Dong Sharlene, Premnath Naveen, Sadeghi Navid, Kainthla Radhika, Chung Stephen S, Collins Robert H, Li Hsiao C, Madanat Yazan F
Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.
Parkland Health, Dallas, TX, USA.
Leuk Res. 2024 Jun;141:107503. doi: 10.1016/j.leukres.2024.107503. Epub 2024 Apr 15.
Despite recent therapeutic advances, ethnic minorities in the U.S. continue to have disproportionately poor outcomes in many hematologic malignancies including AML. We identified 162 adult AML patients treated at a non-transplant safety net hospital from 2007 to 2022 and evaluated differences in disease characteristics, treatment and clinical outcomes based on race and ethnicity. Our cohort consisted of 82 (50.6%) Hispanic, 36 (22.2%) non-Hispanic black and 44 (27.2%) non-Hispanic white and Asian patients. Median age at diagnosis was 42.5, 49.0 and 52.5 years respectively (p=0.025). Hispanics had higher rates of intermediate and high-risk disease (p=0.699) and received high intensity induction and consolidation chemotherapy at lower rates (p=0.962), although differences did not reach statistical significance. Despite this, similar remission rates were achieved. Hispanics with high-risk disease had longer overall survival (OS) than the combined non-Hispanic cohort (mOS 14 m vs 7 m, p=0.030). Multivariate regression analysis showed that OS was negatively associated with age (HR 1.023, p=0.006), intermediate (HR 3.431, p=0.0003) and high-risk disease (HR 4.689, p<0.0001) and positively associated with Hispanic ethnicity (HR 0.614, p=0.026). This report suggests that contrary to other studies, Hispanics, particularly those with high-risk AML, may have improved OS compared to other ethnic groups. These results are unique to our safety net hospital setting where common barriers to medical care and healthcare disparities are largely mitigated.
尽管近期治疗取得了进展，但美国的少数族裔在包括急性髓系白血病（AML）在内的许多血液系统恶性肿瘤中，预后仍然差得不成比例。我们确定了2007年至2022年在一家非移植安全网医院接受治疗的162例成年AML患者，并根据种族和民族评估了疾病特征、治疗和临床结局的差异。我们的队列包括82例（50.6%）西班牙裔、36例（22.2%）非西班牙裔黑人以及44例（27.2%）非西班牙裔白人和亚洲患者。诊断时的中位年龄分别为42.5岁、49.0岁和52.5岁（p = 0.025）。西班牙裔患者中高危疾病的发生率较高（p = 0.699），接受高强度诱导和巩固化疗的比例较低（p = 0.962），尽管差异未达到统计学意义。尽管如此，缓解率相似。高危疾病的西班牙裔患者总生存期（OS）长于非西班牙裔患者的合并队列（中位总生存期14个月对7个月，p = 0.030）。多因素回归分析显示，总生存期与年龄呈负相关（风险比1.023，p = 0.006）、与中危（风险比3.431，p = 0.0003）和高危疾病呈负相关（风险比4.689，p < 0.0001），与西班牙裔种族呈正相关（风险比0.614，p = 0.026）。本报告表明，与其他研究相反，西班牙裔，尤其是那些高危AML患者，与其他种族群体相比，总生存期可能有所改善。这些结果是我们安全网医院环境所特有的，在该环境中，医疗保健的常见障碍和医疗差距在很大程度上得到了缓解。
