A new analysis spanning more than 3 decades of Eastern Cooperative Oncology Group and American College of Radiology Imaging Network (ECOG-ACRIN) clinical trial data demonstrates that Black patients with acute myeloid leukemia (AML) present with the disease at a significantly younger age and experience markedly worse outcomes than White patients—even when treated under standardized conditions within rigorously controlled trials. First author Shella Saint Fleur-Lominy, MD, PhD, of the University of Maryland School of Medicine, stated, “To our knowledge, this study includes data for a larger number of Black patients than any other such study of AML survival across NCI-supported clinical trials.” The results of the analysis were presented at the 2025 American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract 290).
The study, which was supported by the National Cancer Institute (NCI), evaluated outcomes for 3,809 patients (3,469 White patients, 184 Black patients, and 156 patients of other races and ethnicities) with newly diagnosed AML enrolled in 10 trials between 1984 and 2019, offering one of the most extensive assessments to date of racial differences in AML survival.
The investigators found that Black patients were diagnosed with AML at a median age of 47.9 years, compared with 53.5 years for white patients, a statistically significant difference. Survival outcomes revealed even more striking disparities: Black patients had a 31% higher risk of dying from AML and a 21% higher risk of dying from any cause than White patients. According to Dr. Saint Fleur-Lominy, “Our findings confirm those of previous, smaller studies that Black patients with AML develop the disease at a significantly younger age, on average, than White patients and, even when treated in clinical trials, have significantly worse outcomes.”
The researchers examined the incidence and prognostic impact of common AML-associated mutations and found that, in general, mutation frequencies were similar between Black and White patients. A notable exception emerged among individuals with NPM1-mutated AML, a subgroup typically associated with favorable outcomes. Black patients with NPM1 mutations had a median overall survival of just 8.9 months—less than half that of White patients, who lived a median of 19.1 months. “Although the NPM1 mutation is typically associated with more favorable outcomes of AML treatment, we did not see those more favorable outcomes in Black patients,” Dr. Saint Fleur-Lominy said.
Stem cell transplantation patterns also differed between groups. While overall transplantation rates were similar, Black patients were less likely to receive allogeneic transplants from a healthy, matched donor (37.1% vs 48.5% for White patients). Because donor transplants offer the best chance for cure in high-risk AML, this discrepancy may have contributed to inferior outcomes.
Because of the study’s long time span, mutation profiling from earlier eras—before current genomic technologies were available—is incomplete. The investigators plan to integrate their findings with larger contemporary data sets to clarify whether certain mutations hold different prognostic implications for Black patients and to better understand biological, clinical, and structural factors underlying the racial disparities observed.
Disclosure: For full disclosures of all study authors, see meetings-api.hematology.org.
