Acute myeloid leukemia (AML) post-high-dose cytarabine (HiDAC) outcomes: Academic versus collaborating community cancer centers.

Abstract

e18538 Background: The approach to acute myeloid leukemia (AML) management has been evolving towards increased collaboration between academic and community-based cancer centers. This helps alleviate the financial burden for patients traveling long distances for care and promotes better opportunities for local family support. Co-management strategies have particularly risen for AML high-dose cytarabine (HiDAC) consolidation. However, there is limited data exploring this. We present retrospective data on AML post-HiDAC outcomes at our institution and our collaborating community cancer centers. Methods: A total of 50 AML patients who received HiDAC were identified as either Wellstar MCG (WMCG) for on-site or non-WMCG for off-site HiDAC treatment. Inclusion required documentation of age at first HiDAC, total number of cycles, readmissions for infections after HiDAC, median census tract household income, and distance from our institution. Early mortality was defined as death within three months after the first HiDAC infusion. Analyses were descriptive. Results: Forty-eight patients met inclusion criteria with complete data (WMCG = 34, non-WMCG = 14). Median tract household incomes were $68,939 (WMCG) and $79,055 (non-WMCG). Median travel distance was 85.8 miles (range 3–476) for the WMCG group versus 80.2 miles (range 19–219) for the non-WMCG group. The median ages at first HiDAC infusion were 48.8 years (WMCG) and 44.8 years (non-WMCG). Both groups received a median of two HiDAC cycles. Readmissions for infection occurred in 16/34 (47.1%) WMCG patients and 5/14 (35.7%) non-WMCG patients. However, the median number of readmissions for infection was 0 for both cohorts. Early mortality within three months was observed in no patients. Twelve of 34 (35.3%) WMCG patients received post-HiDAC hematopoietic stem cell transplant (HSCT) compared to 8/14 (61.5%) non-WMCG patients. The median number of clinic visits for labs in the post-HiDAC period for the WMCG group was two (range 0–14). Conclusions: In this single center study, AML post-HiDAC outcomes were comparable between our institution and our collaborating community cancer centers. The co-management approach may help reduce travel burden to and from academic centers for follow-up labs without negatively impacting outcomes. This approach could be explored further in clinical trials involving AML HiDAC consolidation to alleviate the financial and travel burden on participating patients. Baseline and clinical characteristics by group>(N=48). Variable WMCG (n=34) non-WMCG (n=14) Median tract household income (USD) $68,939 $79,055 Median distance from our institution (mi) (range) 85.8 (3–476) 80.2 (19–219) Median age at first HiDAC (years) 48.8 44.8 Median number of HiDAC cycles 2 2 Readmissions for infection, n (%) 16 (47.1) 5 (35.7) Early mortality (<3 months), n (%) 0 (0.0) 0 (0.0) HSCT, n (%) 12 (35.3) 8 (61.5)