To the Editor.
—Dr Pui and colleagues1 report the good news that black children with acute lymphoid leukemia (ALL) treated at St Jude Children's Research Hospital since 1984 have an overall 5-year survival rate similar to that of white children. This contrasts with prior experience when black children had substantially lower survival rates. Because St Jude has provided equal access and quality of care to all children since its founding in 1962, the results suggest that improved treatment protocols since 1984 are responsible for the change. However, another factor must be considered.Malnutrition, as determined from height and weight data, is an independent adverse prognostic factor in survival of children with ALL.2 In the first report from St Jude describing the poor prognosis of black children with ALL, Walters et al3 demonstrated their inferior nutritional status as determined from height and weight data. This demonstration was one