Impact of socioeconomic and geographic disparities on early mortality and treatment-related complications in a rural Appalachian cohort with acute promyelocytic leukemia.

Abstract

e23172 Background: Acute promyelocytic leukemia (APL) is a curable yet aggressive subtype of acute myeloid leukemia (AML) associated with early mortality and treatment-related complications. Appalachia, encompassing West Virginia (WV), is a region characterized by rural communities, rugged terrain, and economic isolation posing challenges to timely and effective care for acute leukemia patients. Sociodemographic disparities have been shown to negatively impact survival outcomes in AML (Guinter et al., Blood 2023). Similar analysis is lacking in APL, particularly in a rural cohort. This study aims to explore the socioeconomic and geographic determinants influencing health outcomes in Appalachian APL patients treated at an academic tertiary care center in WV. Methods: This retrospective study analyzed 135 adults with newly-diagnosed APL treated at West Virginia University from 2003 to 2023. Patient and disease characteristics were recorded from electronic medical records (EMR). Risk stratification was calculated using Sanz criteria. EMR addresses were used to calculate state- and national-level Area Deprivation Index (ADI) scores via the University of Wisconsin Neighborhood Atlas as well as census tract-level USDA Rural-Urban Community Area (RUCA), Area Ruggedness Scale (ARS), and Road Ruggedness Scale (RRS) scores. Results: 92 patients had confirmed APL diagnoses. 24% had low risk disease, 45% intermediate risk, and 16% had high risk disease; 15% had unknown risk. Median distance from treatment center was 79 miles. On average, our cohort lived in rural areas (RUCA 4.05) and in moderately-rugged terrain (ARS 3.37) and road conditions (RRS 3.21). Elevated average ADI scores at both state (5.4) and national (73.3) levels were noted. Over 95% (88 patients) began treatment within one week of diagnosis. 4% (4 patients) were transitioned to comfort care shortly after presentation. Furthermore, 10% (10 patients) suffered early mortality [ < 30 days from diagnosis] with higher average RUCA (5.13) and state ADI (6.67) scores as compared to the cohort average. 26% (24 patients) developed differentiation syndrome after treatment initiation; these patients lived on average 83 miles from our treatment center and also had higher average RUCA (5.03) and state ADI (5.88) scores as compared to the cohort average. Conclusions: Appalachian APL patients travel significant distances from rural areas and over rugged terrain to receive care. While able to receive prompt treatment at our institution after diagnosis, the high rates of early mortality and treatment-related complications highlight a potential disproportionate impact of these disparities as compared to patients in more urban and resource-rich areas. Further analysis is planned to evaluate the impact of these factors on survival and treatment outcomes in this cohort.