Young Black patients with AML have worse treatment outcomes

Dec. 22, 2020

Despite advances in treating acute myeloid leukemia (AML), younger Black patients, below the age of 60, with this aggressive blood cancer have a 27 percent higher chance of dying compared with younger white patients, according to a press release from The Ohio State University Comprehensive Cancer Center.

New research conducted by Bhavana Bhatnagar, DO, and Ann-Kathrin Eisfeld, MD, of The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) explored factors that might contribute to this disparity.

They found that, even when Black patients received the same treatment and follow-up care as their white counterparts, they still fared worse. This remained true in Black patients whose cancer carried certain genetic mutations (changes in the cell’s genes) that typically predict better prognosis and survival.

“Survival among young Black people with AML is strikingly and unacceptably worse than what we see in white patients with AML, particularly in younger patients,” says Bhatnagar, who served as first author of the study. “When we looked specifically at the mutations we see in AML, even when Black patients had specific good prognostic risk factors, they had poorer outcomes.”

Full findings have been published in the journal Cancer Discovery.

For this study, team used the National Cancer Institute’s Cancer Surveillance, Epidemiology and End Results (SEER) database to identify more than 25,000 adults diagnosed with AML between 1986 and 2015. They found that, while survival for AML patients, as a whole, has improved across three decades, the survival disparities between Black and white patients with AML actually widened over time, despite improved treatment and understanding of AML as a disease.

They also identified a disparity in survival rates between young Black and white patients (under age 60), with three-year overall survival rates of 34 percent and 43 percent, respectively.

“Historically, one of the biggest arguments for the poorer survival seen among Black AML patients has been challenges with access to treatment, but we found that even if patients have the same access to treatment and the same rates of remission, Black patients have significantly shorter survival time compared to white patients,” Bhatnagar says.

The team then conducted comprehensive genomic analyses to look at 81 genes commonly mutated in AML. Knowing whether a patient has these genetic mutations helps clinicians customize treatment plans for each patient.

“We know that, when looking at the AML patient population as a whole, certain mutations are associated with better treatment outcomes,” Eisfeld explains. “In this study, we showed this did not hold true for all of them when we specifically looked at Black patients alone. Additionally, when we analyzed factors that influence survival in all younger AML patients, Black race was an independent predictor of poor outcome. This suggests that Black race by itself seems to be such a strong risk factor that it adds to the markers we usually rely on to risk-stratify patients.”

Researchers say larger studies and also prospective trials are critically needed to investigate these potential differences in AML biology that may contribute to poorer outcomes among Black Americans with AML.

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