Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: I agree with Dr Ruiz-Argüelles
about the importance of socioeconomic factors in influencing outcome of therapy
for ALL. In my Editorial, I did consider socioeconomic factors and my assessment
of the data focused on studies conducted in industrialized countries, as both
of the 2 articles that I addressed involved children within the United States.
While access to therapy is clearly an important issue worldwide, race and
ethnicity appear to be an independent prognostic feature when children are
treated with identical protocols.1,2 Adherence
is an important issue for ALL, as therapy includes a prolonged maintenance
phase with orally administered therapy. Currently there is little information
to suggest that black or Hispanic patients show lower rates of adherence to
therapy. Although data are limited, parental education and income has not
been shown to affect outcomes among children enrolled on cooperative group
protocols, and the incidence of major protocol deviations is similar between
white, black, and Hispanic patients.1,2 However,
as I mentioned in my Editorial, adherence is difficult to measure and could
have accounted for the different outcomes. The impact of cultural and socioeconomic
factors on adherence is clearly an important area that requires further study.
Carroll WL. Racial and Ethnic Factors in Outcomes of Children With Acute Lymphoblastic Leukemia—Reply. JAMA. 2004;291(21):2541. doi:10.1001/jama.291.21.2541-b