The use of multiagent chemotherapy in acute lymphoblastic leukemia (ALL) has resulted in improvement in overall survival (OS), albeit to a different extent in various age groups. Various studies have demonstrated a worsening trend in chemotherapy utilization especially with increasing age. In this large database study, we aim to assess the disparity in the utilization of chemotherapy in ALL in the real-world setting.


Using the Surveillance, Epidemiology, and End Results database, we identified all patients with a histologic diagnosis of ALL from 2006 to 2016. Demographic and baseline characteristics were compared between the groups who received versus did not receive chemotherapy using χ2 test. Multivariable logistic regression model was used to evaluate the association between various sociodemographic factors and the receipt of chemotherapy in the entire cohort and in different age groups.


A total of 16,196 patients were included in the analysis, of which 1258 patients (8%) did not receive chemotherapy. Compared to 0-18 years age group, patients aged 19-40 years (Odds ratio [OR] 0.49, 95% confidence interval [CI] 0.39-0.62, p<0.001), 41- 65 years (OR 0.21, 95% CI 0.17-0.27, p<0.001), and >65 years (OR 0.04, 95% CI 0.03-0.05, p<0.001) had lower receipt of chemotherapy. Single (OR 0.72, 95% CI 0.59-0.89, p=0.002) or widowed status (OR 0.37, 95% CI 0.29-0.47, p<0.001) and lack of insurance (OR 0.37, 95% CI 0.27-0.50, p<0.001) conferred lower chances of receiving chemotherapy. Family income of $50,000-74,999 (OR 1.24, 95% CI 1.01-1.53, p=0.04) was associated with greater receipt of chemotherapy. When stratified into various age categories, insurance status was the only significant factor associated with the receipt of chemotherapy across all age groups.


Sociodemographic factors like age, marital status, income, and insurance status contribute to disparity in the utilization of chemotherapy in ALL patients