Disparities in early death and survival in children, adolescents and young adults with acute promyelocytic leukemia in California

Details

• Alternative Title:
  Cancer
• Personal Author:
  Abrahão, Renata ; Ribeiro, Raul C. ; Medeiros, Bruno C. ; Keogh, Ruth H. ; Keegan, Theresa H.M.
• Description:
  Background
  
  Findings from clinical trials and population-based studies have differed as to whether mortality within 30 days of diagnosis (early death) of acute promyelocytic leukemia has decreased in the era of all-trans retinoic acid (ATRA) and anthracycline-based chemotherapy.
  
  Methods
  
  We investigated 7- and 30-day mortality and survival in 772 patients aged 0–39 years when diagnosed with APL during 1988–2011, using data from the California Cancer Registry. We used logistic regression and Cox proportional models to examine the association of early death and survival, respectively, with sociodemographic and clinical factors.
  
  Results
  
  Overall 30-day mortality decreased significantly over time, from 26% (1988–1995) to 14% (2004–2011) (P=0.004). In multivariable analysis, the odds of 30-day mortality were 3 times as high during 1988–1995 than 2004–2011 (P=0.001). However, 7-day mortality did not improve over time (P=0.229). When patients who died within 7 days of diagnosis were excluded, 30-day mortality during 1996–2011 was 3%–8%, similar to levels reported in clinical trials. Higher early death and lower survival were associated with lack of health insurance (1996–2011) (early death OR=2.67, P=0.031) and Hispanic race/ethnicity (early death OR=2.13, P=0.014). Early death was not associated with age, sex, socioeconomic status or hospital type. Black patients also experienced worse survival.
  
  Conclusions
  
  Our findings revealed a decreased 30-day mortality during the ATRA era, but 7-day mortality remained high. Efforts to achieve equal outcomes in young patients with APL should focus on improving access to effective treatment, mainly among uninsured patients and those of Hispanic and Black race/ethnicity.
  
  
• Subjects:
  Acute Promyelocytic Leukemia Adolescent Adolescents Adult Article ATRA Child Child, Preschool Children Early Death Female Healthcare Disparities Health Disparities Health Insurance Humans Infant Infant, Newborn Leukemia, Promyelocytic, Acute Logistic Models Male Proportional Hazards Models Survival Young Adult Young Adults

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• Source:
  Cancer. 121(22):3990-3997.
• Pubmed ID:
  26264598
• Pubmed Central ID:
  PMC4635048
• Document Type:
  Journal Article
• Funding:
  U55/CCR921930-02/PHS HHS/United States ; HHSN261201000034C/PHS HHS/United States ; U58DP003862-01/DP/NCCDPHP CDC HHS/United States ; HHSN261201000035/CA/NCI NIH HHS/United States ; HHSN261201000035C/PHS HHS/United States ; HHSN261201000034/CA/NCI NIH HHS/United States ; P30 CA021765/CA/NCI NIH HHS/United States ; U58 DP003862/DP/NCCDPHP CDC HHS/United States ; HHSN261201000140C/PHS HHS/United States ; HHSN261201000140/CA/NCI NIH HHS/United States ; HHSN261201000035/PC,CA/None/None ; P30 CA021765-30/CA/NCI NIH HHS/United States
• Volume:
  121
• Issue:
  22
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:84daed898b99f74921d1a4fba37addf70b90640418cdc048177d7d4330c83b63
• Download URL:
  https://stacks.cdc.gov/view/cdc/37798/cdc_37798_DS1.pdf
• File Type:
  [PDF - 471.36 KB ]