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Effect of Race on the Outcome of Pediatric Patients With Hodgkin's Lymphoma

Monika L. Metzger, Sharon M. Castellino, Melissa M. Hudson, Shesh N. Rai, Sue C. Kaste, Matthew J. Krasin, Larry E. Kun, Ching-Hon Pui, Scott C. Howard

From the Departments of Oncology, Biostatistics, and Radiological Sciences St Jude Children's Research Hospital; the University of Tennessee Health Science Center, Memphis, TN; and Department of Pediatrics, Wake Forest University, Winston-Salem, NC

Corresponding author: Monika L. Metzger, MD, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN 38105-2794; e-mail: monika.metzger{at}stjude.org

Purpose: Some cooperative groups have found a survival disadvantage in black children with various childhood cancers. We examine the effects of race on clinical outcomes among children with Hodgkin's lymphoma (HL) treated with contemporary therapy at a tertiary care children's hospital.

Patients and Methods: Retrospective analysis of 327 children and adolescents diagnosed with HL between 1990 and 2005. Patients were treated with risk-directed multimodal therapy regardless of race, ethnicity, or ability to pay. Event-free and overall survival rates were compared for black and white children. Clinical characteristics, socioeconomic factors, and biologic features were analyzed for prognosis of treatment failure.

Results: The 262 white and 65 black patients did not differ significantly in presenting features, clinical characteristics, or enrollment in a clinical trial. More black patients (71% v 45%) resided in poor counties (P < .001). While black and white children were equally likely to have progressive disease or early relapse, black children were 3.7 times (95% CI, 1.7 to 8.0) more likely to relapse 12 months or more after diagnosis. The 5-year event-free survival was 71% ± 6.1% (SE) for black and 84% ± 2.4% for white children (P = .01). However, the 5-year survival rate did not differ between white and black children (94.4% v 94.7%). While black race and low hemoglobin concentration were independent predictors of treatment failure, only low hemoglobin concentration independently predicted poor survival.

Conclusion: Black children with Hodgkin's lymphoma have lower event-free survival than white children, but both populations have the same 5-year overall survival.

Supported by Grants No. CA-21765, CA-51001, CA-36401, CA-78224, CA-60419, and GM-61393 from the National Institutes of Health, and by the American Lebanese Syrian Associated Charities. C-H.P., MD, is an American Cancer Society Professor.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.