Impact of clinical trial treatment and area deprivation index in the outcomes of adolescent and young adult patients with acute myeloid leukemia.

Abstract

6550 Background: Socioeconomic status (SES) is an independent prognostic factor in patients (pts) with acute myeloid leukemia (AML). Adolescent and young adult (AYA, age 15-39) pts with AML traditionally have better outcomes than older adult pts. Prior studies have shown that SES adversely impacts outcomes in AYA pts. Area Deprivation Index (ADI) is one of the most advanced SE tools, incorporating 17 SE factors to rank neighborhoods based on disadvantaged status. Higher ADI score corresponds to more disadvantaged neighborhoods. Here, we report the largest cohort of AYA pts with AML treated at a single institution with molecular, cytogenetic (CG) and ADI data. Methods: AYA pts with AML treated at MD Anderson Cancer Center from 3/2013 to 3/2023 were included. ADI data was downloaded from https://www.neighborhoodatlas.medicine.wisc.edu . Backward elimination was applied to the multivariable model, removing variables sequentially until only variables with p<0.1 remained. Results: 190 AYA pts were included (non-Hispanic White, NHW-139, non-Hispanic Black-24, Hispanic-16, Asian-11). Median age was 31 years (17-39). 81 pts (43%) had adverse risk by ELN 2022 and 135 (71%) were treated in clinical trials. Both median overall survival (OS) and relapse-free survival (RFS, not censored for transplant (SCT)) was 85.4 months, respectively. ADI national rank 61-100 (HR 1.906, 1.069-3.396, p=0.029), complex CG (HR 2.854, 1.530-5.324, p=0.001), intermediate risk (HR 2.514, 1.160-5.449, p=0.020), and adverse risk (HR 4.257, 1.975-9.177, p<0.001) adversely affected OS. Notably, treatment in clinical trials (HR 0.499, 0.309-0.806, p=0.005) and SCT (HR 0.499, 0.288-0.862, p=0.013) led to longer OS. Only complex CG and adverse risk negatively impacted RFS. Conclusions: AYA pts from disadvantaged neighborhoods (ADI national rank 61-100) had an inferior OS. Our data showed that treatment in clinical trials and SCT led to longer OS. These results underscore the importance of treatment in clinical trials and SCT for improving OS in AYA, particularly for AYA pts from disadvantaged neighborhoods. Efforts to improve access to clinical trials and SCT, especially for AYA pts from disadvantaged neighborhoods are needed. Results of Cox regression analysis for overall survival (p value cutoff 0.100 for MVA). Univariate Multivariate HR 95% CI P HR 95% CI P ADI state1-6 ref ref ref ref ref ref 7-10 1.558 0.964-2.517 0.070 1.178 0.625-2.221 0.612 ADI national 1-60 ref ref ref ref ref ref 61-100 1.918 1.232-2.986 0.004 1.906 1.069-3.396 0.029 CG: Complex 5.046 3.021-9.428 <0.001 2.854 1.530-5.324 0.001 Favorable ref ref ref ref ref ref Intermediate 2.162 1.005-4.650 0.049 2.514 1.160-5.449 0.020 Adverse 4.640 2.347-9.175 <0.001 4.257 1.975-9.177 <0.001 Clinical trial 0.495 0.315-0.779 0.002 0.499 0.309-0.806 0.005 SCT (time-dependent) 0.643 0.389-1.062 0.085 0.499 0.288-0.862 0.013