Dr Hantel on Socioeconomic Influences on First-Line Treatment in AML

Andrew Hantel, MD, physician, Dana-Farber Cancer Institute, instructor of medicine, Harvard Medical School, discusses the influence of race/ethnicity and socioeconomic status on the timeliness of first-line treatment initiation among patients with newly diagnosed acute myeloid leukemia (AML).

At the 2024 ASCO Annual Meeting, Hantel and colleagues presented data from a retrospective study that utilized data from the Flatiron Health electronic database to identify patients at least 18 years of age diagnosed with AML between January 2014 to December 2022 who had 2 visits recorded within 3 months of diagnosis and underwent first-line treatment. Patients were divided into cohorts based on whether they received frontline treatment with intensive chemotherapy (IC).

The key findings indicated that in the IC cohort, the proportion of delayed treatment initiation was comparably low and not significantly different between the POC and White patient populations (24% vs. 25.2%; adjusted odds ratio [OR] 1.31; 95% CI, 1.05-1.63; P = .2). However, there was a marked disparity in patients who underwent stem cell transplantation (SCT) after remission in the POC population compared with the White population (31.3% vs. 47.7%; adjusted OR, 0.45; 95% CI, 0.35-0.59; P < .001).

However, in the non-IC cohort, there was a statistically significant difference in patients who experienced delayed treatment initiation among the POC population vs the White population (28% vs. 23%; adjusted OR, 1.31; 95% CI, 1.05-1.63; P = .02). Excluding Asian patients, the POC population in the non-IC cohort also experienced higher rates of delayed treatment vs the White population (27% vs 23%; adjusted OR, 1.22; 95% CI, 0.97-1.53; P = .032). Additionally, Black patients had a statistically significant higher rate of delayed treatment vs the White population (adjusted OR, adjusted OR, 1.50; 95% CI, 1.03-2.15; P = .032). This difference was numerically greater in the Latinx vs White populations (adjusted OR, 0.98; 95% CI, 0.60-1.55; P > .9).