non-AA Patients Research Articles

Racial Disparities in Microinvasive Glaucoma Surgery for Management of Primary Open-Angle Glaucoma: A Propensity Matched Cohort Study: Racial Disparities in MIGS for the Management of POAG

PurposeTo evaluate racial/ethnic differences in the use of microinvasive glaucoma surgery (MIGS) for the management of mild-moderate primary open-angle glaucoma (POAG) in the United States. DesignRetrospective cohort study. ParticipantsPatients with a diagnosis of mild or moderate POAG, as defined by current procedural terminology (CPT) codes, were included. The experimental group comprised African American (AA) patients and the control group consisted of patients without an AA designation in the TriNetX database. MethodsPropensity scoring was used to match cohorts for age at diagnosis, Charlson Comorbidity Index, sex, nicotine dependence, glaucoma medications, family history of POAG, Body Mass Index, and weight. Outcome was incidence of MIGS over 1 year of follow up. Odds ratios were calculated between cohorts Main Outcome MeasureIncidence of MIGS over 1 year of follow-up post-POAG diagnosis. Results63,418 POAG patients were included (50% AA, 50% non-AA). AA patients were found to undergo MIGS at a significantly lower rate (1,268 of 31,709) compared to non-AA patients (1,508 of 31,709) (OR 0.834, 95% CI: 0.773 – 0.900). ConclusionAlthough POAG is understood to be more prevalent among African Americans, these patients display lower utilization of MIGS, suggesting a possible nationwide racial disparity in the management of POAG.

Metabolic and Bariatric Surgery Outcomes in African American Patients: a Single Institution Experience.

The incidence of obesity in African Americans (AAs) is higher than in non-AA in the USA. Previous studies using large national databases report that AA patients have worse outcomes than non-AA patients. To assess perioperative outcomes among AA patients after MBS at a center of excellence (COE) that serves a large, diverse patient population. University Hospital METHODS: A retrospective analysis was performed on patients undergoing MBS between 2010 and 2020 at our two accredited MBSAQIP (Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program) COEs where the AA population makes up over 35% of the population. Preoperative variables were compared using unpaired t-test or chi-squared test where appropriate. Thirty-day outcomes were compared following propensity score matching (exact algorithm) of demographics and comorbidities. Overall, 5742 patients (AA = 2058, 36%) had Roux-en-Y gastric bypass (AA = 1028, 26%) or sleeve gastrectomy (AA = 1030, 27%). AA patients were more often female (90.2% vs. 80.2%, p < 0.001) and had higher rates of hypertension (56.3% vs. 47.8%, p < 0.001), while non-AA patients had higher rates of hyperlipidemia (27.3% vs. 20.7%, p < 0.001) and obstructive sleep apnea (41.2% vs. 37.1%, p = 0.0024). Matched data showed that AA patients had higher rates of pulmonary embolism (PE) (0.3% vs. 0.1%, p = 0.020) and more emergency department visits (7.0% vs. 5.1%, p = 0.012) but no differences in mortality, readmission, reintervention, or reoperation rates. In a diverse area, AA patients who underwent MBS had similar perioperative outcomes compared to non-AA patients except that they experienced higher rates of PE. They also experienced higher rates of emergency department visits but had similar readmission rates.

18F-Flotufolastat Positron Emission Tomography in African American Patients With Suspected Prostate Cancer Recurrence: Findings From the Phase 3 SPOTLIGHT Study

Although African American (AA) patients are disproportionately affected by prostate cancer, they are often underrepresented in oncology clinical trials. The SPOTLIGHT study (NCT04186845) assessed the novel diagnostic positron emission tomography radiopharmaceutical, 18F-flotufolastat (18F-rhPSMA-7.3), in patients with recurrent prostate cancer. The proportion of AA patients enrolled in SPOTLIGHT (17%) was greater than typically enrolled in oncology trials (8.5%) and was representative of the US population (14%). This post hoc analysis of SPOTLIGHT evaluates the diagnostic performance of 18F-flotufolastat in AA patients. Patients underwent positron emission tomography/computed tomography 50 to 70 minutes after intravenous administration of 296 MBq 18F-flotufolastat. Three blinded readers evaluated all images, with the majority read (agreement of ≥2 readers) result reported here. Standard of truth (SoT) was established with histopathology or correlative imaging. Data from AA patients were evaluated to determine the 18F-flotufolastat overall detection rate (DR), positive predictive value (PPV), and verified DR (VDR). VDR (SoT-verified) is equivalent to DR × PPV. In total, 61 of 366 (17%) patients were AAs. Although baseline characteristics were broadly similar, fewer AA patients (56%) had undergone prostatectomy than non-AA patients (82%). The patient-level DR was 93% (57/61) in AA patients, increasing from 67% at prostate-specific antigen <0.5 ng/mL to 100% at prostate-specific antigen ≥10 ng/mL. Patient-level DR was marginally lower in all other patients (87%, 264/305). However, when stratifying by prior treatment, DRs were similar across ethnic groups in postprostatectomy patients, but in patients with intact prostates, AA patients had higher prostate DR than non-AA patients. SoT-verification (predominantly with conventional imaging [79%]) gave a VDR of 64% and PPV of 68% in AA patients, versus 55% and 64%, respectively, in all other patients. 18F-Flotufolastat DRs were marginally higher in AA patients than in all other patients enrolled in SPOTLIGHT. High VDR and PPV were also achieved in AA patients from across all participating centers, indicating the broad applicability of newly US Food and Drug Administration-approved 18F-flotufolastat to the US population as a whole.

Impact of DAA Treatment for HCV on Hepatocellular Carcinoma in a Predominately African American Population.

This study tested the hypothesis that our predominately AA medical center population would demonstrate a decline in HCV-driven HCC diagnosis following the initiation of DAA treatment in 2014. Also evaluated was whether achieving an SVR prior to diagnosis of HCC improved outcomes in patients who had an HCV diagnosis after completion of treatment. All patients with HCC seen at the Detroit Medical Center from 2009 to 2021 were identified using ICD-10 codes, and medical records were evaluated. Outcomes were evaluated as either alive or death/hospice as of December of 2022. There were 461 patients with HCC of whom 433 (94%) had racial information in the database (AA = 351; non-AA = 82). HCC incidence regardless of race peaked in 2017, with a subsequent decline through 2021. HCV as a risk factor was higher in AA as compared to non-AA (85% vs. 53% p = 0.0001). Outcome (alive vs. death/hospice) was better for SVR patients compared to untreated patients (54% vs. 19%; p = 0.0009). HCC patients who achieved SVR also had better liver function at diagnosis as defined by Child-Pugh score (74% vs. 49% Class A p = 0.04) at the time of diagnosis. Racial disparity in HCC etiology was confirmed with AA more likely to have HCV than non-AA. The reduction in HCC patients with HCV confirms the impact of DAA treatment and prior successful treatment of HCV yields better outcomes. Increasing HCV treatment rates especially in AA patients will have a major impact on HCC development and treatment outcomes. • African Americans are more likely to have HCV infection as compared to non-AA. • Hepatocellular carcinoma is increasing in incidence in the US. • The role of HCV in the development of HCC remains to be further investigated. • HCC diagnosis in a single urban medical center study increased from 2009 as a result of HCV as a risk factor. • HCC declined post 2018 due primarily to a reduction in HCV infection as the risk factor. • African Americans were more likely to have HCV as the risk factor as compared to non-AA patients who were more likely to have no known risk factor on record (i.e., cryptogenic).

Patients with alcohol abuse have higher risks of complications after coronary artery bypass grafting: A population-based study of National Inpatient Sample from 2015 to 2020

BackgroundAlcohol abuse (AA) has s high prevalence, affecting 10 to 15 million Americans. While AA was demonstrated to negatively impact cardiovascular health, limited evidence from existing studies presents conflicting findings regarding the effects of AA on coronary artery bypass grafting (CABG) outcomes. This study aimed to compare the in-hospital outcomes after CABG between AA and non-AA patients. MethodsPatients who underwent CABG were identified in National Inpatient Sample from Q4 2015–2020. Exclusion criteria included age<18 years and concomitant procedures. A 1:3 propensity-score matching was used to address differences in demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer/admission status between AA and non-AA patients. In-hospital outcomes after CABG were examined. ResultsThere were 5694 (3.39%) AA patients who underwent CABG. After matching, 17,315 from 162,488 non-AA patients were matched to all AA patients. AA and non-AA patients had comparable mortality (1.64% vs 1.55%, p = 0.67) and MACE (2.46% vs 2.56%, p = 0.73). However, AA patients had higher cardiogenic shock (8.31% vs 7.43%, p = 0.03), mechanical ventilation (11.51% vs 7.96%, p < 0.01), hemorrhage/hematoma (57.49% vs 54.75%, p < 0.01), superficial (0.99% vs 0.61%, p < 0.01) and deep wound complications (0.37% vs 0.18%, p = 0.02), reopen surgery for bleeding control (0.92% vs 0.63%, p = 0.03), transfer out (21.00% vs 16.38%, p < 0.01), longer time from admission to operation (p < 0.01), longer length of stay (p < 0.01), and higher hospital charge (p < 0.01). ConclusionWhile AA was not found to be linked with in-hospital mortality or MACE after CABG, it was independently associated with postoperative complications. These findings could enhance preoperative risk stratification for AA patients and inform postoperative management following CABG.

Association between Neutropenic Index for Venetoclax Exposure (NIVE) and Survival Outcomes Among AML Patients Highlighting Racial Disparities

Background Venetoclax (Ven) is a potent Bcl-2 inhibitor, approved by FDA for use in combination with hypomethylating agents (HMAs) or low dose cytarabine (LDAC) for newly diagnosed acute myeloid leukemia (AML) in adults 75 years or older, or who have comorbidities based on VIALE trial. The combination regimen often results in severe neutropenia. Febrile neutropenia is one of the most common treatment-associated complications in the management of AML, increasing risk of hospitalization and death. Severe neutropenia is defined as absolute neutrophil count (ANC) &amp;lt;500/uL and often leads to clinicians holding treatment. There have been some studies about racial disparities in genetics and survival outcomes amongst AML patients, however there are limited studies regarding severe neutropenia and its implication between different races. There is also no prediction tool for infection-related death (IRD), overall survival (OS) and event-free survival (EFS) that is helpful in dosing Ven for AML thus far. Method We queried Northwell Health Cancer Institute's electronic health records to identify all patients with AML who received at least one cycle of Ven and HMA between January 2019 and December 2022. We retrospectively analyzed 76 patients who had received at least 3 cycles of Ven with HMA. Data on neutropenic duration was collected by counting the number of days patients had an ANC&amp;lt;500/uL starting from cycle 3 until data censor date, change of treatment, relapse, or transplant. OS was calculated as the time between date of definitive diagnosis to death or date of last contact and EFS was calculated as the time between date of diagnosis to events such as stopping Ven due to intolerability, relapse or transplant. We calculated Neutropenic Index for Ven Exposure (NIVE) by dividing the total number of days of severe neutropenia by total number of days on Ven and multiplying by 100 days. Statistical analysis was done by using Stata. Findings The study cohort consists of 63.1% White, 15.7%, African-American (AA), 7.8% Asians, 2.6% mixed race and 10.5% unknown. While 14% of the patients died of infection, 28.6% of those who died of infection were AA.Among AA, 55% had complex karyotype. Risk of death due to infection was 2.36 times higher in AA compared to non-AA (p= 0.08). We also found that the median OS for non-AA was 20.5 months vs 11.2 months for AA population (p= 0.66) and EFS was 11.6 months for non-AA vs 6.8 months for AA patients (p= 0.25) (Fig.1). On subgroup analysis, the median of NIVE was 77 in patients who received Ven in the frontline setting vs 109 days in relapsed/refractory setting (p= 0.21).The median NIVE for patients who received Azacytidine+Ven was 61.6 vs 94 days for Decitabine+Ven group (p= 0.12). On univariate analysis, high NIVE is associated with lower EFS (p= 0.04) and shows a trend towards decrease in overall survival (p= 0.09) (Fig.2). On Mann-Whitney test, NIVE is higher in AA population (p= 0.04), with median NIVE of 157 days in AA patients vs 82 days in non-AA patients. On multivariate regression analysis including age, sex, ELN risk stratification and age at diagnosis, median NIVE is also higher in AA compared to non-AA patients(p= 0.002) . NIVE is also found to be higher in the patient cohort that died of infections over other causes (p= 0.02). On subgroup analysis, patients with NIVE &amp;gt; 60 were found to have a significantly lower median OS than the NIVE ≤ 60 group (p= 0.04). Discussion s Our findings suggest that AA patients have significantly lower EFS and higher risk of infection-related death (IRD) compared to non-AA group. This highlights the need for further studies to identify the cause of disparities in IRD and outcomes among AA patients which needs explanation beyond socioeconomic factors and access to treatment. Our study shows disparities in median NIVE between AA vs non-AA patients. Larger studies are needed to clarify if AA patients are more susceptible to severe neutropenia while on Ven. Racial consideration may be important in deciding the optimum dose of Ven and interval between cycles. The positive association of NIVE with relapsed/refractory group &amp; Decitabine+Ven group compared to frontline &amp; Azacytidine+Ven group respectively suggests that the former group may benefit from adjustments in Ven dosing or total drug exposure per cycle. NIVE may be a novel prediction tool for IRD, EFS and possibly OS for AML patients on Ven which may help with patient management.

Investigating Racially Induced Metabolic and Genomic Signatures Mediating Inferior Survival in African Americans with Acute Myelogenous Leukemia

Background: African American (AA) patients experience worse survival outcomes compared to other patients with acute myelogenous leukemia (AML), independent of socioeconomic and molecular factors. 1 Indeed, our group previously demonstrated inferior survival in AA associated with the proxy for (1) genomic instability and (2) suggestion for inability to achieve protein damaging threshold among concurrent mutations. 2 In study expansion, we have confirmed worse overall survival (OS) for AA patients, and detected rapid attrition of AA patients, soon after diagnosis and therapy initiation. Given high incidence of cardiometabolic complications in AA patients, this prompted us to investigate the link between deranged metabolism and clinical outcomes. Additionally we explored nucleotide modifications that influence leukemogenesis in AA patients. In previous data, obesity correlated with poor outcomes for patients with acute promyelocytic leukemia (APL), but not in other AML, including in the CALGB cohort. 3-5 Interestingly, obesity is linked to 1) FTO/IRX3 pathways that block hematopoietic stem cell differentiation, and 2) oxidative stress, which may induce DNA damage favoring C&amp;gt;A and G&amp;gt;T nucleotide changes 6,7 and aberrant bone marrow microenvironment 8. Methods: We conducted retrospective analysis of 272 AML patients from Baylor TX, Georgetown DC, and Washington Hospital Center DC, including demographic and clinical variables (age, sex, race, BMI, comorbidities, smoking, treatments, and outcomes). APL patients were excluded. For patients with NGS data, mutation frequencies were annotated by ethnicity and prioritized by ELN 2022 classification. Chi-square and t-test evaluated differences in categorical and continuous variables respectively. Logistic binary regression was used to detect predictors for racial induced survival. SAS software was used. Results: Our expanded cohort has 272 AML patients, with 43 AA and 229 non-AA. AA patients showed worse OS than non-AA patients (Fig 1; 149 days vs 605 days, p=0.01). There were not any AA patients with favorable risk ELN 2022 disease status. Neither ELN 2022 risk groups nor presence of MDS-like mutations differentiated worse outcomes for AA patients, so we opted to examine the effect of obesity among AA and non-AA patients with intermediate and high risk AML (given no favorable risk AA patients in our cohort). Mean BMI for our AA patients was 28, with AA patients with BMI&amp;gt;28 showing significantly worse OS (Fig 1; 67 days vs 198 days, p=0.001), which was not present for non-AA patients. Metabolic derangement with high total cholesterol (p=0.02) and LDL (p=0.04) also segregated with worse OS for AAs (n=8 with cholesterol data), but not for other races. Nucleotide changes C&amp;gt;A and G&amp;gt;T characteristic of oxidative stress were overrepresented in AA patients with high BMI suggestive of clinical trend (33% vs 11%, p=0.06). Conclusion: Metabolic derangement in BMI and lipids correlated with inferior outcomes for AA patients only, supporting a unique pathobiology of highly aggressive AML that afflicts AA patients. Only AA patients demonstrated preference for C&amp;gt;A and G&amp;gt;T nucleotide changes, a hallmark of oxidative stress, also linked to obesity. These negative impacts support further mechanistic studies, and may present therapeutic strategies to improve metabolism, reduce oxidative stress, and suppress FTO/IRX3 pathways to induce myeloid differentiation. Figure 1: Inferior Survival For African American Patients Differentiated by BMI&amp;gt;28

Real-World Validation of the European Leukemia Network 2022 Risk Stratification in Acute Myelogenous Leukemia

Background: The 2017 European LeukemiaNet (ELN 2017) guidelines have become foundational for the risk stratification, prognostication, and treatment of acute myelogenous leukemia (AML). The updated 2022 European LeukemiaNet (ELN 2022) guidelines include additional cytogenetic abnormalities and genetic mutations for risk group assignment. It remains unknown how these updated guidelines compare for risk stratification and prognosis. Methods: We studied (N=287) adults with newly diagnosed AML from MedStar Georgetown University, MedStar Washington Hospital Center, and Baylor University Medical Center from 2012 to June 2023. Patients were stratified as favorable (fav), intermediate (int), or adverse (adv) risk according to ELN 2017 and ELN 2022 criteria. Overall survival (OS) was compared by age, race, and sex. Statistical analysis performed with SAS. Results: Median age was 65+16 years with a predominance of males (N=168, 59%). African-Americans (AA) composed 15% (N=44) of the cohort. Myelodysplastic-related mutations were present in 33 patients (15%), whereas the prevalence of epigenetic mutations was 25% (N=55). By ELN 2017 criteria, 19 (7%) patients were characterized as fav, 64 (23%) as int, and 198 (70%) as adv risk. Using ELN 2022 criteria, 18 (6%) patients were categorized as fav, 52 (19%) as int, and 211 (75%) as adv risk. Kaplan-Meier (KM) curves revealed a median overall survival of 200 days (d), 400 d, and 1532 d in the adv, int, and fav risk groups, respectively (log-rank p&amp;lt;0.001) by ELN 2017 criteria. Median OS was 379 d, 527 d, and 1552 d for the adv, int, and fav groups, respectively (log-rank p&amp;lt;0.001) in the ELN 2022 cohort. Stratifying by age &amp;lt;60 years, median OS was 390 d in the adv group and 832 d in the int group (log-rank p=.021)by ELN 2017 criteria,as compared to 350 d in the adv group and 757 d in the int group (log-rank p=.0012) by ELN 2022 criteria.Among those &amp;gt;60 years of age, median OS was 244 d and 349 d in the adv and int groups, respectively by ELN 2017 criteria (Anova p&amp;lt;0.25). In the ELN 2022 cohort, median OS among those &amp;gt;60 years of age was 284 d for the adv group and 209 days in the int group (Anova p&amp;lt;0.62). Among females, median OS in the adv group was 224 d and 342 d in the int group by ELN 2017 criteria (Anova p=0.4). In the ELN 2022 cohort, median OS among females was 214 d in the adv group and 421 d in the int group (Anova p=.13). Median OS among male patients in the ELN 2017 cohort was 324 d for those of adv risk and 623 d for those of int risk (Anova p&amp;lt;0.004). In the ELN 2022 cohort, median OS in males was 352 d and 563 d in the adv and int groups, respectively (Anova p&amp;lt;0.07) . In the ELN 2017 cohort, median OS was 259 d in AA patients as compared to 719 d in non-AA patients; this was not statistically significant (Anova p=0.16). Comparatively, in the ELN 2022 cohort, median OS for the AA patients was 153 d as compared to 212 d for the non-AA patient population (Anova p=0.86) .Conclusions: In this real-world dataset, the updated ELN 2022 guidelines reproduce differential survival for proposed favorable, intermediate, and adverse risk categories. When considering time to endpoint survival [Kaplan Meier curves] in our study, ELN 2022 seems to lack the ability to clearly discriminate among the adverse and intermediate risk subgroups. It is possible that patients seen in academic institutions not participating in FLT3 directed therapy trials retained inferior survival whereas similar patients fared better through early enrollment in trials using molecular targeted therapy. Finally, neither ELN 2017 nor ELN 2022 discriminate survival in AA populations for either adverse or intermediate subgroups. Efforts should be directed to develop novel risk stratification schemas to better encapsulate this vulnerable population.

Abstract 17159: Chronic Corticosteroid Immunosuppression in African American Pediatric Heart Transplant Recipients Does Not Improve Outcomes

Introduction: Previous studies consistently demonstrate worse outcomes for African American (AA) pediatric heart transplant (HT) recipients when compared to non-AA counterparts. Medical and social factors have been implicated in this discrepancy. As such, chronic corticosteroid use as maintenance immunosuppression for AA HT patients may be beneficial, though this has not been studied. Hypothesis: Chronic maintenance corticosteroid therapy does not decrease rejection or graft failure in AA pediatric HT recipients. Methods: We performed a retrospective analysis of the Pediatric Heart Transplant Society (PHTS) database for all HT recipients &lt;18 y.o. from January 1 st , 2007 to June 30 th , 2021. Retransplants and multiorgan transplants were excluded. Chronic steroid use was defined as taking oral steroids at one-year post-HT in the absence of rejection past 60 days post-HT to exclude patients who were on steroids for-cause. We used Kaplan-Meier and log-rank analyses for outcome comparisons among cohorts after the first year post-HT. Results: A total of 4099 patients were included, of which 780 (19%) were AA. Of the cohort, 756 (18.4%) were on chronic steroids. Within that group, 157 (20.1%) were AA. Patients on chronic steroids at individual centers ranged 0%-64.7% (median 11.5%, SD 16.9%), with no collective difference between steroid use in AA and non-AA patients. Freedom from rejection was worse in AA compared to non-AA patients, both in steroid and no steroid groups (p&lt;0.01). In the non-AA cohort, freedom from rejection was better in the no steroid group (p&lt;0.01). In the AA cohort, there was no statistical difference in rejection between the steroid and no steroid groups (p=0.20). Analyses of graft survival resulted in the same pattern. Conclusion: Use of Chronic steroids varies widely across pediatric HT centers, with no difference between AA and non-AA patients. AA patients have worse rejection and graft failure, and chronic steroid use did not affect these outcomes.

Abstract 13609: Racial Disparities and In-Hospital Outcomes of Atrial Fibrillation Ablations in Hypertrophic Cardiomyopathy: A 5-year Nationwide Inpatient Sample Analysis

Introduction: Atrial fibrillation (AF) is a common supraventricular arrhythmia observed in patients with hypertrophic cardiomyopathy (HCM). However, there is a dearth of data regarding racial disparities and in-hospital outcomes specifically among HCM patients undergoing AF ablation. Methods: National Inpatient Sample database from 2016 to 2020 was queried for patients with HCM undergoing AF ablation using appropriate diagnostic and procedural ICD codes. These were further divided into African American (AA) and non-African American (non-AA) groups. Logistic regression was used to compare baseline characteristics and in-hospital outcomes. Results: A total of 610 HCM patients underwent AF ablation between 2016-2020. Out of these, 45 (7.4%) were AA. Compared to non-AA patients, AA patients undergoing AF ablation were younger (mean age: 61-vs-64 years), more often female (56%-vs-54%, p=0.28) and had a higher burden of comorbidities (Table 1). AA patients had lower length of stay (4.1-vs-4.7 days, p=0.008) and total hospital cost ($113,564-vs-158,904, p&lt;0.001). The AA group had a higher prevalence of hypertension (44.4% -vs- 36.3%, p&lt;0.001), obstructive sleep apnea (55.6% -vs- 21.2%, p&lt;0.001), heart failure with reduced ejection fraction (22.2% -vs- 3.5%, p&lt;0.001), alcohol use (11.1% -vs- 0.9%, p&lt;0.001) and class I obesity (11.1% -vs- % 6.2%, p&lt;0.001). This group also had higher in-hospital mortality (11.0% -vs- 0.9%, p&lt;0.001) and worse in-hospital outcomes including acute pericarditis, cardiogenic shock, and requiring mechanical ventilation (Table 1). Conclusions: Despite lower length of stay and hospital cost, AA patients with HCM that underwent AF ablation had higher in-hospital mortality and complications compared to non-AA patients. These observed disparities warrant further research to gain a deeper understanding of the underlying factors contributing to these outcomes.

Hypomethylating Agents Are Associated with High Rates of Hematologic Toxicity in Patients with Secondary MDS/AML That Develops after Acquired Aplastic Anemia

Acquired aplastic anemia (AA) is an autoimmune bone marrow failure (BMF) associated with depletion of hematopoietic stem and progenitor cells. Approximately 15-20% of AA patients treated with immunosuppressive therapy (IST) develop late complications of myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). Little is known about managing patients with post-AA myeloid neoplasms (MN). We hypothesized that patients with post-AA MN may be particularly susceptible to hematologic toxicities from cytotoxic therapy because of stem cell deficits. To investigate our hypothesis, we retrospectively analyzed post-AA MN patients treated at our 2 institutions over the past 15 years. Fourteen post-AA MN patients were identified: 11 with MDS, 1 with AML, and 2 with clonal cytopenia of undetermined significance (CCUS). Patients with inherited BMF or allogeneic stem cell transplant (SCT) prior to MN diagnosis were excluded. The median age at MN was 56.5 years (range 5-75) with a median time of 5 years (range 0.25-30) between AA diagnosis and MN. At MN diagnosis, 12 of 14 patients (86%) had a partial or complete response of AA with 5 receiving cyclosporine (CSA) maintenance. Two patients (14%) were on CSA within 6 months of IST without response. After MN diagnosis, CSA was discontinued. Ten adults received hypomethylating agents (HMA) as first-line treatment in preparation for SCT. Three pediatric patients were treated with SCT with no prior HMA. One patient died before receiving treatment. The 10 post-AA patients who received HMA were matched in a 3:1 ratio with a similarly aged, randomly selected non-AA MDS cohort treated with HMA at our center during the same period (Table 1). Compared to patients with non-AA MDS, post-AA MN patients tolerated HMA poorly with frequent, severe complications. Their median per-cycle duration of grade 4 neutropenia was longer (9 v. 1.5 days, p = 0.044), as was median duration of grade 4 thrombocytopenia (13 v. 0 days, p = 0.003). Post-AA patients notably had lower baseline platelets prior to HMA (median 36.5 v. 115 k/mL, p =0.007). Following HMA, the post-AA cohort had higher rates of febrile neutropenia (80% v. 17%, RR 4.8, p &amp;lt; 0.001) and infections ≥ grade 3 (90% v. 13%, RR 6.8, p &amp;lt; 0.001). They also had higher rates of ≥ grade 3 bleeding (40% v. 7%, RR 6.0, p = 0.026) with 2 patients (20%) experiencing intracranial hemorrhage on HMA; no such events occurred in the non-AA cohort. Post-AA patients had more hospital admissions - 18 in 25 total chemotherapy cycles (72%) compared to 12 in 207 cycles (6%) in the matched cohort (RR 12.4, p &amp;lt; 0.001). Post-AA MN patients had more treatment delays &amp;gt;2 weeks (28% v. 8% of planned treatment cycles, RR 3.4, p = 0.01) and dose reductions (40% v. 13%, RR 3.0, p = 0.089). HMA was discontinued due to treatment-emergent adverse events (TEAEs) in 70% of post-AA cases v. 3% of non-AA patients (RR 21.0, p &amp;lt; 0.001). Consequently, post-AA MN patients received fewer cycles of HMA compared to non-AA patients (median 2.5 v. 6, p = 0.021). Death occurred following TEAEs in 20% of post-AA MN patients; no deaths on HMA occurred in the non-AA cohort (RR 14.1, p = 0.058). Among surviving patients, SCT was delayed in 20% of the non-AA cohort due to TEAEs, while no delays occurred in the matched cohort. The median months from final chemotherapy cycle to SCT were 4 (range 1-12) in post-AA v. 1 (1-3) in non-AA, while median months from MN diagnosis to SCT were 8.5 (4-21) in post-AA v. 5 (4-15) in non-AA. For all 14 post-AA MN patients, including those not treated with HMA, overall survival (OS) from MN diagnosis was 71% (95% CI 51-99) at 1 year and 56% (95% CI 34-90) at 3 years. OS of post-AA MN patients differed significantly (p = 0.011) based on treatment with SCT. Among the 5 who did not receive SCT, 4 died within 3 years of MN, while 1 patient is alive 13 months from diagnosis receiving supportive care after intracranial hemorrhage during the first cycle of HMA. In contrast, 7 of 9 (78%) patients who received SCT were alive 3 years after MN diagnosis. Of the 6 patients treated with SCT after HMA, 5 stopped HMA due to toxicity, all had morphologic dysplasia at SCT, and 2 were transplanted with ≥ 5% marrow blasts. Our study shows that patients with MN following antecedent autoimmune AA are at high risk of severe toxicities with standard HMA regimens and have difficulty tolerating repeated cycles. Our results do not support routine use of HMA prior to SCT in this patient population and suggest that early SCT may be the most suitable strategy.

THU333 Race Was Not A Predictor Of Poor Outcomes From COVID-19 At University Of Chicago Medicine Hospital

Abstract Disclosure: A. Rashied: None. J. Cursio: None. E.C. Hanlon: None. S. Pannain: None. University of Chicago Medicine (UCM) is a large, 800 bed, urban hospital located on the south side of Chicago that cares for a substantial number of African-American (AA) patients. The COVID-19 pandemic has impacted health drastically, especially for minorities (including AAs) and those with comorbid conditions. We examined COVID outcomes in our UCM patient population, including patterns by race, other demographic information (age, sex), and comorbidities, and the relationship with deaths, intensive care unit (ICU), and mechanical ventilator use. From the period March 2020 to February 2021, 61.6% (11,071/17,945) patients tested for COVID-19 at UCM were positive, and 52.8% (5,850/11,071) of these were hospitalized for further care. Of these hospitalized patients 3,171 were AA and 2,679 were all other races. AA had a higher percentage of patients who were female (62% vs 54%, p&amp;lt;0.0001), were older (49 vs 43 years, p&amp;lt;0.0001), had longer hospital stays (13.5 vs 13.0 days, p&amp;lt;0.0001), were admitted to the ICU (9% vs 4%, p&amp;lt;0.0001), and died (5% vs 2%, p&amp;lt;0.0001) compared to non-AA patients. In addition, the rates of comorbid conditions were higher for AAs compared to non-AAs for hypertension (52% vs 32%, p&amp;lt;0.0001), heart disease (15% vs 9%, p&amp;lt;0.0001), diabetes (36% vs 22%, p&amp;lt;0.0001), kidney disease (21% vs 8%, p&amp;lt;0.0001), and obesity (53% vs 40%, p&amp;lt;0.0001). To explore the relationship of race and death among patients hospitalized with COVID-19, a predictive model for death was estimated including age, race, gender, hospital stay in days, ICU length of stay, and indicators for obesity, heart disease, kidney disease, hypertension, and diabetes. The model shows that AA adults have a higher odds ratio (OR=1.08, p=0.71) for death than non-AA adults, however the p-value was insignificant. Instead, significant predictors of death included age (OR=1.058, p&amp;lt;0.0001) and kidney disease (OR=2.108, p=0.0002). Neither diabetes nor obesity were significant predictors of death in our cohort. Race was also not a predictor of mechanical ventilation or ICU status. However, obesity, diabetes and kidney disease were all significant predictors of requiring ventilation (all p&amp;lt;0.05). Moreover, age (OR=1.013, p=0.001), female gender (OR=0.687, p=0.002), kidney disease (OR=2.431, p&amp;lt;0.0001), and diabetes (OR=2.224, p&amp;lt;0.0001) were significant predictors of ICU admission. The model for death, ventilator, and ICU status for patients with COVID-19 at UCM show increased risks for AA versus non-AAs, however the odds ratios were insignificant. Instead, comorbidities like kidney disease were a significant predicator of death, as were obesity and diabetes for COVID-19 related ventilation and ICU admission. Thus, in our patient population that includes a significant number of AA adults, race was not a predictor of poor COVID-19 outcomes, but kidney disease, obesity, and diabetes were – irrespective of race. Presentation: Thursday, June 15, 2023

Racial Difference in Outcomes in Breast Cancer Patients with Residual Nodal Disease after Neoadjuvant Chemotherapy

African Americans (AA) requiring neoadjuvant chemotherapy (NAC) have been associated with worse outcomes. Residual nodal disease (ypN+) after NAC represents a highly unfavorable risk factor. We hypothesized that even within this unfavorable subgroup, that racial differences in outcome would persist. An IRB-approved retrospective review of breast cancer (BC) patients in a multi-institutional study was performed between 2005-2018 to identify ypN+ patients (excluding metastatic or inflammatory BC). Clinico-pathologic parameters stratified by race were collected and analyzed. For molecular subtype analyses, patients were stratified into triple negative (TN), hormone receptor (HR)+/HER2-, and HR+/HER2+, and HR-/HER2+ subtypes. Overall survival (OS), disease free survival (DFS) and recurrence outcomes were obtained, and univariate and multivariate (MVA) logistic regression models were constructed and analyzed. Among 404 ypN+ patients, 107 (26%) were AA, and 297 (74%) were non-AA. Median follow-up for the non-AA group was 3.8 years (y) (IQR 2.4-6.3) and 3.5y (IQR 2.0-6.2) for the AA group. Clinical and pathologic patient characteristics (age, molecular subtypes, BRCA status, histology, grade, smoking status, primary surgery type, axillary/reconstruction surgery rates, margin status, stage) were without significant statistical differences between the non-AA and AA group, except the non-AA group had proportionally more cN3 disease (10.5% vs. 5.1%; p = .01). Despite this, AA demonstrated worse OS and DFS outcomes (Table). AA also had significantly worse local (15% vs. 6.7%, p = .02), regional (11.2% vs. 5.1%, p = .05) and distant recurrences (32.7% vs. 22.6%, p = .05) compared to non-AA. On MVA for OS and DFS, HR+ status, clinical stage, and AA race (HR 2.1 (CI 1.3-3.4), p = .004 and HR 1.7 (CI 1.1-2.6), p = .01 respectively) remained significant. Molecular subtype analysis demonstrated that AA with HR+/HER2- but not the TN subtypes demonstrated significantly worse outcomes (Table). Utilization of endocrine therapy was not different between AA and non-AA patients (94% vs. 97%, p = 0.3) to explain this discrepancy. Worse outcomes in HER2 subtype for AA group was suggested but could not be statistically verified due to insufficient sample size. There was no discernible difference in chemotherapy and radiation therapy regimen or compliance between the AA and non-AA groups. AA patients who fail to achieve nodal clearance with NAC had higher local, regional and distant recurrence, and worse survival compared to non-AA, particularly those with non-TN status. These differences could not be readily explained by therapeutic disparity, or compliance. These hypothesis generating findings suggest need to explore biological implications, and alternative therapeutic strategies for this unfavorable subgroup.

APOL1 genotype in African American patients with kidney neoplasm

Context: African Americans (AA) may carry high risk Apolipoprotein L1 ( APOL1) genetic variants that predispose them to significantly higher incidence of chronic kidney disease (CKD) and renal cell carcinoma (RCC). Objective: To study the role of APOL1 risk alleles in patients of African descent with kidney neoplasms. Design: AA patients with nephrectomy procedure for kidney neoplasms were retrospectively studied for APOL1 genotype. Non-AA patients with kidney neoplasm served as control group. Results: Thirty-six AA patients with kidney neoplasms were included. Sixteen (44%) patients carried no APOL1 risk alleles; 13 (36%) patients carried one APOL1 risk allele and 7 (19%) patients carried two APOL1 risk alleles. Increased risk of end stage kidney disease (ESKD) was observed in patients with two APOL1 risk alleles (OR = 3.45). We also observed a higher papillary carcinoma (pRCC) percentage in patients with two risk alleles. Five (71.4%) of the seven patients with two risk-alleles had pRCC. In patients with zero or one APOL1 risk allele ( n = 29), 8 (28%) had pRCC. However, in AA patients with ESKD ( n = 6), only 2 (33%) had PRCC. Among the non-AA patients ( n = 319), 7 (2.2%) patients presented with ESKD, of which 2 (33%) had pRCC. Conclusions: We observed a cluster phenomenon in APOL1 high-risk genotype, ESKD, and kidney neoplasm. We observed significantly more frequent papillary RCC prevalence in AA patients with high-risk APOL1 genotype.

Recurrent stroke arrival time

BackgroundStroke patients and family members should receive stroke education including recognition of stroke symptoms and prompt activation of emergency medical services (EMS). The impact of this education is unclear. We aimed to measure the associations between EMS use and timing of hospital arrival and first-ever and recurrent strokes as a proxy for stroke education. MethodsThe study analyzed data from validated strokes identified by the Brain Attack Surveillance in Corpus Christi (BASIC) project between 1/1/2000-1/1/2020. We analyzed 5,617 first-ever strokes, 259 instances of recurrent stroke within 1 year of the first (early recurrence), and 451 recurrent strokes over 1 year from the first (late recurrence). Following imputation, associations of both EMS arrival (available starting late 2011) and early arrival (< 3 hours) with first-ever versus recurrent stroke (early and late) were assessed with logistic models, accounting for the clustering of multiple strokes per participant with generalized estimating equations. Full model covariates included stroke type, initial stroke severity, marital status, race/ethnicity, gender, age, insurance, education, and EMS use (early arrival model only). ResultsCompared to first-ever stroke, there were significantly higher unadjusted odds of arrival by EMS for the late recurrence group (late recurrence OR = 1.54, 95% CI = 1.18-1.99; early arrival OR = 1.24, 95% CI = 0.87-1.76). The association for late recurrence remained significant after adjustment (aOR = 1.46, 95% CI = 1.09-1.95). The pre-2010 unadjusted odds of early arrival were non-significant for both early and late recurrence groups (late recurrence OR = 1.05, CI = 0.70-1.56; early recurrence OR = 0.85, CI = 0.54-1.33), while late recurrence was associated with early arrival after 2010 (OR = 1.32, 95% CI = 1.03-1.69). After full adjustment, it was no longer significant (aOR = 1.25, 95% CI = 0.96-1.62). Higher initial stroke severity, married status, and EMS use were associated with higher odds of early arrival, while African Americans (AAs) had lower odds than non-Hispanic Whites (NHWs). However, AAs did have higher odds of EMS use relative to NHWs. Those who were married and living together had borderline significant lower odds of EMS use compared to those who were not. ConclusionsOur study examines the association of repeat stroke on early arrival and EMS use as a surrogate for adequate stroke education. Recurrence at least one year after the first stroke was associated with higher EMS usage, but there was not enough evidence to establish a relationship with early arrival after accounting for EMS usage and possible confounders. By examining subsets, we can identify groups that would benefit from targeted education. For example, younger, non-AA patients with smaller strokes would benefit from more education on EMS use and African American patients would benefit from education related to faster recognition or urgency of presentation.

PD32-07 RACE MODIFIED ESTIMATED GLOMERULAR FILTRATION RATE UNDERESTIMATES CHRONIC KIDNEY DISEASE PREVALENCE IN AFRICAN-AMERICAN PATIENTS UNDERGOING PARTIAL AND RADICAL NEPHRECTOMY: IMPLICATIONS FOR SURGICAL PLANNING

You have accessJournal of UrologyCME1 Apr 2023PD32-07 RACE MODIFIED ESTIMATED GLOMERULAR FILTRATION RATE UNDERESTIMATES CHRONIC KIDNEY DISEASE PREVALENCE IN AFRICAN-AMERICAN PATIENTS UNDERGOING PARTIAL AND RADICAL NEPHRECTOMY: IMPLICATIONS FOR SURGICAL PLANNING Hunter Hasley, Teona Iarajuli, Jennifer Nguyen, Daniel Thiemann, Martin Malik, Jaqui Roth, Michael Stifelman, Ravi Munver, Mutahar Ahmed, and Nitin Yerram Hunter HasleyHunter Hasley More articles by this author , Teona IarajuliTeona Iarajuli More articles by this author , Jennifer NguyenJennifer Nguyen More articles by this author , Daniel ThiemannDaniel Thiemann More articles by this author , Martin MalikMartin Malik More articles by this author , Jaqui RothJaqui Roth More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , Ravi MunverRavi Munver More articles by this author , Mutahar AhmedMutahar Ahmed More articles by this author , and Nitin YerramNitin Yerram More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003325.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In estimated glomerular filtration rate equations (eGFR), the race multiplier (RM) yields greater eGFR values and may assign less severe CKD stages to African-Americans (AA). When deciding on appropriateness for partial nephrectomy (PN) patients with CKD are often considered a relative or absolute indication for PN. We hypothesize that the eGFR RM may have potential ramifications for patients being counseled for radical (RN) vs. PN to manage their renal tumor. METHODS: We utilized prospective and retrospective, IRB-approved single-center databases to select AA patients who underwent PN or RN between 2016 and 2022. Demographics, preoperative risk factors, preoperative eGFR with and without the RM and surgical management were collected. Descriptive statistics and two-tailed difference of proportion tests were used to compare the percentage of patients with CKD who underwent RN. RESULTS: Out of 1139 patients who underwent RN or PN, 75 (6.6%) patients were AA. The RM vs. no RM mean±SD preoperative eGFR was 76.3±26.1 vs. 62.9±21.5; incidence of CKD 3a were 22.7% vs. 38.7% (p=0.034); incidence of CKD 3b were 8.0% vs. 16.0% (p=0.13), respectively. Table 1 summarizes the eGFR and incidence of CKD in AA with and without the RM compared to non-AA undergoing radical nephrectomy. We noted in all AA patients, regardless of using the RM, that the incidence of CKD3a and CKD 3b was significantly higher compared to non-AA undergoing RN. This difference was accentuated when removing the RM. CONCLUSIONS: We noted a statistically higher incidence of CKD in AA patients undergoing RN compared with non-AA patients. This difference was accentuated when removing the RM. Limitations include selection bias and small cohort of AA. These findings have potential ramifications for surgical planning of PN vs RN based on presence of CKD and may contribute to healthcare inequalities. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e909 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hunter Hasley More articles by this author Teona Iarajuli More articles by this author Jennifer Nguyen More articles by this author Daniel Thiemann More articles by this author Martin Malik More articles by this author Jaqui Roth More articles by this author Michael Stifelman More articles by this author Ravi Munver More articles by this author Mutahar Ahmed More articles by this author Nitin Yerram More articles by this author Expand All Advertisement PDF downloadLoading ...

Racial Disparity in HCV Demographics and Treatment Between Interferon Era (2002-2003) and Direct Acting Anti-viral Era (2019).

Introduction Direct-acting antiviral (DAA) treatment increased the sustained viral response (SVR) rate of patients with the hepatitis C virus (HCV) and eliminated response disparities between African American (AA) and non-AA patients seen with interferon (IFN). The aim of this study was to compare 2019 HCV patients (DAA era) to patients from January 1,2002 and December 31, 2003 (IFN era) in our predominantly AA clinic population. Methods We extracted data on 585 HCV patients seen in 2019 (DAA era) and compared them to 402 patients seen in the IFN era. Results Most HCV patients were born between 1945 and 1965, but in the DAA era more younger patients were identified.Non-AA patients in both eras were less likely to be infected with genotype 1 compared to AA (95% vs 54%, P<0.001). Fibrosis was not increased in the DAA Era as compared to the IFN era as assessedeither by serum-based assays (APRI, FIB-4) or transient elastography (FibroScan) (DAA era) vs biopsy (IFN era).More patients were treated in 2019 compared to 2002-2003 (159/585=27% vs 5/402=1%). For untreated patients, subsequent treatment within one year of the initial visit was low and similar in both eras (35%). Conclusion There continues to be a need to screen patients born between 1945 and 1965 for HCV as well as to identify increasing numbers of patients below this age cohort. Even though current therapies are oral, highly effective, and can be 8-12 weeks in duration, significant numbers of patients were not treated within a year of first visit.

Abstract P4-07-21: Neo-adjuvant chemotherapy in various breast cancer subtypes in the 21st century

Abstract Introduction Breast cancer is a complex, heterogeneous disease encompassing a spectrum of subtypes with distinct biological features, each having unique responses to various treatment modalities and different clinical outcomes. The type of neoadjuvant chemotherapy (NAC) for locally advanced breast cancer is decided based on breast cancer subtype, which includes triple negative breast cancer (TNBC), hormone receptor positive breast cancer (HR+BC), HER2+ breast cancer (HER2+BC) and triple positive breast cancer (TPBC). Multiple NAC regimens exist but have not been directly compared to determine the optimal treatment regimen in patients with various stages (I-III) and subtypes of breast cancer. The objective of this study was to assess pathological complete response (pCR) rates in patients treated with various types of NAC and analyze associated clinical factors in our diverse patient population. Methods This study included 297 patients treated with NAC for breast cancer between 2015 and 2021 at LCMC Heath, New Orleans, Louisiana. The tumor, lymph node, metastasis (TNM) system was used for clinical and pathological staging. Biologic subclassification using estrogen receptor (ER), progesterone receptor (PR), HER2 were performed. Response to NAC was documented as pCR when there was no evidence of residual invasive tumor in the breast or axillary lymph nodes. Categorical variables were summarized by reporting counts and percentages, while continuous variables were summarized by reporting means and standard deviations. Fisher exact tests were used to compare pCR status by each chemotherapy status or demographic factor. Wilcoxon Rank-sum tests were used to compare continuous variables across pCR groups. Multivariable linear regression was performed to predict overall tumor shrinkage %. Results Among all patients, median age was 54.75 years (min-max: 22-78). 30 (10%) patients were stage I, 175 (58.9%) were stage II, 89 (29.9%) were stage III and 3 (1%) were stage IV with oligometastatic disease. 171 (57.6%) were African American (AA), 82 (27.6%) were Caucasians and 41(13.8%) were other race. Table 1. shows chemotherapy and pCR rates among different breast cancer subtypes. Patients with carboplatin (57.3 vs 35.3; p&amp;lt; 0.001), had a higher likelihood of complete remission than non-users. After multivariable linear regression adjustment, Paclitaxel increased the % reduction in tumor size significantly (EST= 39%, CI 2% – 77%; p=0.042) compared to non-users. In the subset of TNBC patients this held in terms of pCR rates (47.1% vs 25%, p=0.036). In TPBC, pCR was higher in younger (p=0.028) and non-AA (p=0.0023) patients. Conclusion Multiple NAC regimens for breast cancer exist and optimization of regimens is key. We explored the use of several different chemotherapy agents and found the use of carboplatin beneficial, while doxorubicin, cyclophosphamide and cisplatin had a decreased likelihood of achieving a pCR; however, this may be due to the intrinsic nature of the subtypes that would be treated with these NAC regimens. We plan to explore by subtype and treatment regimen in future analysis.Interestingly, AA have significantly less pCR in TPBC, compared to non-AA, although this finding was not seen in other subtypes. Future studies are needed to investigate this further. Table 1: Chemotheraphy and pCR rates among different breast cancer subtypes. Citation Format: Aneesha Ananthula, Katharine Thomas, Lily Chen, Vincent K. Carey, Caitlin M. Sullivan, Karla M. Martin, Emily Baas, Kara C. Plasko, Brandi Sun, Madison Lanza, Cindy Nguyen, Andrew Chapple, Michelle M. Loch. Neo-adjuvant chemotherapy in various breast cancer subtypes in the 21st century. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-21.

Disparity analysis of postoperative patients undergoing laparoscopic microwave ablation for HCC

Background: Disparities in mortality exist for African American (AA) patients with hepatocellular carcinoma (HCC) compared to non-AA-HCC patients. Overall, AA HCC patients are less likely to be screened for HCC and have worse surgical outcomes following intervention compared to non-AA patients. The goal of this study was to assess our internal processes and pathways in delivering care for patients undergoing laparoscopic microwave ablation (MWA) for HCC to identify potential disparities.

Pulse Oximetry Error in Patients With Single-Ventricle Palliation.

Pulse Oximetry Error in Patients With Single-Ventricle Palliation.