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October 15, 2003

Race and Outcome in Childhood Acute Lymphoblastic Leukemia

Author Affiliations

Author Affiliation: Division of Pediatric Oncology, New York University and Mount Sinai Schools of Medicine, New York, NY.

JAMA. 2003;290(15):2061-2063. doi:10.1001/jama.290.15.2061

The dramatic improvement in overall survival for childhood acute lymphoblastic leukemia (ALL) is one of the most notable achievements to date in the fight against cancer. In the 1960s, only 15% of children survived 5 years from time of diagnosis, whereas today more than 80% of children are cured.1,2 Many factors have led to these remarkable results, including identification of agents active in the treatment of ALL, recognition of sanctuary sites with routine administration of preventive central nervous system–directed therapy, increasing emphasis on risk-adapted therapy in which treatment is tailored to predictive clinical and biological variables, and more recently intensification of treatment. Participation in clinical trials, a hallmark of pediatric oncology, identifies the most successful components of therapy and ensures that all children receive the most advanced, up-to-date treatment. However, not all children have benefited equally from this progress. Many reports have documented that children of certain race/ethnic groups have inferior outcomes. Two reports in this issue of THE JOURNAL focus on this issue and illustrate some of the challenges of investigating multifaceted clinical relationships.3,4