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Subset of Latino children with acute lymphoblastic leukemia may have higher relapse risk

By April 14, 2022COVID-19

April 13, 2022

3 min read


Sok P, et al. Abstract 3633. Presented at American Association for Cancer Research Annual Meeting; April 8-13, 2022; New Orleans.

The researchers report no relevant financial disclosures.

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Among children diagnosed with acute lymphoblastic leukemia, Latinos without minimal residual disease had a higher likelihood of relapse than their white counterparts, according to study results.

Researchers reported the findings at American Association for Cancer Research Annual Meeting.

Relapse rates among children with ALL.

Data derived from Sok P, et al. Abstract 3633. Presented at American Association for Cancer Research Annual Meeting; April 8-13, 2022; New Orleans.

“Several studies have indicated that Latinos have worse outcomes compared with non-Latino whites, so trying to understand when during therapy that disparity begins was key to this assessment,” Philip J. Lupo, PhD, MPH, professor of pediatrics at Baylor College of Medicine and director of the epidemiology and population sciences program at Texas Children’s Cancer and Hematology Center, told Healio. “Additionally, there have been few assessments of relapse in contemporary multiethnic populations. It is critical to understand risk factors for relapse in these individuals.”

Background and methodology

The study included 1,662 children (> 60% Latino) diagnosed with ALL between 2004 and 2018 from the Reducing Ethnic Disparities in Acute Leukemia (REDIAL) Consortium, which comprises seven major pediatric cancer centers in the southwestern United States. About one-quarter of patients had minimal residual disease (MRD)-positive status.

Researchers defined time to relapse as time from ALL diagnosis to the initial relapse event. They censored patients at date of death, last follow-up or bone marrow transplant.

Philip J. Lupo, PhD, MPH

Philip J. Lupo

Clinical factors Lupo and colleagues evaluated included race/ethnicity, sex, age at diagnosis (1-5, 6-10, 11-15, > 15 years), ALL immunophenotype (B-cell, T-cell), NCI risk group, central nervous system involvement, enrollment on a Children’s Oncology Group clinical trial, end-induction disease failure, and end-induction bone marrow flow cytometric MRD.

Key findings

Results showed 237 (14.3%) experienced relapse, and 63% of those who relapsed had MRD-negative status.

An analysis of cumulative incidence of relapse by MRD status showed a higher proportion of children with MRD positivity relapsed compared with children with MRD negativity (22.9% vs. 11.5%).

Factors associated with relapse included MRD-positive status (adjusted HR [aHR] = 1.59; 95% CI, 1.11-2.29), race/ethnicity (Latino vs. white, aHR = 1.43; 95% CI, 0.9-2.29; Black vs. white, aHR = 1.4; 95% CI, 0.67-2.93), older age at diagnosis (15 years or older vs. 1-4 years, aHR = 3.13; 95% CI, 1.81-5.43) and unfavorable vs. favorable cytogenetics (aHR = 3.05; 95% CI, 1.74-5.33).

Among children with MRD-positive status, Latino children appeared less likely to relapse than white children in analyses adjusted for patient-level factors (aHR = 0.77; 95% CI, 0.45-1.32) and patient- and neighborhood-level factors (aHR = 0.89, 95% CI, 0.39-4.65). However, among those with MRD-negative status, Latinos had a higher risk for relapse in the patient-level (aHR = 1.61; 95% CI, 1.03-2.52) and patient- and neighborhood-level (aHR = 2.05; 95% CI, 1.11-3.76) adjusted analyses.

“Interestingly, while minimal residual disease is one of the strongest risk factors for relapse in the overall population, it did not predict relapse in Latino patients after accounting for other clinical and sociodemographic factors,” Lupo said. “In fact, we found that Latino patients who were negative for minimal residual disease were more likely to relapse. Clinically, this could influence risk stratification protocols for these children.”


Researchers noted that study limitations included they did not have complete information on all the factors that could have influenced relapse risk. In continuing the research, they plan to incorporate other critical factors into predictive models for ALL outcomes, with the ultimate goal, Lupo said, of eliminating disparities in outcomes among those diagnosed with ALL.

“It is important to evaluate the epidemiology and biology of relapse in Latino patients, which could improve risk stratification protocols for these individuals. And we must consider the impact of social determinants on these outcomes — clinical trials do not typically account for these factors,” Lupo said.


Sok P, et al. Abstract 3633. Presented at American Association for Cancer Research Annual Meeting; April 8-13, 2022; New Orleans.
Some Latino children diagnosed with acute lymphoblastic leukemia face higher risk of relapse compared to non-Latino white children. at: Published April 12, 2022. Accessed April 12, 2022.

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