<0.001），女性比例更高（55%比 45%，p<0.001），中位家庭收入估计值更低（$42,677 比每年$53,534，p<0.001）。黑人患者更常出现复杂核型（26%比 12%，p=0.002），正常核型较少（27%比 42%，p=0.02）。FLT3 突变频率相似。转诊时间和接受强化化疗的患者比例没有差异，但黑人患者参与临床试验（43%比 54%，p=0.04）和 HSCT（对于≤70 岁的患者，17%比 35%，p=0.001）的比例均低于白人患者。然而，所有黑人患者和白人患者的 OS 相似（中位数 15 比 14 个月，p=0.23），并且在按年龄、性别和核型风险分类分层时也是如此。
结论
AML 的表现和治疗在黑人和白人患者中有所不同，但 OS 相似。黑人患者似乎在参与临床试验和 HSCT 方面存在障碍，并且黑人男性可能存在获得三级护理转诊的障碍。
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