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2525 Intensity of Front-Line Regimen Is Associated with Admissions, in-Hospital Days, and Discharge Destination in Older Adults with Acute Myeloid Leukemia: A Population-Based Analysis

Program: Oral and Poster Abstracts
Session: 903. Health Services Research—Malignant Conditions (Myeloid Disease): Poster II
Hematology Disease Topics & Pathways:
Clinically relevant
Sunday, December 6, 2020, 7:00 AM-3:30 PM

Vanessa E Kennedy, MD1, Theresa Keegan, PhD, MS2, Qian Li, MS3*, Fran Maguire, PhD, MPH4* and Lori Muffly, MD, MS5

1University of California- San Francisco, San Francisco, CA
2University of California, Davis, Sacramento, CA
3Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA
4California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Health, Institute for Population Health Improvement, Davis, CA
5Assistant Professor of Medicine, Stanford University School of Medicine, Stanford, CA

Acute myeloid leukemia (AML) is predominantly a cancer of older adults, with median age at diagnosis of 68 years. Traditionally, AML is treated with intensive induction chemotherapy; however, older adults with AML are often poor chemotherapy candidates due to reduced performance status and multiple comorbidities. Recently, several non-traditional treatment regimens for AML have emerged that may offer less intense toxicity profiles compared to traditional chemotherapy, can be administered in the outpatient setting, and provide new front-line options for older or frailer adults with AML. We hypothesized that relative to traditional cytotoxic chemotherapy, these non-traditional options would be associated with fewer hospital admissions, fewer days in-hospital, and more frequent discharges to home rather than skilled nursing facilities among newly diagnosed older AML patients.

Patients ≥ 60 years with a first diagnosis of AML in the California Cancer Registry (CCR) between 2014-2017 were included. Front-line treatment regimen was manually abstracted from unstructured free-text fields in the CCR and categorized as no treatment, traditional cytotoxic chemotherapy, or non-traditional therapy. Non-traditional therapy was defined as a hypomethylating agent and venetoclax in monotherapy or combination, liposomal cytarabine and anthracycline, or non-cytotoxic targeted agents. The CCR was linked with statewide hospitalization data to obtain number of in-hospital days and number of admissions during the first 100 days following diagnosis as well as discharge destination (home/usual care vs non-home location).

Of the 4,086 patients identified, 3,068 (75.1%) had available treatment data and are included in the current analysis. Thirty-four percent of patients were 60-69 years at diagnosis, 39.0% were 70-90 years, and 27.1% were ³ 80 years. Nearly one-third (28.5%) had ≥ 2 comorbidities. During the study period, 36.3% received traditional cytotoxic chemotherapy, 41.6% received non-traditional therapy, and 22.0% received no treatment.

Across the full cohort, during the first 100 days following diagnosis, the median number of in-hospital days was 22, and 79.8% of patients had at least one hospitalization. Compared to patients receiving traditional chemotherapy, patients receiving non-traditional therapy spent less time in the hospital (42 vs 15 days, p < 0.001). Patients receiving traditional chemotherapy also had more hospital admissions, with 63.4% having ≥ 2 admissions compared with 46.8% of patients receiving non-traditional therapy (p < 0.001) (Table 1).

Of the 2,443 patients with at least one hospitalization, 2,046 (83.7%) were discharged alive to either a home or non-home location; of these, 68.4% were discharged to home and/or usual self-care, 8.6% to a non-home location, such as acute rehabilitation or a skilled nursing facility, and 6.7% to hospice. The remaining patients either died in the hospital (13.5%) or had an alternate discharge destination, such as intrahospital transfer (2.7%)

Compared to patients receiving traditional chemotherapy, a lower proportion of patients receiving non-traditional therapies died in the hospital ( 11.0% vs 6.4% p <0.001) and a greater proportion were discharged to hospice (1.6% vs 3.3%, p = 0.009). Although patients receiving non-traditional therapies were less commonly hospitalized, if hospitalized, these patients were more likely to require skilled care upon discharge. Of the patients receiving non-traditional therapy discharged alive and without hospice, 11.5% were discharged to a non-home location compared to only 5.8% of patients receiving traditional chemotherapy.

Using a population-based approach, we demonstrate that older adults with AML receiving non-traditional induction therapies have fewer admissions, in-hospital days, and in-hospital deaths, but did not have a decreased need for skilled services upon hospital discharge. At the population level, non-traditional therapies offer new treatment opportunities for older and frailer adults with AML. Additional studies evaluating health-related quality of life among older adults treated with these approaches are needed to delineate the patient-centered benefit of these therapies relative to traditional chemotherapy.

Disclosures: Muffly: Amgen: Consultancy; Servier: Research Funding; Adaptive: Research Funding.

*signifies non-member of ASH