The dramatic improvement in overall survival for childhood acute lymphoblastic
leukemia (ALL) is one of the most notable achievements to date in the fight
against cancer. In the 1960s, only 15% of children survived 5 years from time
of diagnosis, whereas today more than 80% of children are cured.1,2 Many
factors have led to these remarkable results, including identification of
agents active in the treatment of ALL, recognition of sanctuary sites with
routine administration of preventive central nervous system–directed
therapy, increasing emphasis on risk-adapted therapy in which treatment is
tailored to predictive clinical and biological variables, and more recently
intensification of treatment. Participation in clinical trials, a hallmark
of pediatric oncology, identifies the most successful components of therapy
and ensures that all children receive the most advanced, up-to-date treatment.
However, not all children have benefited equally from this progress. Many
reports have documented that children of certain race/ethnic groups have inferior
outcomes. Two reports in this issue of THE JOURNAL focus on this issue and
illustrate some of the challenges of investigating multifaceted clinical relationships.3,4
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