Journal article
Poverty and Relapse Risk in Children with Acute Lymphoblastic Leukemia: Children’s Oncology Group Study AALL03N1 Report
Blood, Vol.142(3), pp.221-229
07/20/2023
DOI: 10.1182/blood.2023019631
PMCID: PMC10375268
PMID: 37070673
Abstract
•Children living in extreme poverty during maintenance therapy for childhood ALL experience a 1.9-fold greater hazard of relapse•Lower proportion of children with ALL living in extreme poverty achieve critical adherence (95%) to oral mercaptopurine
The association between individual-level poverty and relapse in children receiving maintenance treatment for acute lymphoblastic leukemia (ALL) remains unclear. In a secondary analysis of COG-AALL03N1, we used data from US Census Bureau to categorize patients living below year-specific federal poverty thresholds, calculated using self-reported annual household income and size of household. Participants living 120% below federal poverty thresholds were categorized as living in extreme poverty. Hazard of relapse was estimated using multivariable proportional subdistributional hazards regression for patients living in extreme poverty while receiving ALL maintenance therapy after adjusting for relevant predictors. Among 592 patients in this analysis, 12.3% of the patients were living in extreme poverty. After a median follow-up of 7.9y, the cumulative incidence of relapse at 3y from study enrollment among those living in extreme poverty was significantly higher (14.3%, 95% confidence interval [CI]= 7.3-23.6) compared to those not living in extreme poverty (7.6%, 95%CI=5.5-10.1, P=0.04). Multivariable analysis demonstrated that children living in extreme poverty had a 1.95-fold greater hazard of relapse (95%CI=1.03-3.72, P=0.04) compared to those not living in extreme poverty; this association was mitigated after inclusion of race/ethnicity in the model (hazard ratio=1.68, 95%CI=0.86-3.28, P=0.1), likely due to collinearity between race/ethnicity and poverty. A greater proportion of children living in extreme poverty were non-adherent to mercaptopurine (57.1% vs 40.9%, P=0.04); however, poor adherence did not completely explain the association between poverty and relapse risk. Future studies need to understand the mechanisms underlying the association between extreme poverty and relapse risk. Clinical Trial number: NCT00268528.
Details
- Title: Subtitle
- Poverty and Relapse Risk in Children with Acute Lymphoblastic Leukemia: Children’s Oncology Group Study AALL03N1 Report
- Creators
- Aman Wadhwa - University of Alabama at BirminghamYanjun Chen - University of Alabama at BirminghamLindsey Hageman - University of Alabama at BirminghamAnna Hoppmann - University of South CarolinaAnne Angiolillo - Servier Pharmaceuticals, Boston, Massachusetts, United States.David S. Dickens - University of IowaJoseph P Neglia - University of MinnesotaYaddanapudi Ravindranath - Children's Hospital of MichiganA Kim Ritchey - University of Pittsburgh Medical CenterAmanda Termuhlen - University of Illinois ChicagoF. Lennie Wong - City Of Hope National Medical CenterWendy Landier - University of Alabama at BirminghamSmita Bhatia - University of Alabama at Birmingham
- Resource Type
- Journal article
- Publication Details
- Blood, Vol.142(3), pp.221-229
- DOI
- 10.1182/blood.2023019631
- PMID
- 37070673
- PMCID
- PMC10375268
- NLM abbreviation
- Blood
- ISSN
- 0006-4971
- eISSN
- 1528-0020
- Publisher
- Elsevier Inc
- Language
- English
- Electronic publication date
- 04/17/2023
- Date published
- 07/20/2023
- Academic Unit
- Stead Family Department of Pediatrics; Hematology/Oncology
- Record Identifier
- 9984398345102771
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