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Thursday, October 16, 2003

Native American children with leukemia do not respond to treatment as well as their counterparts, according to a study published on Wednesday.

Of all racial and ethnic groups, American Indian and Alaska Native children, along with Hispanic children, have the lowest survival rates, researchers found. Only 72 percent of Native and Hispanic children outlived the disease, compared to 84 percent for White children, 81 percent for Asian/Pacific Islander children and 75 percent for African-American children.

Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy in the United States. According to the National Institutes of Health, ALL comprises 25 percent of all cancers in persons younger than 20.

In the past, ALL was almost always fatal. But advances in treatment have pushed the national survival rate to 80 percent, according to a study published in 1996.

Researchers have wondered whether minorities are benefiting from improved care. Yesterday's study in the Journal of the American Medical Association (JAMA), concludes they do not.

"Our data suggest that children of different racial and ethnic groups vary in their survival from ALL, even in the modern treatment era," the researchers wrote.

The study, however, conflicts with another one that compared survival rates among White and African-American children. In data published in JAMA, researchers at St. Jude Children's Research Hospital in Memphis, Tennessee, found no disparity.

Research among Native children with ALL has differed too. A 1991 study among Natives treated at University of New Mexico found their survival rates were just as good as other children.

In an editorial comment, the researchers noted that their data for Native children was limited. "We found that Native Americans had the worst ALL survival probability of any race/ethnic group, but with only 61 Native American children in the analysis this finding must be viewed with considerable caution," they wrote.

But they said their study was the largest to date. The UNM study involved 28 Native children.

The researchers gleaned their information from a database offered by the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. For the years 1973 to 1999, a total of 4952 individuals younger than 19 were diagnosed with leukemia. Of these cases, 1.2 percent were identified as Native American.

Most (77 percent) of the Natives were diagnosed with ALL between the ages of 1-9 while the rest were diagnosed between the ages of 10-19. This data allowed researchers to determine the probability of survival -- the younger one is diagnosed, the better chance for outliving the disease.

"Averaged over the study period of 1973-1999, Native American children had an 80 percent higher adjusted risk of death than did white children," the authors said.

The primary treatment for ALL is chemotherapy. Drugs can be taken to kill the cancer cells.

In certain cases, radiation therapy can be used. Radiation kills cancer cells and shrinks tumors.

Bone marrow transplantation is a newer type of treatment that combines chemotherapy and a transfer of bone marrow. The donor has to have the same or similar tissue for a transplant to have a chance of success. The National Marrow Donor Program encourages Native Americans to be tested for possible donations.

Get the Studies:
Survival Variability by Race and Ethnicity in Childhood Acute Lymphoblastic Leukemia | Results of Therapy for Acute Lymphoblastic Leukemia in Black and White Children

Relevant Links:
Childhood Acute Lymphoblastic Leukemia, National Cancer Institute - http://www.cancer.gov/cancerinfo/pdq/treatment/childALL/patient
Acute Lymphocytic Leukemia, National Marrow Donor Program - http://www.marrow.org/MEDICAL/all.html

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Marrow donor search for Navajo boy elusive (7/31)

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