Association of social deprivation with survival in younger adult patients with AML: an Alliance study

Chemotherapy Trends in Acute Myeloid Leukemia: 2004 to 2020

BACKGROUND

Chemotherapy is crucial for treating acute myeloid leukemia (AML), as it improves survival and quality of life. However, prior studies have shown that many eligible patients in the United States do not receive chemotherapy due to demographic and socioeconomic disparities.

PATIENTS AND METHODS

We utilized the National Cancer Database to analyze chemotherapy utilization in 82,755 patients with AML from 2004 to 2020. We examined trends in 2 time periods, 2004 to 2010 and 2011 to 2019, with a separate analysis for 2020 to evaluate the impact of the COVID pandemic on chemotherapy use.

RESULTS

Among all patients with AML, 57.1% received multiagent chemotherapy, 20.5% received single-agent chemotherapy, and 22.4% received no chemotherapy. Chemotherapy use rose from 72.9% in 2004 to 81.3% in 2019, then slightly declined to 80.6% in 2020. The odds of receiving chemotherapy increased significantly in 2011 to 2019 compared to 2004 to 2010 based on age (P = .02), race (P < .01), and AML subtype (P = .03). Patients aged 18 to 40 consistently had higher chemotherapy utilization rates, with treatment odds rising across all age groups. While Black patients were less likely than White patients to receive chemotherapy from 2004 to 2010, their odds improved significantly in 2011 to 2019. Despite increased chemotherapy use across all AML subtypes, therapy-related AML consistently showed the lowest odds of treatment. Lower-income patients, those with more co-morbidities, and female patients had reduced chances of receiving chemotherapy, and these inequities remained largely consistent over time.

CONCLUSION

This large database study highlights improved but persistent disparities based on demographic and socioeconomic status, calling for innovative measures to expand chemotherapy use.

Impact of patient demographics on treatment outcomes in AML: a population-based registry in England, 2013-2020

ABSTRACT

We report 1- and 5-year survival after acute myeloid leukemia (AML) diagnosis and early mortality within 30 days of systemic anticancer therapy (SACT) treatments, using national cancer registry data in England. Patients aged 18 to 99 years diagnosed between 2013 and 2020 were included. Overall survival (OS) was calculated using Kaplan-Meier methodology, and adjusted hazard ratios (aHRs; adjusted for intensity of treatment, age at diagnosis, sex, ethnicity, socioeconomic deprivation, comorbidity, and year of diagnosis) using Cox proportional hazards regression. Odds of 30-day mortality (adjusted odds ratios [aORs], adjusted for aforementioned characteristics), along with performance status and body mass index, were calculated using logistic regression. Among 17 107 patients identified, older age and comorbidity were associated with worse survival. Asian and Black patients had better survival than White patients: 5-year OS of 34.6%, 29.7%, and 17.8%, respectively; aHR of 0.86; (95% confidence interval [CI], 0.77-0.96) Asian vs White, and 0.84 (95% CI, 0.73-0.96) Black vs White. Socioeconomic deprivation was associated with worse survival. Overall, 7906 (46.2%) patients were documented as having received SACT. Thirty-day mortality was lower for patients receiving intensive rather than nonintensive SACT. After adjustment for cofactors, the risk was higher in those treated intensively (aOR, 0.74; 95% CI, 0.60-0.92). We show that ethnicity and socioeconomic status affects outcomes in AML. Further work is needed to understand how these effects may differ in different health care settings, and whether this because of effects on disease biology, responsiveness to treatment, or drug toxicity. Selection of intensive vs nonintensive treatment should be based on individual patient factors, balancing improved long-term survival against higher early mortality.

Disparities in acute myeloid leukemia treatments and outcomes

PURPOSE OF REVIEW

This review aims to summarize different contributors to survival disparities in acute myeloid leukemia (AML) patients. The focus is set on African-American (hereafter referred to as Black) patients, with separate consideration of self-reported race and ancestry. It aims to also highlight the interconnectivity of the different features that impact on despair survival.

RECENT FINDINGS

The main themes in the literature covered in this article include the impact of social deprivation, clinical trial enrollment and biobanking, structural racism and ancestry-associated differences in genetic features on survival outcomes.

SUMMARY

An increasing number of studies have not only shown persistent survival disparities between Black and non-Hispanic White AML patients, but uncovered a multitude of contributors that have additive adverse effects on patient outcomes. In addition to potentially modifiable features, such as socioeconomic factors and trial enrollment odds that require urgent interventions, there is emerging data on differences in disease biology with respect to genetic ancestry, including frequencies of known AML-driver mutations and their associated prognostic impact.

Socioeconomic determinants of the biology and outcomes of acute lymphoblastic leukemia in adults

ABSTRACT

Various socioeconomic and biologic factors affect cancer health disparities and differences in health outcomes. To better characterize the socioeconomic vs biologic determinants of acute lymphoblastic leukemia (ALL) outcomes, we conducted a single-institution, retrospective analysis of adult patients with ALL treated at the University of Chicago (UChicago) from 2010 to 2022 and compared our outcomes with the US national data (the Surveillance, Epidemiology, and End Results [SEER] database). Among 221 adult patients with ALL treated at UChicago, BCR::ABL1 was more frequent in patients with higher body mass index (BMI; odds ratio [OR], 7.64; 95% confidence interval [CI], 1.17-49.9) and non-Hispanic Black (NHB) ancestry (59% vs 24% in non-Hispanic White (NHW) and 20% in Hispanic patients; P = .001). In a multivariable analysis, age (hazard ratio [HR], 6.93; 95% CI, 2.27-21.1) and higher BMI at diagnosis (HR, 10.3; 95% CI, 2.56-41.5) were independent predictors of poor overall survival (OS). In contrast, race or income were not predictors of OS in the UChicago cohort. Analysis of the national SEER database (2010-2020) demonstrated worse survival outcomes in Hispanic and NHB patients than in NHW patients among adolescent and young adults (AYAs) but not in older adults (aged >40 years). Both AYA and older adult patients with higher median household income had better OS than those with lower income. Therefore, multidisciplinary medical care coupled with essential supportive care services offered at centers experienced in ALL care may alleviate the socioeconomic disparities in ALL outcomes in the United States.