Pediatric acute myeloid leukemia (AML) is an aggressive blood cancer in which the bone marrow produces abnormal immature blood cells that crowd out healthy cells. Pediatric AML is a rare condition, affecting about 500 to 700 U.S. children each year.
While survival outcomes for pediatric AML have improved overall, racial and ethnic disparities persist.
A new study from JAMA Network Open examined whether differences in disease presentation, treatment-related toxicities, or relapse rates help explain survival disparities among Black, Hispanic, and white children with AML.
The findings revealed that Black and Hispanic children experienced worse overall survival than their white peers, but differences in relapse rates didn’t account for the disparity.
The researchers analyzed 773 pediatric AML patients treated at 13 U.S. children’s hospitals between 2011 and 2024.
The five-year overall rate was:
After adjustment, Black children had a 55 percent higher hazard of death and Hispanic children had a 32 percent higher hazard of death compared with white peers.
These disparities persisted in the contemporary treatment era, suggesting that improvements in therapy alone have not eliminated outcome gaps.
While cancer therapies continue to advance thanks to precision medicine and other new approaches, survival inequities remain a significant quality-of-care and health equity challenge in pediatric oncology for patients from marginalized communities.
The researchers examined “presentation acuity,” or how ill the children were when they first presented for care. They found that Black children were more likely to present with cardiovascular, respiratory, and renal complications requiring higher-intensity care. In fact, cardiovascular acuity was twice as common among Black patients compared with white patients. Higher cardiovascular and respiratory acuity were independently associated with increased mortality risk.
Although the study was not designed to identify the causes of these differences, factors such as delayed diagnosis, barriers to specialty care, healthcare access challenges, and broader social determinants of health may contribute to higher-acuity presentation.
The study frames race and ethnicity as proxies for exposure to structural and social disadvantages rather than biological differences.
For clinicians, early recognition of access barriers and social risk factors may help identify patients at greater risk of presenting with advanced disease or severe complications.
Researchers also evaluated severe treatment-related organ toxicities and AML relapse. Pediatric AML treatments often include a combination of chemotherapy, stem cell transplant, and targeted therapy.
Intensive AML treatment can cause significant short- and long-term toxicities, including cardiovascular, renal, neurologic, endocrine, and hepatic complications. However, the study found that the rates of severe frontline toxicities were largely similar across racial and ethnic groups.
Relapse rates were also nearly identical:
These findings challenge assumptions that differences in cancer recurrence are driving survival inequities.
For clinicians treating pediatric AML, intervention opportunities may lie earlier in the care continuum, before or immediately after diagnosis.
The study found that cardiovascular acuity explained about 14 percent of the survival disparity observed among Black children, while respiratory acuity explained about 8 percent. However, most of the survival gaps remained unexplained, suggesting that other factors across the care continuum need investigation.
When treating children with AML, clinicians should consider:
The findings suggest that reducing survival disparities in pediatric AML may require a greater focus on what happens before treatment begins. While advances in therapy continue to improve outcomes overall, ensuring timely diagnosis, equitable access to specialty care, and support for families facing structural barriers may be critical to closing persistent survival gaps.
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