Disparities in early death and survival in children, adolescents and young adults with acute promyelocytic leukemia in California
Published Date:Aug 11 2015
Keywords:Acute Promyelocytic Leukemia
Leukemia, Promyelocytic, Acute
Proportional Hazards Models
Pubmed Central ID:PMC4635048
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
P30 CA021765-30/CA/NCI NIH HHS/United States
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.
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.
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.
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.
application/vnd.openxmlformats-officedocument.wordprocessingml.document application/octet-stream image/gif image/jpeg image/gif image/jpeg image/gif image/jpeg image/gif image/jpeg
You May Also Like: