Inequities in timely treatment (Tx) initiation for patients (pts) with acute myeloid leukemia (AML) treated in a predominantly community setting in the United States (US).

Abstract

1574 Background: AML is a highly morbid but treatable cancer with several novel Tx available. This study evaluates associations between race/ethnicity and socioeconomic status (SES) on timely Tx initiation in pts with newly diagnosed (ND) AML in a routine clinical setting. Methods: This retrospective cohort study uses the Flatiron Health electronic health record-derived, US nationwide, de-identified database. Pts aged ≥18 years, with AML diagnosis (Dx) Jan 2014–Dec 2022, had ≥2 visits recorded ≤3 months after Dx, and who received first line (1L) active Tx were included. 1L Tx was categorized as intensive chemotherapy (IC) or non-IC. Timely Tx was defined as initiation ≤14 days after Dx. Race/ethnicity was defined as White or People of Color (POC; including Black, Latinx, Asian, or Other). Logistic regression assessed associations between race/ethnicity and Yost Index-based SES on timely Tx initiation (adjusted for age at Dx, sex, practice type, hydroxyurea as part of 1L Tx [proxy of disease burden], European LeukemiaNet 2017 risk, and secondary AML), with adjusted odds ratios (aOR) reported. Results: Overall, 5981 pts with ND AML were included; 58% received non-IC and 42% received IC. Median ages were 76 and 60 years; 80% and 66% were treated in community settings; and median time from Dx to 1L initiation was 11 and 4 days. In the IC cohort, POC vs White pts had similar delays in Tx initiation (13.3% vs 13.8%, aOR 1.22, p=.2); significantly fewer POC vs White pts underwent stem cell transplant (SCT) post-remission (30.8% vs 47.7%, aOR 0.44, p<.001).In the non-IC cohort, numerically more POC had delayed Tx initiation vs White pts (40.6% vs 36.2%, aOR 1.19, p=.074). This disparity was larger in pts of low SES (POC vs White pts: 42.5% vs 34.4%, aOR 1.35, p=.077) vs high SES (38.7% vs 35.6%, aOR 1.16, p=.4) (Table). Conclusions: In a predominantly US community setting, numerical but non-significant race/ethnic disparities in timely 1L Tx initiation were observed for pts with ND AML. Fewer POC vs White pts receiving IC underwent SCT post-remission. Analyses are ongoing to assess mediators and impact on survival. [Table: see text]