个体贫困与接受急性淋巴细胞白血病（ALL）维持治疗的儿童复发之间的关联仍不清楚。在COG-AALL03N1的二次分析中，我们使用来自美国人口普查局的数据将生活在年度特定联邦贫困门槛以下的患者进行分类，计算时使用自报的年度家庭收入和家庭规模。生活在联邦贫困门槛以下120%的参与者被归类为极端贫困。在调整相关预测因素后，我们使用多变量比例次分布危险回归法估计在接受ALL维持治疗期间生活在极端贫困中的患者的复发风险。在这项分析中的592位患者中，12.3%的患者生活在极端贫困中。在平均随访7.9年后，生活在极端贫困中的被研究者中，3年内复发的累积发生率明显较高（14.3%，95%置信区间[CI]=7.3-23.6），与未生活在极端贫困中的被研究者（7.6%，95%CI=5.5-10.1，P=0.04）相比。多变量分析显示，与未生活在极端贫困中的患者相比，生活在极端贫困中的儿童复发的危险性增加了1.95倍（95% CI=1.03-3.72，P=0.04）；加入种族/族裔后，这种关联得到缓解（危险比=1.68，95% CI=0.86-3.28，P=0.1），这可能是由于种族/族裔与贫困之间存在共线性。生活在极端贫困中的儿童中有更大比例的非遵从性硫唑嘌呤（57.1% vs 40.9%，P=0.04），然而，不良遵从并不能完全解释贫困和复发风险之间的关联。未来的研究需要了解极端贫困与复发风险之间的关联机制。临床试验号：NCT00268528。版权所有©2023美国血液学会。

The association between individual-level poverty and relapse in children receiving maintenance treatment for acute lymphoblastic leukemia (ALL) remains unclear. In a secondary analysis of COG-AALL03N1, we used data from US Census Bureau to categorize patients living below year-specific federal poverty thresholds, calculated using self-reported annual household income and size of household. Participants living 120% below federal poverty thresholds were categorized as living in extreme poverty. Hazard of relapse was estimated using multivariable proportional subdistributional hazards regression for patients living in extreme poverty while receiving ALL maintenance therapy after adjusting for relevant predictors. Among 592 patients in this analysis, 12.3% of the patients were living in extreme poverty. After a median follow-up of 7.9y, the cumulative incidence of relapse at 3y from study enrollment among those living in extreme poverty was significantly higher (14.3%, 95% confidence interval [CI]= 7.3-23.6) compared to those not living in extreme poverty (7.6%, 95%CI=5.5-10.1, P=0.04). Multivariable analysis demonstrated that children living in extreme poverty had a 1.95-fold greater hazard of relapse (95%CI=1.03-3.72, P=0.04) compared to those not living in extreme poverty; this association was mitigated after inclusion of race/ethnicity in the model (hazard ratio=1.68, 95%CI=0.86-3.28, P=0.1), likely due to collinearity between race/ethnicity and poverty. A greater proportion of children living in extreme poverty were non-adherent to mercaptopurine (57.1% vs 40.9%, P=0.04); however, poor adherence did not completely explain the association between poverty and relapse risk. Future studies need to understand the mechanisms underlying the association between extreme poverty and relapse risk. Clinical Trial number: NCT00268528.Copyright © 2023 American Society of Hematology.