Assessment of racial and age disparities in response and survival among acute myeloid leukemia (AML) patients treated with hypomethylating agents (HMA) and venetoclax.

Abstract

e18619 Background: Venetoclax combined with an HMA has improved outcomes for older or cytotoxic chemotherapy-ineligible AML patients. Historically, intensively treated non-Hispanic black (NHB) and older patients have worse survival. To what extent these disparities are seen with venetoclax and HMA is not known. Methods: We conducted a retrospective cohort study of 184 newly diagnosed adults treated with HMA and venetoclax between January 2018 and the present at our cancer center. Outcomes were examined by race and age (<70 vs ≥70 years). Data collected included demographics, performance status, comorbidities, cytogenetics, molecular mutations, and risk stratification per ELN 2024 criteria. Endpoints were overall survival (OS), 30-/60-day mortality, and response according to ELN 2022 criteria. Results: Of 184 patients, 21 were NHB and 163 were non-Hispanic White (NHW). NHB patients were younger (66 vs 73.8 years, p = 0.0011) and more likely to have Medicaid (28.6% vs 3.1%, p < 0.0001). Median OS was 6.9 months for NHB versus 8.3 months for NHW (log-rank p = 0.3662). Response differed significantly ( p = 0.0136): CR 9.5% (NHB) vs 4.3% (NHW), CRi 23.8% vs 33.7%, and MLFS 33.3% vs 21.5%. Of the 184 patients, 53 were younger than 70 at the time of AML diagnosis and 131 were 70 or older. Older patients were more likely to have Medicare (47.2% vs 84%, p < 0.0001). Median OS was 7.2 months for younger patients versus 8.4 months for the older group (log-rank p = 0.1275); the difference was not statistically significant, but Kaplan-Meier curves show separation after 6 months. Response trended toward significance ( p = 0.0574): CR 9.4% (<70) vs 3.1% (70+), CRi 22.6% vs 36.6%, and MLFS 30.2% vs 19.8%. Conclusions: OS did not differ significantly by race or age, but response patterns varied. While not significantly different, Kaplan-Meier curves suggest a trend toward decreased OS among NHB and younger patients. Our limited sample size from a single institution reduces the ability to draw definitive conclusions. However, older patients demonstrated a numerically superior OS; historically, worse outcomes have been observed in older patients when treated with intensive chemotherapy. Additionally, NHB patients demonstrated a numerically lower OS, however significantly superior rates of CR. Future research incorporating larger, multi-institutional cancer centers is needed to confirm these results.