Outcome of Black AYA patients, especially those aged 18-29 years, was worse than outcome of White patients receiving similar intensive therapy
Black AYA patient outcomes, especially those aged 18-29 years, was worse than outcome of White patients receiving similar intensive therapy
Survival of patients with acute myeloid leukemia (AML) is inversely associated with age, but the impact of race on outcomes of adolescent and young adult (AYA, 18-39-year-old) patients is unknown. We compared survival of 89 Non-Hispanic Black AYA AML patients with survival of 566 Non-Hispanic White patients treated on frontline Cancer and Leukemia Group B/Alliance for Clinical Trials in Oncology protocols. Samples of 327 patients (50 Black and 277 White) were analyzed via targeted sequencing. Integrated genomic profiling was performed on select longitudinal samples. Black patients had worse outcomes, especially those aged 18-29 years, who had a higher early death rate (16% vs 3%, P=.002), lower complete remission rate (66% vs 83%, P=.01), and decreased overall survival (OS; 5-year rates: 22% vs 51%, P<.001) compared with White patients. Survival disparities persisted across cytogenetic groups: 18-29-year-old Black patients with non-core-binding-factor(CBF)-AML had worse OS than White patients (5-year rates: 12% vs 44%, P<.001), including patients with cytogenetically normal AML (13% vs 50%, P=0.003). Genetic features differed, including lower frequencies of normal karyotypes and NPM1 and bi-allelic CEBPA mutations, and higher frequencies of CBF rearrangements and ASXL1, BCOR, and KRAS mutations in Black patients. Integrated genomic analysis identified both known and novel somatic variants, and relative clonal stability at relapse. Reduced response rates to induction chemotherapy and leukemic clone persistence suggest a need for different treatment intensities and/or modalities in Black AYA patients with AML. Higher early death rates suggest a delay in diagnosis and treatment, calling for systematic changes to patient care.