Study Highlights Racial and Ethnic Disparities in AML Trials

Studies have reported racial and ethnic disparities in the survival and incidence of patients with acute myeloid leukemia (AML), which may stem from underrepresentation in clinical trial enrollment.

To investigate these disparities, Nathalie Loeb, of McMaster Children’s Hospital, and colleagues performed a systemic review of literature on the enrollment of members of racial and ethnic minority groups and older adults into randomized controlled trials for AML. In total, the review included 90 studies across 157 full texts and 7759 titles and abstracts discovered through the MEDLINE database.

The researchers also conducted a meta-analysis of enrollment incidence ratios (EIRs), defined as “the ratio of trial proportions of members of a racial and ethnic subgroup divided by the US population–based incidence in the corresponding racial and ethnic subgroup in the SEER [Surveillance, Epidemiology, and End Results] database.”

Twenty-one of 90 trials (23.3%) reported patients’ race or ethnicity. Of these, 15 (71.4%) included data on Black patients, 21 (100%) on White patients, 14 (66.7%) on Asian or Pacific Islander patients, 2 (9.52%) on Native American/Alaska Native patients, and 4 (19.0%) on Hispanic patients. The percentage of trials reporting on race increased from 19.5% before 2014 to 46.2% after 2024. In addition, 26 of 90 trials (28.9%) reported age of 65 years and older.

Of the 21 trials that reported race, 4.7% of patients were Black, 9.8% were Asian/Pacific Islander, 0.5% were Native American/Alaska Native, 80.8% were White, and 3.4% were Hispanic. The proportion of members of racial minority groups enrolled in trials also increased in the last 20 years.

The proportion of trials reporting race and ethnicity was also stratified by geographic location. Of the 14 trials conducted in the United States, 4 (28.6%) reported on race or ethnicity, and 4 (28.6%) reported the proportion of older adults enrolled. In the 4 US trials that reported on race and ethnicity, Hispanic patients (EIR, 0.28; 95% CI, 0.15-0.50; I²=46.9%) and Asian patients (EIR, 0.16; 95% CI, 0.09-0.28; I²=0%) were significantly underrepresented, and White patients (EIR, 1.23; 95% CI, 1.13-1.35; I²=0%) were significantly overrepresented.

“Most trials did not report data on race and ethnicity or on enrollment proportion of participants aged ≥65 years,” the researchers concluded. “Efforts should continue to include patients from underrepresented minority groups in clinical trials to prevent racial disparities in research.”

The researchers acknowledged limitations of the study, including the fact that a low number of randomized trials had data on race or ethnicity. “Another limitation is the publication bias of the studies included in the systematic review, in which more studies conducted in countries with a majority White population would be published,” they wrote.

Reference

Loeb N, Katsnelson O, Jain A, Tahvildar P, Teitelbaum D, Garcia-Horton A. Race and age disparities in randomized trials of acute myeloid leukemia: a systematic review and meta-analysis. Blood Neoplasia. 2025;2(2):100070. doi:10.1016/j.bneo.2025.100070