Division of Pediatric Hematology, Oncology, Transplant and Cellular Therapy, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA.
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
Cancer Med. 2023 Jun;12(11):12827-12836. doi: 10.1002/cam4.5951. Epub 2023 Apr 16.
Ethnic and racial disparities have recently been observed both in treatment-related toxicities and rates of long-lasting cure in acute lymphoblastic leukemia (ALL) and acute lymphoblastic lymphoma (ALLy), the most common pediatric malignancy. Despite significant improvements in overall survival in the recent past, a large number of children die from aggressive disease.
We performed a retrospective cohort analysis of 274 pediatric ALL/ALLy patients within Montefiore Health System from 2004 to 2021 to determine differences in all-cause mortality within the Pediatric Hematologic Malignancies Cohort using Cox Proportional Hazard regression modeling, adjusted for age at diagnosis, race/ethnicity, administration of intensive chemotherapy, preferred language, maximum glucose, and hypertension.
Among our 274 patients, 132 were Hispanic, 54 Non-Hispanic Black, and 25 Non-Hispanic White, with 25 identified as "Non-Hispanic Other," including Asian, Arabic, and Other. Hispanic patients were 78% less likely to die (HR 0.22; 95% CI 0.07, 0.73) when compared with Non-Hispanic Black individuals. Spanish speakers were 2.91 times more likely to die compared with those who spoke English (HR 2.91; 95% CI 1.08, 7.82). Among those English speakers, the diagnosis of hypertension and Hispanic ethnicity significantly impacted the risk of death, while these factors did not impact survival in Spanish speakers. High-risk cytogenetics did not impact survival.
Hispanic children with ALL/ALLy have improved survival outcomes compared with Non-Hispanic Blacks. Additionally, Spanish language preference was strongly associated with poorer survival, a novel finding that should be validated in future studies.
在急性淋巴细胞白血病（ALL）和急性淋巴母细胞淋巴瘤（ALLy）——最常见的儿科恶性肿瘤中，最近观察到治疗相关毒性和长期治愈率方面存在种族和民族差异。尽管最近整体生存率有了显著提高，但仍有大量儿童死于侵袭性疾病。
我们对 2004 年至 2021 年期间在蒙特菲奥雷健康系统内的 274 例儿科 ALL/ALLy 患者进行了回顾性队列分析，以确定在儿科血液恶性肿瘤队列中，使用 Cox 比例风险回归模型，根据诊断时的年龄、种族/民族、强化化疗的应用、首选语言、最大血糖和高血压，全因死亡率的差异。
在我们的 274 例患者中，132 例为西班牙裔，54 例为非西班牙裔黑人，25 例为非西班牙裔白人，其中 25 例被确定为“非西班牙裔其他”，包括亚洲人、阿拉伯人和其他。与非西班牙裔黑人相比，西班牙裔患者死亡的可能性降低了 78%（HR 0.22；95%CI 0.07，0.73）。与讲英语的人相比，讲西班牙语的人死亡的可能性高 2.91 倍（HR 2.91；95%CI 1.08，7.82）。在讲英语的人中，高血压和西班牙裔种族显著影响死亡风险，而这些因素对讲西班牙语的人的生存没有影响。高危细胞遗传学对生存没有影响。
与非西班牙裔黑人相比，患有 ALL/ALLy 的西班牙裔儿童的生存结果得到改善。此外，西班牙语偏好与较差的生存密切相关，这是一个应在未来研究中验证的新发现。
