AML-343 Outcomes of Patients With Acute Myeloid Leukemia Treated at a Safety-Net Hospital

Abstract

Achievement of complete remission (CR) is the goal of initial treatment in patients with acute myeloid leukemia (AML). However, even when CR is achieved, these patients are at risk of having their disease relapse. Consolidation treatment, either with chemotherapy or an allogeneic hematopoietic cell transplant (HCT), is offered after CR to achieve long-term survival. HCT provides the best chance to cure patients with relapsed or refractory AML. HCT is available only in specialized centers. Patients who are uninsured/self-pay are treated at safety-net hospitals and have difficulty getting HCT. We looked at outcomes of AML at John Peter Smith (JPS) Hospital, a safety-net hospital in Tarrant County, Texas. We used data from the JPS Oncology Registry to identify patients with AML from 1/1/2017 to 12/31/2020 who received partial or full treatment at JPS. Patients who were diagnosed at JPS but received all their treatment elsewhere were excluded. Patients who were only offered supportive care were excluded. Using EPIC EMR and its Care Everywhere features, information was collected, including induction regimens, bone marrow reports, initial cytogenetics, consolidation chemotherapy regimen, HCT, relapse, and how relapse was treated. Nineteen patients were included. Median age at diagnosis was 56 years (range 30-63 years), and 5 were younger than 50 years. Four patients did not have a social security number (SSN) (undocumented). Eleven have died (2 without SSNs), 1 from toxicity, and 10 from leukemia (refractory or relapsed). CR was achieved in 12/19 (63%) patients after induction chemotherapy. Of the 8 patients that remain alive, 2 received chemotherapy only and are cured (both had favorable cytogenetics); 3 received HCT, and a fourth patient is awaiting HCT; and 2 have active disease and are on palliative chemotherapy only, with no access to HCT in the United States because they do not have SSNs. Survival is poor for patients with AML treated at JPS with chemotherapy alone. Allogeneic HCT improves the cure rate for patients with AML. Patients without SSNs do not have the option of HCT and have poor outcomes. Institutional and state-level policymakers should address how to best care for patients without SSNs.