The neutrophil count is a crucial measurement for cancer patients, especially those undergoing therapies like chemotherapy. However, individuals with the Duffy-null phenotype, predominantly found in African Americans, face challenges due to their naturally lower neutrophil levels. This can lead to exclusion from cancer clinical trials and impact treatment outcomes, as highlighted in a recent study published in JAMA Network Open.
The Duffy-null phenotype, previously referred to as “benign ethnic neutropenia,” is a genetic variation that affects the red blood cells. It is prevalent in regions where malaria is endemic, such as Africa and the Middle East. Individuals with this phenotype may have lower neutrophil levels, potentially skewing their immune system’s readiness to fight infections. Consequently, they may be deemed ineligible for certain treatments or trials that rely on specific neutrophil counts.
Dr. Andrew Hantel, a medical oncologist and researcher at Dana-Farber Cancer Institute, emphasized the impact of excluding individuals with the Duffy-null phenotype from clinical trials. This exclusion could contribute to the historically low participation of African Americans in cancer trials, reflecting systemic racism in healthcare practices.
The study revealed that current protocols for cancer clinical trials do not consider the unique neutrophil range of individuals with the Duffy-null phenotype. This oversight could lead to dose modifications that negatively affect these individuals’ overall survival. Dr. Hantel and his team found that a significant percentage of trials and drug regimens fail to account for this genetic variation, highlighting the need for more inclusive and personalized healthcare approaches.
Dr. Consuelo Wilkins, a health equity expert at Vanderbilt University, emphasized the broader implications of medical norms based on European ancestry populations. She highlighted the structural racism embedded in clinical trial criteria and called for greater inclusivity in medical research.
Moving forward, Dr. Hantel advocates for the inclusion of exceptions and conditions for individuals with the Duffy-null phenotype in clinical trial design. By understanding and acknowledging the unique neutrophil ranges of these individuals, healthcare providers can ensure fairer and more accurate treatment for cancer patients of African or Middle Eastern descent. This effort towards inclusivity and personalized care is essential in addressing healthcare disparities and promoting equitable access to treatment for all individuals.
