Black Americans with acute myeloid leukemia are dying sooner than their White counterparts, even when treated on the same carefully run clinical trials that are designed to level the playing field. In a sweeping review of three decades of ECOG-ACRIN trials, researchers found that Black race itself emerged as an independent prognostic factor for poorer overall and disease-free survival, despite similar remission rates and treatment tolerability.
The findings challenge long-standing assumptions about what drives racial gaps in cancer outcomes. Researchers reported no differences between Black and White patients in the prevalence of key high-risk cytogenetic features or major mutations such as FLT3-ITD, CEBPA, TP53, or NPM1, undercutting the idea that known genomic risks fully explain the survival divide. Lead investigator Shella Saint Fleur-Lominy, MD, PhD, suggested that “social factors” or “other mutations that we don’t know about” may be at play and warned that “we don’t fully understand all the factors that are contributing to the disparity in outcomes.”
The study also exposes how standard prognostic tools may fall short for Black patients. European LeukemiaNet 2017 risk categories predicted overall survival in both groups but failed to predict disease-free survival in Black patients. Hematologist-oncologist Bhavana “Tina” Bhatnagar, DO, noted that current prognostic systems are “based on a predominantly White population” and cautioned that what looks favorable for the overall AML population “might not apply to Black patients,” who may ultimately require more aggressive treatment.
See: “AML: Clinical Data Confirms Lower Survival in Black Patients” (December 07, 2025)
