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June 2, 2004

Racial and Ethnic Factors in Outcomes of Children With Acute Lymphoblastic Leukemia

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(21):2541. doi:10.1001/jama.291.21.2541-a

To the Editor: In his Editorial about possible reasons for racial differences in outcomes of children with acute lymphoblastic leukemia (ALL), Dr Carroll1 did not discuss problems relating to poverty, such as malnutrition, poor adherence to treatment, compliance, and socioeconomic status.2,3 This is especially critical in developing countries, where more than 50% of the world's children live. Other authors have described poverty as an important prognostic factor in ALL occurring during childhood.4,5 For instance, Pui et al6 reported that, in a setting where all children had equal access to effective treatment, children had similar outcomes irrespective of their race or ethnicity. Furthermore, nutritional status, which is intimately linked with socioeconomic status, is an important prognostic factor in patients with ALL.25

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