Neighborhood factors and treatment outcomes in pediatric acute lymphoblastic leukemia: A REDIAL Consortium report.
In a multicenter Texas cohort of 1,348 patients aged 0–24 years with ALL, neighborhood socioeconomic disadvantage and Hispanic enclave residence were not independently associated with end-of-induction MRD positivity, relapse, event-free survival, or overall survival after adjustment for clinical and cytogenetic factors.
Open original publication →What the AI sees
In a multicenter Texas cohort of 1,348 patients aged 0–24 years with ALL, neighborhood socioeconomic disadvantage and Hispanic enclave residence were not independently associated with end-of-induction MRD positivity, relapse, event-free survival, or overall survival after adjustment for clinical and cytogenetic factors.
Research significance
The evidence does not identify a therapeutic target or intervention; as an inference, the adjusted null findings suggest that efforts to reduce ALL outcome disparities may need to address other social determinants, treatment-access factors, disease characteristics, survivorship, or late effects rather than neighborhood indices alone.
Source abstract
Acute lymphoblastic leukemia (ALL) shows persistent outcomes disparities among socioeconomically disadvantaged and Hispanic children. Neighborhood socioeconomic status (nSES) and residence in Hispanic enclaves may contribute to these disparities, yet their impact on pediatric ALL is unclear. We examined associations of nSES and Hispanic enclave residence with ALL treatment outcomes. We analyzed children (0-24 years) diagnosed with ALL between 2005-2017 and treated at REDIAL Consortium centers in Texas. Census tract nSES (Yost) and Hispanic enclave indices were computed from U.S. Census and ACS data, classifying tracts into low-high nSES and enclave-no enclave residence. Outcomes included end-of-induction (EOI) minimal residual disease positivity (MRD ≥0.01%), relapse, event-free survival (EFS), and overall survival (OS). Associations were evaluated using multivariable logistic and Cox regression models adjusting for sex, age at diagnosis, race/ethnicity, EOI MRD, cytogenetic features, NCI risk group at diagnosis, ALL immunophenotype and treating institution. Among 1,348 patients, 41% resided in low nSES tracts and 42% in Hispanic enclaves. Neither enclave residence nor low nSES were associated with EOI MRD positivity; similar null associations were observed for relapse, EFS, and OS. Although unadjusted analyses indicated slightly poorer 5-year EFS for low nSES areas (81% vs. 85%, p=0.04), this difference attenuated after adjustment. In this large, multi-center, and diverse cohort of children with ALL, neighborhood socioeconomic disadvantage and Hispanic enclave residence were not independently associated with treatment outcomes after accounting for clinical and cytogenetic features. Future studies should examine other social determinants and neighborhood influences on disease characteristics, survivorship, and late effects.