Clinical outcomes of patients with newly diagnosed acute myeloid leukemia receiving treatment in a safety-net hospital system.

Abstract

7035 Background: Standard induction therapy for acute myeloid leukemia (AML) results in 5-year overall survival (OS) rates of 30-45%. Further risk stratification and novel therapeutic options have improved 5-year OS rates to 75-80% in certain subgroups. Despite these advances, many patients lack proper socioeconomic resources, leading to limited access to new therapies, clinical trials, and hematopoietic cell transplantation (HCT), which remains the only curative therapy for AML. Many of these patients receive care within publicly funded ‘safety net’ institutions designed to serve all individuals, regardless of ability to pay, insurance status, or immigration status. Outcomes of historically underserved patients with AML treated within a large county hospital system remain unknown. Methods: This retrospective cohort analysis evaluated clinical outcomes of patients aged ≥18 years with newly diagnosed AML (ND-AML) treated in the Harris County Health System, Houston, TX, from January 2005 to July 2019. Results: One hundred ninety-two patients with ND-AML were included (de novo AML [n = 140], secondary AML [n = 45], and therapy-related AML [n = 7]). Median age was 52 years (range: 19-89) at diagnosis, and 102 (52.3%) were male. Most patients identified as Hispanic (n = 110). Sixty-two percent of patients were uninsured or indigent, receiving care under the county’s financial assistance programs. The majority had adverse risk 84 (44.3%), while 78 were intermediate (40.6%), and 26 favorable risk (13.5%). Standard induction therapy was administered in 172 (88%) of patients. Cytarabine and Anthracycline (7+3) based regimens were most commonly used (72.8%). 192 patients were evaluable for response. 139 (72.4%) achieved composite complete remission (CR/CRi) and 41 (21.4%) had primary refractory disease. For those who achieved CR after first or second induction, the median duration of CR was 16.7 months. with 25 (13.7%) ultimately receiving HCT. Common reasons for not receiving HCT included lack of insurance (19.2%) or non-citizen status (23.1%) (n = 77). 82 of the 139 patients who achieved CR relapsed. After a median follow up of 16 months, five-year OS rates were 20.7% from our entire cohort of patients. Conclusions: In this cohort of patients treated in a safety-net system, median OS and EFS were lower than reported outcomes in the past decade. In addition, only 13.7% received HCT, one of the only curative treatments for AML. Some barriers included inability to refer to transplant center due to lack of financial support or immigration status. Addressing socioeconomic and institutional barriers to AML therapy and HCT will advance care for disadvantaged patients, thereby improving outcomes of patients AML.