Association of race and ethnicity with clinical phenotype, genetics, and survival in pediatric acute myeloid leukemia.
Association of race and ethnicity with clinical phenotype, genetics, and survival in pediatric acute myeloid leukemia.
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种族和种族与小儿急性髓样白血病的临床表型，遗传学和生存的关联。
DOI：
10.1182/bloodadvances.2021004735
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发表时间：
2021-12-14
期刊：
影响因子：
7.5
通讯作者：
Rau, Rachel E.
中科院分区：
文献类型：
--
作者：
Conneely, Shannon E.;McAtee, Casey L.;Gupta, Rohit;Lubega, Joseph;Scheurer, Michael E.;Rau, Rachel E.
儿童急性髓系白血病（AML）的细胞遗传学病变存在种族差异，黑人儿童中特定不良预后病变的发生率更高。
无论疾病的遗传特征如何，少数族裔儿童在AML中的预后更差。
与白人儿童相比，患有急性髓系白血病（AML）的黑人和西班牙裔儿童预后更差。AML是一种异质性疾病，有众多基因亚型，而这些差异尚未得到专门研究。在本研究中，我们利用“治疗应用研究以产生有效治疗方案”（TARGET）数据库，在儿童AML主要细胞遗传学亚组中，研究种族与白血病细胞遗传学、临床特征及生存结局之间的关联。与非西班牙裔白人患者相比，t(8;21) AML在黑人（优势比[OR]为2.22；95%置信区间[CI]为1.28 - 3.74）和西班牙裔患者（OR为1.74；95% CI为1.05 - 2.83）中更为常见。预后不良的KMT2A重排t(6;11)(q27;q23)在黑人患者中更为常见（OR为6.12；95% CI为1.81 - 21.59）。在患有KMT2Ar AML的患者中，黑人的无事件生存期（EFS）较差（风险比[HR]为2.31；95% CI为1.41 - 3.79），总生存期（OS）也较差（HR为2.54；95% CI为1.43 - 4.51）。患有KMT2Ar AML的西班牙裔患者EFS（HR为2.20；95% CI为1.27 - 3.80）和OS（HR为2.07；95% CI为1.09 - 3.93）同样较差。类似地，在患有t(8;21)或inv(16) AML（即核心结合因子[CBF] AML）的患者中，黑人患者预后较差（EFS的HR为1.93；95% CI为1.14 - 3.28，OS的HR为3.24；95% CI为1.60 - 6.57）。但在接受吉妥珠单抗奥唑米星（GO）治疗的患者中未发现这种差异。总之，患有AML的年轻人在生存结局方面的种族差异显著，且在不同细胞遗传学亚类中有所不同。未来的研究应探索这些差异的社会经济和生物学决定因素。
Cytogenetic lesions in pediatric AML differ by race-ethnicity including higher rates of specific poor prognosis lesions among Black children. Racial-ethnic minorities experience worse outcomes in pediatric AML regardless of genetic disease features. Black and Hispanic children with acute myeloid leukemia (AML) have worse outcomes compared with White children. AML is a heterogeneous disease with numerous genetic subtypes in which these disparities have not been specifically investigated. In this study, we used the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) database to examine the association of race-ethnicity with leukemia cytogenetics, clinical features, and survival outcomes within major cytogenetic subgroups of pediatric AML. Compared with White non-Hispanic patients, t(8;21) AML was more prevalent among Black (odds ratio [OR], 2.22; 95% confidence interval [CI], 1.28-3.74) and Hispanic patients (OR, 1.74; 95% CI, 1.05-2.83). The poor prognosis KMT2A rearrangement t(6;11)(q27;q23) was more prevalent among Black patients (OR, 6.12; 95% CI, 1.81-21.59). Among those with KMT2Ar AML, Black race was associated with inferior event-free survival (EFS) (hazard ratio [HR], 2.31; 95% CI, 1.41-3.79) and overall survival (OS) (HR, 2.54; 1.43-4.51). Hispanic patients with KMT2Ar AML also had inferior EFS (HR, 2.20; 95% CI, 1.27-3.80) and OS (HR, 2.07; 95% CI, 1.09-3.93). Similarly, among patients with t(8;21) or inv(16) AML (ie, core-binding factor [CBF] AML), Black patients had inferior outcomes (EFS HR, 1.93; 95% CI, 1.14-3.28 and OS HR, 3.24; 95% CI, 1.60-6.57). This disparity was not detected among patients receiving gemtuzumab ozogamicin (GO). In conclusion, racial-ethnic disparities in survival outcomes among young people with AML are prominent and vary across cytogenetic subclasses. Future studies should explore the socioeconomic and biologic determinants of these disparities.
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影响因子：
1.7
作者：
Scheurer ME;Lupo PJ;Schüz J;Spector LG;Wiemels JL;Aplenc R;Gramatges MM;Schiffman JD;Pombo-de-Oliveira MS;Yang JJ;Heck JE;Metayer C;Orjuela-Grimm MA;Bona K;Aristizabal P;Austin MT;Rabin KR;Russell HV;Poplack DG
通讯作者：
Poplack DG
影响因子：
28.2
作者：
Bhatnagar B;Kohlschmidt J;Mrózek K;Zhao Q;Fisher JL;Nicolet D;Walker CJ;Mims AS;Oakes C;Giacopelli B;Orwick S;Boateng I;Blachly JS;Maharry SE;Carroll AJ;Powell BL;Kolitz JE;Stone RM;Byrd JC;Paskett ED;de la Chapelle A;Garzon R;Eisfeld AK
通讯作者：
Eisfeld AK
影响因子：
45.3
作者：
Lamba, Jatinder K.;Chauhan, Lata;Meshinchi, Soheil
通讯作者：
Meshinchi, Soheil
影响因子：
20.3
作者：
Lange, Beverly J.;Smith, Franklin O.;Alonzo, Todd A.
通讯作者：
Alonzo, Todd A.
影响因子：
12.8
作者：
Rafiee, Roya;Chauhan, Lata;Lamba, Jatinder K.
通讯作者：
Lamba, Jatinder K.