Neighborhood factors and treatment outcomes in pediatric acute lymphoblastic leukemia: A REDIAL Consortium report

Abstract

Acute lymphoblastic leukemia (ALL) shows persistent outcomes disparities among socioeconomically disadvantaged and Hispanic children. Neighborhood socioeconomic status (nSES) and residence in Hispanic enclaves may contribute to these disparities, yet their impact on pediatric ALL is unclear. We examined associations of nSES and Hispanic enclave residence with ALL treatment outcomes. We analyzed children (0–24 years) diagnosed with ALL between 2005–2017 and treated at REDIAL Consortium centers in Texas. Census tract nSES (Yost) and Hispanic enclave indices were computed from U.S. Census and ACS data, classifying tracts into low-high nSES and enclave-no enclave residence. Outcomes included end-of-induction (EOI) minimal residual disease positivity (MRD ≥0.01%), relapse, event-free survival (EFS), and overall survival (OS). Associations were evaluated using multivariable logistic and Cox regression models adjusting for sex, age at diagnosis, race/ethnicity, EOI MRD, cytogenetic features, NCI risk group at diagnosis, ALL immunophenotype and treating institution. Among 1,348 patients, 41% resided in low nSES tracts and 42% in Hispanic enclaves. Neither enclave residence nor low nSES were associated with EOI MRD positivity; similar null associations were observed for relapse, EFS, and OS. Although unadjusted analyses indicated slightly poorer 5-year EFS for low nSES areas (81% vs. 85%, p=0.04), this difference attenuated after adjustment. In this large, multi-center, and diverse cohort of children with ALL, neighborhood socioeconomic disadvantage and Hispanic enclave residence were not independently associated with treatment outcomes after accounting for clinical and cytogenetic features. Future studies should examine other social determinants and neighborhood influences on disease characteristics, survivorship, and late effects.