Changes in Survival in Acute Myeloblastic Leukemia by Racial and Ethnic Group: Greater Improvement for Non-Hispanic Whites and Increase in the Disparity for Minority Patients in the Early 21^st Century

Acute myeloblastic leukemia (AML) is a potentially curable disease but treatment is intense, prolonged, and expensive. Survival has improved for adults age less than 75 with AML in the early 21^st century¹ , but it is unknown whether people of all ethnic and racial backgrounds have benefitted equally. Here, we examine changes in survival in patients with AML by racial and ethnic group between 1993–97 and 2003–07.

Using cancer registry data from the Surveillance, Epidemiology and End Results (SEER9) Program, we assessed trends in 5-year relative survival for patients with AML by racial and ethnic group, including non-Hispanic whites (nHw), African-Americans (AA), Hispanics, and Asian-Americans (Asian) for the periods 1993–97 and 2003–07. Modelled period analysis was used to obtain the most up-to-date measurements of survival. Because survival varies greatly with age, survival for patients age 15–54 was calculated separately.

Median age at diagnosis was highest for nHw, lowest for Hispanics. A statistically significant improvement in survival was seen for nHw patients with AML between 1993–97 and 2003–07. Better survival was observed for other racial/ethnic groups, but the differences were small and non-significant (table 1). When only patients age 15–54 were considered, this effect was enhanced and a trend towards shorter survival was observed for AA patients (table 2). In 1993–97, five year relative survival rates were lower for nHw than for other racial or ethnic groups overall and for patients age 15–54 (tables 1 and 2). In 2003–07, nHw had a 5-year relative survival rate that was higher than AA overall and higher than any other ethnic group for ages 15–54 (table 2).

Significant disparities in survival exist for patients with AML between nHw and people of other ethnic or racial groups and these disparities are increasing, especially in younger patients. The disparity was more notable for patients age 15–54, suggesting that lack of access to aggressive treatment, particularly transplant, may be a factor in the growing disparity. Further research is needed to pinpoint where on the cancer continuum factors determining survival, including diagnosis, treatment, and biological prognostic markers, are worse for people from minority ethnic groups, and hence where interventions may be the most effective.

No relevant conflicts of interest to declare.