Associations between race and survival in pediatric patients with diffuse large B‐cell lymphoma

• Published in: Cancer medicine (Malden, MA) Vol. 10; no. 4; pp. 1327 - 1334
• Main Authors: Khullar, Karishma, Plascak, Jesse J., Drachtman, Richard, Cole, Peter D., Parikh, Rahul R.
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01-02-2021; John Wiley and Sons Inc; Wiley
• Subjects: Adolescent; Adult; Age; B-cell lymphoma; Black People - statistics & numerical data; Bone marrow; Cancer therapies; Chemotherapy; Clinical Cancer Research; Databases, Factual; diffuse large B‐cell lymphoma; Disease; Ethnicity; Family income; Health insurance; Healthcare Disparities - statistics & numerical data; health‐care disparities; Hispanic people; Humans; Inequality; Leukemia; Lymphocytes B; Lymphoma; Lymphoma, Large B-Cell, Diffuse - ethnology; Lymphoma, Large B-Cell, Diffuse - mortality; Lymphoma, Large B-Cell, Diffuse - therapy; Medicaid; Missing data; non‐Hodgkin lymphoma; Original Research; Patients; Pediatrics; Postal codes; Prognosis; Race; Racial differences; Radiation therapy; Retrospective Studies; Secondary schools; Socioeconomic factors; Stem cell transplantation; survival; Survival Rate; United States - epidemiology; White People - statistics & numerical data; Young Adult; Young adults; United States; non-Hodgkin lymphoma; health-care disparities; diffuse large B-cell lymphoma; race; survival
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.3736

Background
The purpose of this study was to examine the factors associated with disparities in overall survival (OS) by race in pediatric diffuse large B‐cell lymphoma (DLBCL) patients.
Methods
We evaluated clinical features and survival among patients ≤21 years of age diagnosed with stage I–IV DLBCL from 2004 to 2014 from the National Cancer Database (NCDB) using a multivariable Cox proportional hazards model.
Results
Among 1386 pediatric patients with DLBCL, 1023 patients met eligibility criteria. In unadjusted analysis, Black patients had a significantly higher overall death rate than White patients (HRBlack vs. White 1.51; 95% CI: 1.02–2.23, p = 0.041). The survival disparity did not remain significant in adjusted analysis, though controlling for covariates had little effect on the magnitude of the disparity (HR 1.46; 95% CI 0.93–2.31, p = 0.103). In adjusted models, presence of B symptoms, receipt of chemotherapy, stage of disease, and Other insurance were significantly associated with OS. Specifically, patients with B symptoms and those with Other insurance were more likely to die than those without B symptoms or private insurance, respectively (HR 1.75; 95% CI 1.22–2.50, p = 0.002) and (HR 2.56; 95% CI, 1.39–4.73, p = 0.0027), patients who did not receive chemotherapy were three times more likely to die than those who received chemotherapy (HR 3.10; CI 1.80–5.35, p < 0.001), and patients who presented with earlier stage disease were less likely to die from their disease than those with stage IV disease (stages I–III HR 0.34, CI 0.18–0.64, p < 0.001; HR 0.50, CI 0.30–0.82, p = 0.006, HR 0.72, CI 0.43–1.13, p = 0.152, respectively).
Conclusions
Our results suggest that racial disparities in survival may be mediated by clinical and treatment parameters.
The purpose of this study was to examine the factors associated with disparities in overall survival (OS) by race in pediatric diffuse large B‐cell lymphoma (DLBCL) patients. Black patients had a significantly higher overall death rate than White patients (HRBlack vs. White 1.54; 95% CI: 1.01–2.35, p =0.044). Our results suggest that racial disparities in survival may be mediated by clinical and treatment parameters.