Background Race-based survival in children and adolescents with hematologic malignancies has been a national challenge for decades. Large-scale investigations of age- and race-based survival trends over time in these patients have not previously been reported. Objective To investigate whether race- and age-related differences in pediatric and adolescent and young adult (AYA) leukemia and lymphoma survival persist and to what extent these differences have changed over time. Methods Using the Surveillance, Epidemiology and End Results (SEER) Program we investigated the outcomes of black and white (1975–2012; N=27,369) and white and Hispanic (1992–2012; N=20,574) children (0–14 years old) and AYAs (15–39 years old) with acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML) and Hodgkin lymphoma (HL). Five- and 10-year relative survival estimates were compared over time. Results Trends showed convergence of survival in white and black children with ALL, but divergence in survival in AYA patients. Hispanic children and AYAs both suffer inferior outcomes. Trends for AML revealed persistent survival differences between black and white children and suggested worsening disparities for AYAs. Survival trends in HL revealed sustained survival differences between black and white AYA patients whereas no differences were found in Hispanic vs. white patient outcomes for AML or HL. Conclusion Although survival in children and AYAs with ALL, AML and HL has improved over the past four decades, differences persist between black, white, and Hispanic children and AYAs; Survival disparities between black and white children with ALL has been nearly eliminated. Strategies aimed at identifying causality and reducing disparities are warranted.

Adolescents and young adults (AYAs, 15-39 years) with acute lymphoblastic leukemia (ALL) represent a heterogeneous population who receive care in pediatric or adult cancer settings. Using the California Cancer Registry, we describe AYA ALL patterns of care and outcomes over the past decade. Sociodemographics, treatment location, and front-line therapies administered to AYAs diagnosed with ALL between 2004 and 2014 were obtained. Cox regression models evaluated associations between ALL setting and regimen and overall survival (OS) and leukemia-specific survival (LSS) for the entire cohort, younger AYA (<25 years), and AYAs treated in the adult cancer setting only. Of 1473 cases, 67.7% were treated in an adult setting; of these, 24.8% received a pediatric ALL regimen and 40.7% were treated at a National Cancer Institute (NCI)-designated center. In multivariable analyses, front-line treatment in a pediatric (vs adult) setting (OS HR = 0.53, 95% confidence interval [CI], 0.37-0.76; LSS HR = 0.51, 95% CI, 0.35-0.74) and at an NCI/Children's Oncology Group (COG) center (OS HR = 0.80, 95% CI, 0.66-0.96; LSS HR = 0.80, 95% CI, 0.65-0.97) were associated with significantly superior survival. Results were similar when analyses were limited to younger AYAs. Outcomes for AYAs treated in an adult setting did not differ following front-line pediatric or adult ALL regimens. Our population-level findings demonstrate that two-thirds of AYAs with newly diagnosed ALL are treated in an adult cancer setting, with the majority receiving care in community settings. Given the potential survival benefits, front-line treatment of AYA ALL at pediatric and/or NCI/COG-designated cancer centers should be considered.

Background Despite advances in treatment, survival from acute lymphoblastic leukemia (ALL) remains lower among non‐White children than White children in the US. We investigated the association of race/ethnicity and socioeconomic status (SES) with survival. Procedures We analyzed 9,295 Californian children (3,251 Whites, 4,890 Hispanics, 796 Asians, and 358 Blacks) aged ≤19 years diagnosed with a first primary ALL during 1988–2011. We used the Kaplan–Meier method to estimate survival at 1, 5, and 10 years after diagnosis for three calendar periods. Hazard ratios of death for race/ethnicity, SES, and clinical factors were estimated by Cox regression models. Results Median follow‐up time was 7.4 years (range 0–25 years). Over time, survival after ALL improved steadily, but inequalities persisted across races/ethnicities. Five‐year survival (95% confidence interval) was 85.0% (83.6–86.2) for White, 81.4% (78.3–84.0) for Asian, 79.0% (77.8–80.2) for Hispanic, and 74.4% (69.4–78.8) for Black children. In multivariable‐adjusted models, the hazard of death was increased by 57% among Black, 38% among Hispanic, and 33% among Asian children compared with White children. Patients residing in the lowest SES neighborhoods at diagnosis had a 39% increased risk of death relative to those living in higher SES neighborhoods. Conclusion Despite significant improvements in survival, non‐White children and children residing in low SES neighborhoods experienced worse survival even after adjusting for potential confounders. Our findings highlight the need to capture specific information on disease biology, treatment, and treatment adherence to better understand the predictors of lower survival in minority and low SES groups. Pediatr Blood Cancer 2015;62:1819–1825. © 2015 Wiley Periodicals, Inc.