Socioeconomic determinants of the biology and outcomes of acute lymphoblastic leukemia in adults.

Various socioeconomic and biologic factors impact cancer health disparities and differences in health outcomes. To better characterize the socioeconomic versus biologic determinants of acute lymphoblastic leukemia (ALL) outcomes, we conducted a single-institution, retrospective analysis of adult patients with ALL treated at the University of Chicago (UChicago) from 2010 to 2022, and compared our outcomes with the United States national data (SEER database). Among 221 adult patients with ALL treated at UChicago, BCR::ABL1 was more frequent in patients with higher BMI (OR: 7.64; 95% CI=1.17-49.9) and Non-Hispanic Black (NHB) ancestry (59% vs 24% in Non-Hispanic White (NHW) and 20% in Hispanic patients, p= 0.001). In a multivariable analysis, age (HR: 6.93; 95% CI=2.27-21.1) and higher BMI at diagnosis (HR: 10.3; 95%=CI 2.56-41.5) were independent predictors of poor overall survival (OS). In contrast, race or income were not predictors of OS in the UChicago cohort. Analysis of the national SEER database (2010-2020) demonstrated worse survival outcomes in Hispanic and NHB patients compared to NHW patients among adolescent and young adult (AYA) patients, but not in older adults (>40 years). Both AYA and older adult patients with higher median household income had better OS than those with lower income. Therefore, multidisciplinary medical care coupled with essential supportive care services offered at centers experienced in ALL care may alleviate the socioeconomic disparities in ALL outcomes in the US.