Conflict of interest: Nothing to declare.
Impact of Socioeconomic Status on Timing of Relapse and Overall Survival for Children Treated on Dana-Farber Cancer Institute ALL Consortium Protocols (2000–2010)
Version of Record online: 23 FEB 2016
© 2016 Wiley Periodicals, Inc.
Pediatric Blood & Cancer
Volume 63, Issue 6, pages 1012–1018, June 2016
How to Cite
Bona, K., Blonquist, T. M., Neuberg, D. S., Silverman, L. B. and Wolfe, J. (2016), Impact of Socioeconomic Status on Timing of Relapse and Overall Survival for Children Treated on Dana-Farber Cancer Institute ALL Consortium Protocols (2000–2010). Pediatr. Blood Cancer, 63: 1012–1018. doi: 10.1002/pbc.25928
Grant sponsor: St. Baldrick's Foundation; Grant sponsor: National Palliative Care Research Center; Grant sponsor: Pablove Foundation; Grant sponsor: NIH P01; Grant number: 5PO1CA068484.
- Issue online: 13 APR 2016
- Version of Record online: 23 FEB 2016
- Manuscript Accepted: 8 JAN 2016
- Manuscript Received: 23 DEC 2015
- acute lymphoblastic leukemia;
- socioeconomic status
Population-based evidence suggests that lower socioeconomic status (SES) negatively impacts the overall survival (OS) of children with leukemia; however, the relationships between SES and treatment-related mortality, relapse, and timing of relapse remain unclear.
We examined OS, event-free survival (EFS) and cumulative incidence (CI) and timing of relapse by community-level poverty for 575 children aged 1–18 years with newly diagnosed acute lymphoblastic leukemia (ALL) treated on consecutive phase III multicenter Dana-Farber Cancer Institute ALL Consortium Protocols between 2000 and 2010. Children were categorized into high- and low-poverty areas for the analysis using aggregate U.S. Census data linked to zip code.
Children living in high-poverty areas experienced a 5-year OS of 85% as compared with 92% for those in low-poverty areas (P = 0.02); poverty remained marginally significant (P = 0.07) after adjustment for immunophenotype, age, and white blood cell count. There were no differences detected in EFS or CI relapse by poverty area. However, 92% of the relapses observed in children from high-poverty areas occurred <36 months from complete remission, compared to 48% of those in children from low-poverty areas (P = 0.008).
U.S. children with ALL living in high-poverty areas have a higher risk of early relapse when compared with those living in low-poverty areas despite uniform treatment. This may in part explain decreased OS observed in these children. This finding highlights disparities in childhood cancer outcomes by SES despite uniform treatment. Further investigations of the mechanistic pathways underlying this finding are needed.