Association of ethnicity with overall survival in patients with T-cell acute lymphoblastic leukemia/lymphoblastic lymphoma
Authors: Neupane Karun , Dahal Riyasha , Bazarbachi Abdul-Hamid , Reef Daniel Klein , Al Hamed Rama , Pradhan Kith , Gritsman Kira , Feldman Eric J. , Goldfinger Mendel , Kornblum Noah , Shastri Aditi , Shi Yang , Wang Yanhua , Mantzaris Ioannis , Shah Nishi , Cooper Dennis , Verma Amit , Konopleva Marina , Sica R. Alejandro 
Published: June 2023

e18557

Background: T-cell acute lymphoblastic leukemia/lymphoblastic lymphoma (T-ALL/T-LBL) is a rare and aggressive form of malignancy of immature T-Cells. Despite advancements in treatment, disparities in survival rates among different racial/ethnic groups have been reported. While there is some data available comparing survival outcomes in children with ALL based on ethnicity, there is limited data on comparison of survival outcomes in patients specifically with T-ALL. Here we compared the survival outcomes of T-ALL patients from a minority rich cohort including both children and adults. Methods: This is a single center observational retrospective study analyzing T-ALL patients from 2004-2022 who were followed up at our center. We collected and analyzed data on demographics, race, immunophenotype, treatment regimens, and survival outcomes. Race (used here interchangeably with ethnicity) was categorized as Hispanic, Black, White and other races. Immunophenotype was classified as Pro-TALL, Pre-TALL, Cortical TALL, Medullary TALL and Early T cell precursor-ALL. Univariate and multivariate Cox regression models were used for analysis. Overall survival (OS) was compared using the Kaplan-Meier curve and log-rank test. P-values < / = 0.05 were considered as statistically significant. All analyses were done using R statistical software. Results: We included 59 patients with T-ALL (78% males and 22% females) for analysis. The median age at diagnosis was 20 years (range 1-48 years). Thirty two percent were Black, 29% Hispanic, 17% White and 14% were of other races (8%-not reported). Median follow up duration was 30 months. We compared OS based on sex, race, and immunophenotype. Univariate analysis showed significant difference in OS only for race (p value 0.006). Hispanic patients had the worse outcomes with lower OS compared to White (p = 0.02), and other ethnicities (p = 0.04). The difference was still significant (p = 0.016 and 0.01 respectively) after correction for age using multivariate analysis (age groups: < 15 and = / > 15 years; 15 years being the median age for Hispanic population). There was no difference in OS between remaining races. Median overall survival was not reached in any group. Conclusions: Although sample size is small, our study showed that the OS in Hispanics was lower than in White and other races in a minority rich population including adults and children with T-ALL. Whether this difference is due to systemic barriers in accessing care and/or due to inherent characteristics affecting disease severity/response to treatment remains to be explored. Interestingly, we didn’t find any difference in survival outcomes for black race and for different immunophenotypes. This study adds to the literature demonstrating disparities in survival among different racial groups with T-ALL and the need to address these disparities through targeted interventions.