Evaluating the Impact of Race, Ethnicity, and Social Deprivation on the Incidence and Severity of Adverse Events in Children with Acute Lymphoblastic Leukemia Público
Stevenson, Jason (Spring 2025)
Abstract
Background: Therapies used to treat pediatric acute lymphoblastic leukemia (ALL) lead to high cure rates but can cause significant adverse events (AEs). Children from racial and ethnic minority groups with oncologic diagnoses, , have increased acuity of illness at presentation, higher rates of relapse, and decreased overall survival (OS). These disparities are multifactorial and may be influenced by differences in AE incidence, yet the relationship between race, ethnicity, social deprivation, and AE development has not been comprehensively evaluated.
Objective: Compare the incidence and severity of clinically-significant AEs during induction therapy for de novo pediatric ALL by race and ethnicity, social deprivation level, and the combined effect of these factors.
Methods: This is a single-institution retrospective cohort study of pediatric patients diagnosed with de novo ALL at Children’s Healthcare of Atlanta between January 1, 2010 and September 1, 2022. Incidence and severity, defined as the highest grade of each AE per National Cancer Institute Common Terminology Criteria for Adverse Events definitions, were manually abstracted following a detailed chart abstraction guide. Addresses at diagnosis were mapped to the Social Deprivation Index (SDI) by census tract. The association of (a) race and ethnicity and (b) SDI quintiles with the incidence and severity of each AE was analyzed using multivariable binary logistic regression, adjusting for age at diagnosis, sex, and leukemia risk classification.
Results: Of the 728 patients in the cohort, 156 (21.4%) were non-Hispanic Black, 189 (30.0%) were Hispanic, and 348 (47.8%) were non-Hispanic White. Compared to non-Hispanic White patients, non-Hispanic Black patients had significantly lower odds of ileus, neuropathy, and sepsis, while Hispanic patients had a significantly lower odds of ileus and neuropathy. Non-Hispanic Black patients had a 1.96 times higher odds (95% CI 1.07-3.57) of severe hyperglycemia compared to non-Hispanic White patients. There was no statistically significant interaction between SDI quintile, race, and ethnicity.
Conclusions: Non-Hispanic Black race was an independent risk for severe hyperglycemia during induction highlighting a targetable group for early prevention and intervention. Higher rates of relapse and decreased OS previously described in racial and ethnic minority groups may not be attributable to AEs experienced during ALL induction.
Table of Contents
A. BACKGROUND……………………………………………………………………………………………1
B. METHODS………………………………………………………………………………………………….6
C. RESULTS…………………………………………………………………………………………………..12
D. DISCUSSION……………………………………………………………………………………………..16
E. REFERENCES……………………………………………………………………………………………24
F. TABLES/FIGURES…………………………………………………………………………………….26
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Evaluating the Impact of Race, Ethnicity, and Social Deprivation on the Incidence and Severity of Adverse Events in Children with Acute Lymphoblastic Leukemia () | 2025-03-31 20:22:07 -0400 |
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