Influence of race and socioeconomic status on outcome of children treated for childhood acute lymphoblastic leukemia.

PURPOSE OF REVIEW: Overall, childhood acute lymphoblastic leukemia is associated with an excellent outcome. The improvement in survival achieved during the last three decades is partially attributed to the identification of risk factors predicting a poor outcome and risk-stratified treatment of patients placed on well-designed therapeutic trials. Accordingly, it is important to continue to identify patient subgroups with differences in outcome to focus efforts to improve overall survival. Black children historically have been reported to have a poorer survival rate compared with whites, but limited information is available for children from other racial/ethnic backgrounds.

RECENT FINDINGS: Several groups have published reports on ethnic and racial differences in survival after childhood acute lymphoblastic leukemia, with poorer outcomes reported for black children compared with whites reported by the majority of the studies. Limited information is available for children from other racial/ethnic backgrounds, such as Hispanics and Asians, but data indicate that Hispanics have poorer survival than whites, whereas Asians from the United States have outcomes that are as good or better than those of the whites, especially among the high-risk group treated with contemporary risk-based therapy. The influence of race and ethnicity on survival should be closely linked with socioeconomic status. However, few studies have specifically investigated the influence of nutrition and socioeconomic factors on the prognosis of children with acute lymphoblastic leukemia, and the results are conflicting.

SUMMARY: Future studies need to focus on the reasons for these differences, including racial and ethnic differences in adherence with therapeutic protocols, and ethnic differences in drug metabolism and bioavailability of the agents commonly used in acute lymphoblastic leukemia, so that drug administration can be modified if needed.