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Johnston H, Youshanlouei HR, Osei C, Patel AA, DuVall A, Wang P, Wanjari P, Segal J, Venkataraman G, Cheng JX, Gurbuxani S, Lager A, Fitzpatrick C, Thirman M, Nawas M, Liu H, Drazer M, Odenike O, Larson R, Stock W, Saygin C. Socioeconomic determinants of the biology and outcomes of acute lymphoblastic leukemia in adults. Blood Adv 2024; 8:164-171. [PMID: 38039510 PMCID: PMC10787242 DOI: 10.1182/bloodadvances.2023011862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023] Open
Abstract
ABSTRACT Various socioeconomic and biologic factors affect cancer health disparities and differences in health outcomes. To better characterize the socioeconomic vs biologic determinants of acute lymphoblastic leukemia (ALL) outcomes, we conducted a single-institution, retrospective analysis of adult patients with ALL treated at the University of Chicago (UChicago) from 2010 to 2022 and compared our outcomes with the US national data (the Surveillance, Epidemiology, and End Results [SEER] database). Among 221 adult patients with ALL treated at UChicago, BCR::ABL1 was more frequent in patients with higher body mass index (BMI; odds ratio [OR], 7.64; 95% confidence interval [CI], 1.17-49.9) and non-Hispanic Black (NHB) ancestry (59% vs 24% in non-Hispanic White (NHW) and 20% in Hispanic patients; P = .001). In a multivariable analysis, age (hazard ratio [HR], 6.93; 95% CI, 2.27-21.1) and higher BMI at diagnosis (HR, 10.3; 95% CI, 2.56-41.5) were independent predictors of poor overall survival (OS). In contrast, race or income were not predictors of OS in the UChicago cohort. Analysis of the national SEER database (2010-2020) demonstrated worse survival outcomes in Hispanic and NHB patients than in NHW patients among adolescent and young adults (AYAs) but not in older adults (aged >40 years). Both AYA and older adult patients with higher median household income had better OS than those with lower income. Therefore, multidisciplinary medical care coupled with essential supportive care services offered at centers experienced in ALL care may alleviate the socioeconomic disparities in ALL outcomes in the United States.
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Affiliation(s)
| | | | - Clinton Osei
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Anand A. Patel
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Adam DuVall
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Peng Wang
- Department of Pathology, University of Chicago, Chicago, IL
| | | | - Jeremy Segal
- Department of Pathology, University of Chicago, Chicago, IL
| | | | - Jason X. Cheng
- Department of Pathology, University of Chicago, Chicago, IL
| | | | - Angela Lager
- Department of Pathology, University of Chicago, Chicago, IL
| | | | - Michael Thirman
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Mariam Nawas
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Hongtao Liu
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Michael Drazer
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Olatoyosi Odenike
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Richard Larson
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Wendy Stock
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Caner Saygin
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
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