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Peer-reviewedCC BY 4.0Current Hematologic Malignancy Reports

The Influence of Social Determinants of Health on Treatment Delivery and Outcomes in Acute Leukemia

  • Jordan Atkins1
  • Jerry Luo2
  • Hae Lin Cho3
  • Hannah Johnston4
  • Danyal Shah5
  • Stephanie Tsai6
  • Mark Fiala7
  • Andrew Hantel3,8
  • Anand Patel4
  • Irum Khan1
8 affiliations
  1. 1Division of Hematology/Oncology, and the Robert H Lurie Comprehensive Cancer Center, Northwestern University, 303 E Superior Ave, Ste 5-117, Chicago, IL 60611 USA
  2. 2Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Stanford University, Palto Alto, CA USA
  3. 3Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA USA
  4. 4Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL USA
  5. 5College of Arts and Sciences, Washington University, St Louis, MO USA
  6. 6Division of Hematology/Oncology, Loyola University Medical Center, Chicago, IL USA
  7. 7Division of Oncology, Washington University, St Louis, MO USA
  8. 8Center for Bioethics, Harvard Medical School, Boston, MA USA
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Abstract

Purpose of Review: Acute leukemia outcomes have conventionally been predicated on the genomic characteristics of leukemia cells. However, emerging evidence from population-based and national co-operative group studies suggests a pivotal role of social determinants of health (SDOH) on acute leukemia survival outcomes.

Recent Findings: Acute leukemia outcomes over the past two decades have benefited from advances in molecular diagnostics, which have ushered in a multitude of targeted therapies including small molecule inhibitors and immunotherapies, liberalization of donor matching for transplantation, and early incorporation of supportive care. However, these advances have not benefited all populations equally. Environmental exposures, insurance status, access to transportation, and language barriers are some evaluable domains of social determinants of health (SDOH) that have been linked to leukemia outcomes. SDOH can influence leukemia outcomes through impact on patient access to specialized care, clinical trial enrollment, allogeneic stem cell transplantation, and palliative care. Beyond well-established disparities in access to care, emerging epidemiologic evidence suggests that SDOH may influence the genomic and biological characteristics of leukemia. Clinical prognostic leukemia models such as ELN 2022 do not accurately predict chemotherapy outcomes in diverse patient populations. This may be attributable to biologic differences in leukemia conferred by the social and heritable aspects of race. With the current landscape shifting to incorporate small-molecule inhibitors and immunotherapies into the frontline treatment of leukemia, SDOH-informed risk stratification can optimize prognostication and guide vulnerable patients toward less toxic, equally effective therapeutic alternatives.

Summary: This review summarizes current evidence on how social determinants of health can influence multiple aspects of leukemia biology and outcomes and provides a framework to address the influence of SDOH along the continuum of acute leukemia care.

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Cite

BibTeXRIS
BibTeX
@article{atkins2026influence,
  title = {{The Influence of Social Determinants of Health on Treatment Delivery and Outcomes in Acute Leukemia}},
  author = {Jordan Atkins and Jerry Luo and Hae Lin Cho and Hannah Johnston and Danyal Shah and Stephanie Tsai and Mark Fiala and Andrew Hantel and Anand Patel and Irum Khan},
  journal = {Current Hematologic Malignancy Reports},
  year = {2026},
  month = nov,
  doi = {10.1007/s11899-026-00792-3},
  url = {https://doi.org/10.1007/s11899-026-00792-3},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - The Influence of Social Determinants of Health on Treatment Delivery and Outcomes in Acute Leukemia
AU  - Jordan Atkins
AU  - Jerry Luo
AU  - Hae Lin Cho
AU  - Hannah Johnston
AU  - Danyal Shah
AU  - Stephanie Tsai
AU  - Mark Fiala
AU  - Andrew Hantel
AU  - Anand Patel
AU  - Irum Khan
PY  - 2026
DA  - 2026/11/04
JO  - Current Hematologic Malignancy Reports
DO  - 10.1007/s11899-026-00792-3
UR  - https://doi.org/10.1007/s11899-026-00792-3
AB  - Purpose of Review: Acute leukemia outcomes have conventionally been predicated on the genomic characteristics of leukemia cells. However, emerging evidence from population-based and national co-operative group studies suggests a pivotal role of social determinants of health (SDOH) on acute leukemia survival outcomes.  Recent Findings: Acute leukemia outcomes over the past two decades have benefited from advances in molecular diagnostics, which have ushered in a multitude of targeted therapies including small molecule inhibitors and immunotherapies, liberalization of donor matching for transplantation, and early incorporation of supportive care. However, these advances have not benefited all populations equally. Environmental exposures, insurance status, access to transportation, and language barriers are some evaluable domains of social determinants of health (SDOH) that have been linked to leukemia outcomes. SDOH can influence leukemia outcomes through impact on patient access to specialized care, clinical trial enrollment, allogeneic stem cell transplantation, and palliative care. Beyond well-established disparities in access to care, emerging epidemiologic evidence suggests that SDOH may influence the genomic and biological characteristics of leukemia. Clinical prognostic leukemia models such as ELN 2022 do not accurately predict chemotherapy outcomes in diverse patient populations. This may be attributable to biologic differences in leukemia conferred by the social and heritable aspects of race. With the current landscape shifting to incorporate small-molecule inhibitors and immunotherapies into the frontline treatment of leukemia, SDOH-informed risk stratification can optimize prognostication and guide vulnerable patients toward less toxic, equally effective therapeutic alternatives.  Summary: This review summarizes current evidence on how social determinants of health can influence multiple aspects of leukemia biology and outcomes and provides a framework to address the influence of SDOH along the continuum of acute leukemia care.
SN  - 1558-8211
SN  - 1558-822X
ER  -