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To the Editor: In his Editorial about possible reasons for racial differences in outcomes of children with acute lymphoblastic leukemia (ALL), Dr Carroll¹ did not discuss problems relating to poverty, such as malnutrition, poor adherence to treatment, compliance, and socioeconomic status.^2-3 This is especially critical in developing countries, where more than 50% of the world's children live. Other authors have described poverty as an important prognostic factor in ALL occurring during childhood.^4-5 For instance, Pui et al⁶ reported that, in a setting where all children had equal access to effective treatment, children had similar outcomes irrespective of their race or ethnicity. Furthermore, nutritional status, which is intimately linked with socioeconomic status, is an important prognostic factor in patients with ALL.^2-5

Guillermo J. Ruiz-Argüelles, MD, FRCP(Glasg)
gruiz1{at}clinicaruiz.com
Centro de Hematología y Medicina Interna de Puebla
Puebla, México

1. Carroll WL. Race and outcome in childhood acute lymphoblastic leukemia. JAMA. 2003;290:2061-2063. FREE FULL TEXT 2. UICC Workshop. Nutritional morbidity in children with cancer: mechanisms, measures and management. Int J Cancer. 1998;92(suppl 11):1-66. 3. Barr RD, Ruiz-Argüelles GJ. Nutrition and cancer in children. Med Pediatr Oncol. 2003;41:54-57. FULL TEXT 4. Pinkel D. Selecting treatment for children with acute lymphoblastic leukemia. J Clin Oncol. 1996;14:4-6. WEB OF SCIENCE | PUBMED 5. Barr RD, Gibson BE. Nutritional status and cancer in childhood. J Pediatr Hematol Oncol. 2000;22:491-494. FULL TEXT | WEB OF SCIENCE | PUBMED 6. Pui C-H, Sandlund JT, Pei D, et al. Results of therapy for acute lymphoblastic leukemia in black and white children. JAMA. 2003;290:2001-2007. FREE FULL TEXT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291:2541.

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