Treatment related mortality (TRM) for AML pts managed at a non-transplant, safety net hospital.

Abstract

e18092 Background: Induction treatment for AML is associated with severe, life threatening toxicities. An accepted criterion for TRM is the 4 week mortality rate. A recent 18 yr study of AML pts treated with 3+7 induction regimens at SWOG institutions revealed an overall TRM at 4 weeks of 11%. Management of AML pts at non-transplant centers is controversial due to concerns over lower volumes, possibly leading to excess TRM. Over a 15-year period TRM was evaluated at a safety net, non-transplant center and compared to a national benchmark. Adherence to national guidelines for diagnostic testing was also assessed. Methods: MetroHealth Medical Center is a safety net hospital with a mission statement requiring all pts to be seen regardless of their ability to pay. Using tumor registry data, all cases of AML from 2001- 2016 were identified. Demographic data, 4 week TRM and compliance with standard diagnostic evaluation per NCCN guidelines were assessed.. Results: 67 cases were identified; average age was 59 (25-89), with equal distribution in gender. 73% were Caucasian, 18% African American, 4.5% Asian and 4.5% Hispanic. All but one (who went into hospice) had standard diagnostic tests sent (flow cytometry, cytogenetics and, for those with normal karyotyping, all had molecular testing for FLT-3 ITD, NPM-1, CEPBA and c-kit). Of the 67 patients, 5 received azacitadine, 2 received decitabine and 12 did not get treated due to co-morbidities and/or poor performance status. 48 patients received induction chemotherapy, of which 5 had APL appropriate therapies and the rest (43) received 3+7 induction regimens. For these 48 pts the 4 week mortality was 10%. Of those who received induction chemotherapy, 27% had favorable, 23% intermediate and 50% had poor risk molecular studies. Conclusions: A 15 yr review of outcomes during AML induction at a non-transplant, safety net institution revealed a TRM rate similar to a national benchmark, in spite of a relatively high percentage of poor risk cases. There was also good adherence to national diagnostic standards. Given the potential changes in the US healthcare delivery system which may result in more pts being seen at safety net institutions, these findings may have implications for future allocation of care.