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In Reply: I agree with Dr Ruiz-Argüelles about the importance of socioeconomic factors in influencing outcome of therapy for ALL. In my Editorial, I did consider socioeconomic factors and my assessment of the data focused on studies conducted in industrialized countries, as both of the 2 articles that I addressed involved children within the United States. While access to therapy is clearly an important issue worldwide, race and ethnicity appear to be an independent prognostic feature when children are treated with identical protocols.^1-2 Adherence is an important issue for ALL, as therapy includes a prolonged maintenance phase with orally administered therapy. Currently there is little information to suggest that black or Hispanic patients show lower rates of adherence to therapy. Although data are limited, parental education and income has not been shown to affect outcomes among children enrolled on cooperative group protocols, and the incidence of major protocol deviations is . . . [Full Text of this Article]

William L. Carroll, MD
Program in Pediatric Hematology/Oncology
New York University and Mount Sinai Schools of Medicine
New York, NY

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