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June 2, 2004

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

Author Affiliations

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

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

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.

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