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3799 Neighborhood Disadvantage Is Associated with Inferior Overall Survival for Acute Myeloid Leukemia Patients Treated with Standard Intensive Induction

Program: Oral and Poster Abstracts
Session: 906. Outcomes Research—Myeloid Malignancies: Poster II
Hematology Disease Topics & Pathways:
Research, Acute Myeloid Malignancies, AML, Clinical Practice (Health Services and Quality), Clinical Research, health outcomes research, health disparities research, Diseases, Myeloid Malignancies
Sunday, December 10, 2023, 6:00 PM-8:00 PM

Brittany Knick Ragon, MD1, Danielle Boselli, MS2*, Rupali Bose, MS, MBA2*, Stephanie Begley, MS2*, Melissa Aguiar, MSN3*, Kris Blackley, MSN3*, Nilay Shah, MD1*, Aleksander L. Chojecki, MD1, Srinivasa Reddy Sanikommu, MD1, Yifan Pang, MD1, Jing Ai, MD, PhD1, Belinda Avalos, MD1, Edward A. Copelan, MD1, Thomas G. Knight, MD1 and Michael R. Grunwald1

1Department of Hematologic Oncology and Blood Disorders, Atrium Health Levine Cancer Institute, Charlotte, NC
2Department of Biostatistics and Data Sciences, Atrium Health Levine Cancer Institute, Charlotte, NC
3Department of Supportive Oncology, Atrium Health Levine Cancer Institute, Charlotte, NC

Background: Identifying biologic and socioeconomic contributors to disparities in outcomes is critical for the management of acute myeloid leukemia (AML). Prior studies in AML revealed that Black patients (pts) have inferior survival compared to White pts, with more striking disparity for Black pts aged <60. We previously explored our large and diverse AML cohort from urban and large rural areas and did not identify inferior survival for pts with self-reported Black race or Hispanic ethnicity. Although no surrogates for social determinants of health (SDOH) or insurance status were recognized as contributing to survival differences, oncology nurse navigation (ONN) was associated with a survival benefit, with no significant difference in access to ONN among racial or ethnic groups. To further evaluate socioeconomic drivers of disparities in this population supported by ONN, we aim to use the Area Deprivation Index (ADI) to determine the impact of neighborhood disadvantage on survival in AML.

Methods: AML pts diagnosed at Levine Cancer Institute between 12/2015 and 12/2020 were included. Pts with acute promyelocytic leukemia (APL) were excluded from this analysis. Details regarding insurance coverage, ONN services, induction therapy, stem cell transplant (SCT) status, and survival outcomes were collected. Race and ethnicity were self-reported. European LeukemiaNet (ELN) 2017 criteria were used to assign AML risk. Pt and disease characteristics were summarized, described, and compared with Fisher exact tests and Wilcoxon rank-sum tests for categorical and continuous data, respectively. Pts were grouped into 4 quartiles based on ADI national percentile. Subsequent models were fit with ADI dichotomized at the median after adjacent ADI groups were removed with backward elimination. Associations between overall survival (OS) and pt and disease characteristics, insurance status, race, ethnicity, ONN services, and ADI were investigated. OS was defined as the time from diagnosis (dx) to death from any cause, with surviving subjects censored at the time of last follow-up. Kaplan-Meier methods were used to summarize OS and calculate landmark survival rates. Survival was compared with unadjusted log-rank tests. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CIs) associated with OS.

Results: Three hundred eighty pts with available baseline characteristics were included in our analysis (Table 1). For pts <60 who received intensive induction and had available ADI (N=86), there was a significant difference in OS amongst the quartiles of ADI (P=0.007), with differences even more pronounced with dichotomized ADI (P<0.001) (Figure 1). With a median follow-up of 38.1 months for the intensively treated pts <60, the estimated two-year OS was 96.6% for more advantaged/low ADI pts and 55.4% for less advantaged/high ADI pts (HR 5.21; 95% CI 1.82 to 14.95). Within the cohort of pts <60 who received intensive induction, sixty-eight percent were Non-Hispanic White and 28% were Non-Hispanic Black. Many (66%) were privately insured at dx, with 24% uninsured or with Medicaid. ONN services were accessed by most (72%) pts with known ADI. Care barriers were expressed by pts of all ADI quartiles, with transportation being the only barrier most reported by pts of increased disadvantage (P<0.01). Forty-two percent of pts received SCT (N=38). Nearly 60% of socially advantaged pts (ADI≤51) received SCT versus 33% of socially disadvantaged pts (P=0.03). In univariate models, receipt of SCT (P=0.016) was associated with improved OS while receiving navigation services (P=0.32) was not.

Conclusions: Higher ADI was associated with inferior OS in AML pts <60 who received intensive induction. Receipt of SCT was observed more often in pts with more neighborhood advantage, which is of great importance since SCT improved OS in this cohort. Although insurance status is often linked to SCT access, insurance status did not significantly impact OS. Of the ONN reported barriers to care, transportation issues had a greater impact on pts with more neighborhood disadvantage. Expanding access to SCT and addressing barriers to care, such as transportation, is necessary to overcome the detrimental impact of neighborhood disadvantage on survival in AML.

Disclosures: Ragon: Pfizer: Other: Advisory board; Astellas: Other: Advisory board; Genentech: Other: Advisory Board. Bose: AstraZeneca: Honoraria; Gilead Science: Honoraria. Chojecki: CTI Biopharma: Membership on an entity's Board of Directors or advisory committees; Incyte: Research Funding; Morphosys: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Servier Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Research to Practice: Consultancy. Grunwald: Medtronic: Current equity holder in publicly-traded company; Karius, Novartis, Ono Pharmaceutical, Pfizer, Pharmacosmos, Premier, Stemline Therapeutics: Consultancy; Incyte Corporation, Janssen: Research Funding; AbbVie, Agios/Servier, Amgen, Astellas Pharma, Blueprint Medicines, Bristol Myers Squibb, Cardinal Health, CTI BioPharma/Sobi, Daiichi Sankyo, Gamida Cell, Genentech, Gilead Sciences, GSK/Sierra Oncology, Incyte Corporation, Invitae, Jazz Pharmaceuticals: Consultancy.

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*signifies non-member of ASH