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Dong S, Premnath N, Sadeghi N, Kainthla R, Chung SS, Collins RH, Li HC, Madanat YF. Racial and ethnic disparities in Acute Myeloid Leukemia: 15-year experience at a safety net hospital system. Leuk Res 2024; 141:107503. [PMID: 38676993 DOI: 10.1016/j.leukres.2024.107503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/23/2024] [Accepted: 04/13/2024] [Indexed: 04/29/2024]
Abstract
Despite recent therapeutic advances, ethnic minorities in the U.S. continue to have disproportionately poor outcomes in many hematologic malignancies including AML. We identified 162 adult AML patients treated at a non-transplant safety net hospital from 2007 to 2022 and evaluated differences in disease characteristics, treatment and clinical outcomes based on race and ethnicity. Our cohort consisted of 82 (50.6%) Hispanic, 36 (22.2%) non-Hispanic black and 44 (27.2%) non-Hispanic white and Asian patients. Median age at diagnosis was 42.5, 49.0 and 52.5 years respectively (p=0.025). Hispanics had higher rates of intermediate and high-risk disease (p=0.699) and received high intensity induction and consolidation chemotherapy at lower rates (p=0.962), although differences did not reach statistical significance. Despite this, similar remission rates were achieved. Hispanics with high-risk disease had longer overall survival (OS) than the combined non-Hispanic cohort (mOS 14 m vs 7 m, p=0.030). Multivariate regression analysis showed that OS was negatively associated with age (HR 1.023, p=0.006), intermediate (HR 3.431, p=0.0003) and high-risk disease (HR 4.689, p<0.0001) and positively associated with Hispanic ethnicity (HR 0.614, p=0.026). This report suggests that contrary to other studies, Hispanics, particularly those with high-risk AML, may have improved OS compared to other ethnic groups. These results are unique to our safety net hospital setting where common barriers to medical care and healthcare disparities are largely mitigated.
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Affiliation(s)
- Sharlene Dong
- Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Naveen Premnath
- Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Stephen S Chung
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Robert H Collins
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Yazan F Madanat
- Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA; Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.
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Ashouri K, Ginosyan AA, Chu M, Hom B, Hwang J, Resnick K, Rahimi Y, Chaudhary P, Woan K, Siddiqi I, Ladha A, Ali A, Tam EL, Yaghmour G. Donor matters: Donor selection impact on hematopoietic stem cell transplantation outcomes in Hispanic patients with B-cell acute lymphocytic leukemia: Insights from a myeloablative HSCT study. Leuk Res 2024; 141:107501. [PMID: 38631149 DOI: 10.1016/j.leukres.2024.107501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/17/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) is a pivotal treatment for high-risk acute lymphocytic leukemia (ALL), although limited by suitable human leukocyte antigen (HLA)-matched sibling donors (MSD). This study evaluates the impact of donor selection on outcomes in post-HSCT Hispanic B-cell ALL patients. METHODOLOGY This single-center retrospective study evaluates outcomes in 88 adult Hispanic B-cell ALL patients who underwent haploidentical, MSD, or MUD myeloablative HSCT between 2013 and 2023. RESULTS Compared to Haploidentical transplants, MSD exhibited worse cumulative incidence of relapse (CIR) (HR = 3.39; P = 0.014) and disease-free survival (DFS) (HR = 2.44; P = 0.048) whereas MUD outcomes did not differ. This effect persisted even when controlling for pre-HSCT stage and Minimal residual disease (MRD) status. In addition, Ph-like was a significant predictor of worse DFS (HR = 3.60; P=0.014) and CIR (HR = 2.97; P=0.035) on multivariate analysis. Older donor age correlated with worse GVHD-free, relapse-free survival (GRFS) in haploidentical transplants (HR = 1.05; P=0.036). CONCLUSION Our data highlights improved outcomes with younger, haploidentical donors among Hispanic B-cell ALL patients undergoing myeloablative HSCT. This underscores the importance of donor selection in optimizing outcomes for ALL patients.
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Affiliation(s)
- Karam Ashouri
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anush A Ginosyan
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mollee Chu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brian Hom
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer Hwang
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Karen Resnick
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yekta Rahimi
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Preet Chaudhary
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Karrune Woan
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Imran Siddiqi
- Division of Pathology, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Abdullah Ladha
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Amir Ali
- Department of Pharmacy, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Eric Leon Tam
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - George Yaghmour
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA.
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Cochran ED, Jacobson JC, Nehrubabu M, Qiao J, McCreery S, Chung DH. Social Determinants of Outcomes Disparity among Pediatric Patients with Solid Tumor. J Am Coll Surg 2024; 238:463-478. [PMID: 38258890 DOI: 10.1097/xcs.0000000000001010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Socioeconomic factors have a significant impact on healthcare outcomes. Metrics such as area deprivation index (ADI) are used to quantify the anticipated influence of these factors. Here, we sought to assess the impact of socioeconomic factors on clinical outcomes among pediatric patients with solid tumor in our region. STUDY DESIGN We identified 3,863 pediatric patients who were diagnosed with a malignant solid tumor in the Texas Cancer Registry between 1995 and 2019. ADI was used to quantify socioeconomic determinants of health. These outcome variables were determined: stage of disease at diagnosis, time between diagnosis and treatment initiation, and overall mortality. Statistical analysis was performed using logistic regression, linear regression, Cox proportional hazards regression, and Kaplan-Meier survival curves. RESULTS A total of 53.5% of patients were male and the average age at diagnosis was 4.5 years. Forty-seven percent of patients were White, 13.3% were Black, 36.2% were Hispanic, 1.7% were Asian, and other rare minority groups made up 1.8%. On multivariable analysis, increased risk of death was associated with Black race, rare minority race, residence in a border county, and increasing ADI score, with the risk of death at 5 years rising 4% with each increasing ADI point. CONCLUSIONS Social determinants of health are associated with disparate outcomes among pediatric patients with solid tumor. Our results suggest that patients who are part of racial minority groups and those who reside in socioeconomically disadvantaged neighborhoods or regions near the Texas-Mexico border are at an increased risk of death. This information may be useful in strategizing outreach and expanding resources to improve outcomes in at-risk communities.
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Affiliation(s)
- Elizabeth D Cochran
- From the Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Cochran, Jacobson, Qiao, McCreery, Chung)
| | - Jillian C Jacobson
- From the Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Cochran, Jacobson, Qiao, McCreery, Chung)
| | - Mithin Nehrubabu
- Department of Mathematical Sciences, University of Dallas, Dallas, TX (Nehrubabu)
| | - Jingbo Qiao
- From the Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Cochran, Jacobson, Qiao, McCreery, Chung)
| | - Sullivan McCreery
- From the Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Cochran, Jacobson, Qiao, McCreery, Chung)
| | - Dai H Chung
- From the Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Cochran, Jacobson, Qiao, McCreery, Chung)
- Children's Health, Dallas, TX (Chung)
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Castellanos MI, Oluyomi AO, Chambers TM, Gramatges MM, Winestone LE, Lupo PJ, Scheurer ME. Ethnic disparities in childhood leukemia survival by border residence: A Texas population-based analysis. Cancer 2023; 129:1276-1286. [PMID: 36805949 DOI: 10.1002/cncr.34636] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 02/23/2023]
Abstract
BACKGROUND The US-Mexico border is a medically underserved region where survival disparities have been observed in adults diagnosed and treated for various malignancies. Studies examining survival disparities among children living in this region and diagnosed with cancer are lacking. The objective of this study was to evaluate the impact of border residence on survival among children with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and living near the Texas-Mexico border at the time of their diagnosis. The authors hypothesized that this group experiences inferior survival compared with patients with childhood leukemia living in nonborder areas. METHODS The authors conducted a retrospective survival analysis leveraging data from the Texas Cancer Registry. The study included patients aged birth to 19 years who were diagnosed with ALL or AML between 1995 and 2017. Cox proportional hazards models were used to evaluate the factors associated with the risk of death. Overall survival estimates were calculated using Kaplan-Meier methods. RESULTS During the study period, there were 6002 children diagnosed with ALL and 1279 diagnosed with AML. Inferior 5-year overall survival was observed among children with ALL living along the border region compared with those living in nonborder areas (77.5% vs. 85.8%). In adjusted models, children with ALL living along the border experienced a 30% increased hazard of death versus children living in nonborder areas. In contrast, for children with AML, survival estimates did not vary by border versus nonborder residence. CONCLUSIONS Living along the border was associated with inferior survival among children with ALL, but not among children with AML. Additional studies are urgently needed to identify the factors driving these disparities to effectively design multilevel interventions and influence state and national cancer control programs.
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Affiliation(s)
- Maria I Castellanos
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Abiodun O Oluyomi
- Department of Medicine, Epidemiology, and Population Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Tiffany M Chambers
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Maria M Gramatges
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Lena E Winestone
- Division of Allergy, Immunology, and Blood and Marrow Transplant, University of California-San Francisco Benioff Children's Hospitals, San Francisco, California, USA
| | - Philip J Lupo
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Michael E Scheurer
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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Bradley T, Kwon D, Monge J, Sekeres M, Chandhok N, Thomassen A, Swords R, Padron E, Lancet J, Talati C, Watts J. Molecular characteristics and outcomes in Hispanic and non-Hispanic patients with acute myeloid leukemia. EJHAEM 2022; 3:1231-1240. [PMID: 36467830 PMCID: PMC9713060 DOI: 10.1002/jha2.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 06/17/2023]
Abstract
Hispanic patients have been reported to have an increased incidence of AML and possibly inferior outcomes compared to non-Hispanics. We conducted a retrospective study of 225 AML patients (58 Hispanic and 167 non-Hispanic) at two academic medical centers in Florida. Disease characteristics, cytogenetics, mutation profiles, and clinical outcomes were assessed. Hispanic patients were younger at presentation than non-Hispanics (p = 0.0013). We found associations between single gene mutations and ethnicity, with IDH1 mutations being more common in non-Hispanics (95.2% vs. 4.8%, p = 0.0182) and WT1 mutations more common in Hispanics (62.5% vs. 37.5%, p = 0.0455). We also found an emerging trend towards adverse risk cytogenetics in Hispanic patients (p = 0.1796), as well as high risk fusions such as MLL-r (70% vs. 30%, p = 0.004). There was no difference in overall survival (OS) between Hispanic and non-Hispanics patients. When examining only newly diagnosed patients (n = 105), there was improved OS in Hispanics (median 44.7 months vs. 14 months, p = 0.026) by univariate analysis and equivalent OS by multivariate analysis (hazard ratio = 1.52 [95% CI = 0.74-3.15]). Hispanics with a driver mutation not class-defining had improved survival compared to non-Hispanics. Our study demonstrates significant genetic differences between Floridian Hispanics and non-Hispanics, but no difference in OS in patients treated at an academic medical center.
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Affiliation(s)
- Terrence Bradley
- Division of Hematology, Sylvester Comprehensive Cancer CenterUniversity of MiamiMiamiFloridaUSA
| | - Deukwoo Kwon
- Division of Biostatistics, Sylvester Comprehensive Cancer CenterUniversity of MiamiMiamiFloridaUSA
| | - Jorge Monge
- Division of Hematology and Medical OncologyWeill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Mikkael Sekeres
- Division of Hematology, Sylvester Comprehensive Cancer CenterUniversity of MiamiMiamiFloridaUSA
| | - Namrata Chandhok
- Division of Hematology, Sylvester Comprehensive Cancer CenterUniversity of MiamiMiamiFloridaUSA
| | - Amber Thomassen
- Division of Hematology, Sylvester Comprehensive Cancer CenterUniversity of MiamiMiamiFloridaUSA
| | - Ronan Swords
- Division of Hematology and Medical OncologyOregon Health Sciences UniversityPortlandOregonUSA
| | - Eric Padron
- Department of Malignant HematologyMoffitt Cancer CenterTampaFloridaUSA
| | - Jeff Lancet
- Department of Malignant HematologyMoffitt Cancer CenterTampaFloridaUSA
| | - Chetasi Talati
- Department of Malignant HematologyMoffitt Cancer CenterTampaFloridaUSA
| | - Justin Watts
- Division of Hematology, Sylvester Comprehensive Cancer CenterUniversity of MiamiMiamiFloridaUSA
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Valenzuela R, Saadiq S, Cobos S, Salinas JJ. Engagement in Physical Activity Improves after Participation in Pasos Para Prevenir Cancer-An Obesity-Related Cancer Prevention Program in El Paso, Texas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11607. [PMID: 36141878 PMCID: PMC9517185 DOI: 10.3390/ijerph191811607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/02/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND This present study experimentally evaluated the Pasos Para Prevenir Cancer (PPPC) program to determine whether participation was associated with improved physical activity engagement. Evidence suggests that obesity prevention programs improve physical activity (PA) engagement and lead to healthier weights, which substantially impacts cancer and cardiometabolic disease risk. There is a shortage of knowledge on the effectiveness of programs tailored to populations along the U.S.-Mexico border. METHODS We collected demographic, nutrition, and physical activity data at baseline, 6 months, and 12 months using the Research Electronic Data Capture (REDCap) for 209 participants. We analyzed the average metabolic equivalents (METS) per week for all physical activity levels and types and the achievement of the recommended METS per week to determine the demographic characteristics most associated with a change between baseline, 6 months, and 12 months. RESULTS Light activity was the most common activity at all three points, and it slightly increased at 6 months in work settings. Subjects conducted moderate physical activity primarily at home and work, and moderate physical activity increased more compared to vigorous physical activity. CONCLUSIONS Intervention tailoring might improve PA engagement in Mexican Americans residing on the U.S.-Mexico border; however, larger studies that are more diverse are required.
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Affiliation(s)
- Roy Valenzuela
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
| | - Stefan Saadiq
- Francis Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
| | - Sandra Cobos
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
| | - Jennifer J. Salinas
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
- Francis Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
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Suero-Abreu GA, Patel S, Duma N. Disparities in Cardio-Oncology Care in the Hispanic/Latinx Population. JCO Oncol Pract 2022; 18:404-409. [PMID: 35544659 DOI: 10.1200/op.22.00045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Emole J, Lawal O, Lupak O, Dias A, Shune L, Yusuf K. Demographic differences among patients treated with chimeric antigen receptor T-cell therapy in the United States. Cancer Med 2022; 11:4440-4448. [PMID: 35527361 PMCID: PMC9741965 DOI: 10.1002/cam4.4797] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/27/2022] [Accepted: 04/21/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND It is not clear if all Americans have benefitted equally from the availability of chimeric antigen receptor T-cell (CART) therapy. We aimed to evaluate if demographic differences existed among adult patients who received CART therapy and to assess predictors of CART treatment outcomes. METHODS Records of patients ≥18 years who received CART therapy for non-Hodgkin's lymphoma, acute lymphoblastic leukemia, and multiple myeloma in 2018 were evaluated in the National Inpatient Sample. Acute complications and inhospital mortality were compared between two groups of CART recipients: Whites and non-Whites. Logistic regression analysis was used to evaluate the association between sociodemographic factors and inhospital mortality. RESULTS Of 1275 CART recipients that met inclusion criteria, there were 40.4% of females, 66.9% of Whites, Blacks (4.2%), Hispanics (13.3%), Asians or Pacific Islanders (4.2%), and Native Americans (1.3%). Up to 96.8% of CART procedures were performed in urban teaching hospitals, and 85.3% of CART recipients lived in metropolitan counties. Non-Whites, compared to Whites, were younger at the time of CART therapy (p < 0.001). The inhospital mortality rate was higher in non-Whites, though not statistically significant (5.4% vs. 4.4%, p = 0.764). There were no differences in length of hospital stay, hospital charges, or rates of acute toxicities between the two race groups. We found no association between race and treatment outcomes. Gender, neurotoxicity, and Charlson Comorbidity Index were significant predictors of inhospital mortality. CONCLUSIONS CART therapy recipients in the United States were more likely to be Whites and more likely to be residents of metropolitan areas. These observed demographic differences were not associated with treatment outcomes or inhospital mortalities.
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Affiliation(s)
- Josephine Emole
- Stem Cell Transplantation and Cellular TherapyHenry Ford HospitalDetroitMichiganUSA
| | - Odunayo Lawal
- Clinical and Translational Science ProgramUniversity of ArizonaTucsonArizonaUSA
| | - Oleksandra Lupak
- Hematology/OncologyUniversity of South CarolinaCharlestonSouth CarolinaUSA
| | - Ajoy Dias
- Blood and Marrow TransplantationBeth Israel Deaconess HospitalBostonMassachusettsUSA
| | - Leyla Shune
- Hematological Malignancies and Cellular TherapeuticsThe University of Kansas Health SystemKansas CityUSA
| | - Korede Yusuf
- Public Health ProgramAdelphi UniversityGarden CityNew YorkUSA
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[Combination of socio-demographic and clinical co-variates for predicting treatment responses and outcomes in patients with chronic myeloid leukemia in the chronic phase]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:54-62. [PMID: 35231994 PMCID: PMC8980668 DOI: 10.3760/cma.j.issn.0253-2727.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To explore the impacts of socio-demographic and clinical co-variates on treatment responses and outcomes in patients with chronic myeloid leukemia in the chronic phase (CML-CP) receiving tyrosine kinase inhibitor (TKI) and identified the predictive models for them. Methods: Data of newly diagnosed adult patients with CML-CP receiving first-line TKI and having complete socio-demographic data and clinical information were reviewed. Cox model was used to identify the independent variables associated with complete cytogenetic response (CCyR) , major molecular response (MMR) , molecular response 4 (MR(4)) and molecular response 4.5 (MR(4.5)) , as well as failure-free survival (FFS) , progression-free survival (PFS) , overall survival (OS) and CML-related OS. Results: A total of 1414 CML-CP patients treated with first-line imatinib (n=1176) , nilotinib (n=170) or dasatinib (n=68) were reviewed. Median age was 40 (18-83) years and 873 patients (61.7% ) were males. Result of the multivariate analysis showed that lower educational level (P<0.001-0.070) and EUTOS long-term survival intermediate or high-risk (P<0.001-0.009) were significantly associated with lower cumulative incidences of CCyR, MMR, MR(4) and MR(4.5), as well as the inferior FFS, PFS, OS and CML-related OS. In addition, those who were males, from rural households, had white blood cells (WBC) ≥120×10(9)/L, hemoglobin (HGB) <115 g/L and treated with first-line imatinib had significantly lower cumulative incidences of cytogenetic and/or molecular responses. Being single, divorced or widowed, having, rural household registration, WBC≥120×10(9)/L, HGB<15 g/L, and comorbidity (ies) was significantly associated with inferior FFS, PFS, OS, and/or CML-related OS. Thereafter, the patients were classified into several subgroups using the socio-demographic characteristics and clinical variables by cytogenetic and molecular responses, treatment failure and disease progression, as well as overall survival and CML-related OS, respectively. There were significant differences in treatment responses and outcomes among the subgroups (P<0.001) . Conclusion: Except for clinical co-variates, socio-demographic co-variates significantly correlated with TKI treatment responses and outcomes in CML-CP patients. Models established by the combination of independent socio-demographic and clinical co-variates could effectively predict the responses and outcome.
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Sterrenberg JN, Folkerts ML, Rangel V, Lee SE, Pannunzio NR. Diversity upon diversity: linking DNA double-strand break repair to blood cancer health disparities. Trends Cancer 2022; 8:328-343. [PMID: 35094960 PMCID: PMC9248772 DOI: 10.1016/j.trecan.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/20/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
Chromosomal translocations arising from aberrant repair of multiple DNA double-strand breaks (DSBs) are a defining characteristic of many cancers. DSBs are an essential part of physiological processes in antibody-producing B cells. The B cell environment is poised to generate genome instability leading to translocations relevant to the pathology of blood cancers. These are a diverse set of cancers, but limited data from under-represented groups have pointed to health disparities associated with each. We focus on the DSBs that occur in developing B cells and propose the most likely mechanism behind the formation of translocations. We also highlight specific cancers in which these rearrangements occur and address the growing concern of health disparities associated with them.
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Ayala-Marin YM, Grant AH, Rodriguez G, Kirken RA. Quadruple and Truncated MEK3 Mutants Identified from Acute Lymphoblastic Leukemia Promote Degradation and Enhance Proliferation. Int J Mol Sci 2021; 22:12210. [PMID: 34830095 PMCID: PMC8618549 DOI: 10.3390/ijms222212210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
Compared to other ethnicities, Hispanic children incur the highest rates of leukemia, and most cases are diagnosed as Acute Lymphoblastic Leukemia (ALL). Despite improved treatment and survival for ALL, disproportionate health outcomes in Hispanics persist. Thus, it is essential to identify oncogenic mutations within this demographic to aid in the development of new strategies to diagnose and treat ALL. Using whole-exome sequencing, five single nucleotide polymorphisms within mitogen-activated protein kinase 3 (MAP2K3) were identified in an ALL cancer patient library from the U.S./Mexico border. MAP2K3 R26T and P11T are located near the substrate-binding site, while R65L and R67W localized to the kinase domain. Truncated-MAP2K3 mutant Q73* was also identified. Transfection in HEK293 cells showed that the quadruple-MEK3 mutant (4M-MEK3) impacted protein stability, inducing degradation and reducing expression. The expression of 4M-MEK3 could be rescued by cysteine/serine protease inhibition, and proteasomal degradation of truncated-MEK3 occurred in a ubiquitin-independent manner. MEK3 mutants displayed reduced auto-phosphorylation and enzymatic activity, as seen by decreases in p38 phosphorylation. Furthermore, uncoupling of the MEK3/p38 signaling pathway resulted in less suppressive activity on HEK293 cell viability. Thus, disruption of MEK3 activation may promote proliferative signals in ALL. These findings suggest that MEK3 represents a potential therapeutic target for treating ALL.
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Affiliation(s)
| | | | | | - Robert A. Kirken
- Border Biomedical Research Center, Department of Biological Sciences, The University of Texas at El Paso, El Paso, TX 79968, USA; (Y.M.A.-M.); (A.H.G.); (G.R.)
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Grant AH, Ayala-Marin YM, Mohl JE, Robles-Escajeda E, Rodriguez G, Dutil J, Kirken RA. The Genomic Landscape of a Restricted ALL Cohort from Patients Residing on the U.S./Mexico Border. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147345. [PMID: 34299796 PMCID: PMC8307122 DOI: 10.3390/ijerph18147345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/12/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022]
Abstract
Next-generation sequencing (NGS) has identified unique biomarkers yielding new strategies in precision medicine for the treatment of Acute lymphoblastic leukemia (ALL). Hispanics show marked health disparities in ALL, often absent in clinical trials or cancer research. Thus, it is unknown whether Hispanics would benefit equally from curated data currently guiding precision oncology. Using whole-exome sequencing, nine ALL patients were screened for mutations within genes known to possess diagnostic, prognostic and therapeutic value. Genes mutated in Hispanic ALL patients from the borderland were mined for potentially pathogenic variants within clinically relevant genes. KRAS G12A was detected in this unique cohort and its frequency in Hispanics from the TARGET-ALL Phase II database was three-fold greater than that of non-Hispanics. STAT5B N642H was also detected with low frequency in Hispanic and non-Hispanic individuals within TARGET. Its detection within this small cohort may reflect a common event in this demographic. Such variants occurring in the MAPK and JAK/STAT pathways may be contributing to Hispanic health disparities in ALL. Notable variants in ROS1, WT1, and NOTCH2 were observed in the ALL borderland cohort, with NOTCH2 C19W occurring most frequently. Further investigations on the pathogenicity of these variants are needed to assess their relevance in ALL.
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Affiliation(s)
- Alice Hernandez Grant
- Department of Biological Sciences, College of Science, The University of Texas at El Paso, El Paso, TX 79968, USA; (A.H.G.); (Y.M.A.-M.); (E.R.-E.); (G.R.)
| | - Yoshira Marie Ayala-Marin
- Department of Biological Sciences, College of Science, The University of Texas at El Paso, El Paso, TX 79968, USA; (A.H.G.); (Y.M.A.-M.); (E.R.-E.); (G.R.)
| | - Jonathon Edward Mohl
- Department of Mathematical Sciences, College of Science, The University of Texas at El Paso, El Paso, TX 79968, USA;
| | - Elisa Robles-Escajeda
- Department of Biological Sciences, College of Science, The University of Texas at El Paso, El Paso, TX 79968, USA; (A.H.G.); (Y.M.A.-M.); (E.R.-E.); (G.R.)
| | - Georgialina Rodriguez
- Department of Biological Sciences, College of Science, The University of Texas at El Paso, El Paso, TX 79968, USA; (A.H.G.); (Y.M.A.-M.); (E.R.-E.); (G.R.)
| | - Julie Dutil
- Department of Biochemistry, Cancer Biology Division, Ponce Research Institute, Ponce Health Sciences University, Ponce, PR 00716, USA;
| | - Robert Arthur Kirken
- Department of Biological Sciences, College of Science, The University of Texas at El Paso, El Paso, TX 79968, USA; (A.H.G.); (Y.M.A.-M.); (E.R.-E.); (G.R.)
- Correspondence: ; Tel.: +1-(915)-747-5536
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13
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Bencomo-Alvarez AE, Rubio AJ, Gonzalez MA, Eiring AM. Blood cancer health disparities in the United States Hispanic population. Cold Spring Harb Mol Case Stud 2021; 7:a005967. [PMID: 33593728 PMCID: PMC8040735 DOI: 10.1101/mcs.a005967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Cancer is a challenging, multifaceted disease that involves a combination of biological and nonbiological factors. Aside from COVID-19, cancer is the second leading cause of death in the United States and the first among Hispanic Americans. The Hispanic population is the largest minority group in the United States, which is rapidly growing in size. Unfortunately, U.S. Hispanics and other minority groups experience many different health disparities, resulting in poor survival outcomes and a reduced quality of life. Factors such as genomic mutations, lower socioeconomic status, lack of education, reduced access to health care, comorbidities, and environmental factors all contribute to these health-care inequalities. In the context of blood cancer health disparities, Hispanic patients are often diagnosed at a younger age and have worse outcomes compared with non-Hispanic individuals. In this commentary, we highlight the existing knowledge about cancer health disparities in the Hispanic population, with a focus on chronic and acute leukemia. In our experience at the U.S./Mexican border, analysis of several different blood cancers demonstrated that younger Hispanic patients with acute lymphoid or myeloid leukemia have higher incidence rates and worse prognoses. A combined approach, involving improved health-care access and better knowledge of the underlying factors, will allow for more timely diagnoses and the development of intervention strategies aimed at reducing or eliminating the disparities.
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Affiliation(s)
- Alfonso E Bencomo-Alvarez
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas 79905, USA
| | - Andres J Rubio
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas 79905, USA
| | - Mayra A Gonzalez
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas 79905, USA
| | - Anna M Eiring
- Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas 79905, USA
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