Persistent racial disparities in AML survival in the FLT3 inhibitor era.

Abstract

e18528 Background: FLT3 inhibitors for FLT3 mutated acute myelocytic leukemia (AML) were introduced in 2017 secondary to FDA approval. Historically, FLT3 mutations have been reported to occur at similar frequencies in Black and White patients. Despite this comparable mutation rate, prior studies have suggested that Black patients with AML experience worse overall survival compared to their White counterparts. Given the introduction of FLT3-targeted therapies, it remains unclear whether this racial survival disparity has persisted in the FLT3 inhibitor era. Our study aims to evaluate whether disparities in survival outcomes among Black patients with AML have persisted. Methods: We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database to evaluate racial disparities in AML survival outcomes in the FLT3 inhibitor era (2018 and beyond). Adult patients diagnosed with AML from 2018 onward were identified from SEER. Demographic and clinical variables, including age, sex, race, marital status, income, and rural-urban residence, were extracted. Overall survival was the primary outcome, assessed using Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression. Hazard ratios (HR) with 95% confidence intervals (CI) were estimated to evaluate racial differences in survival. Results: A total of 11,072 individuals were included in our study. Of these, 7,414 (66.96%) were Non-Hispanic White (NHW), 1,560 (14.09%) were Hispanic (H), 980 (8.85%) were Non-Hispanic Black (NHB), and the remaining patients were Non-Hispanic Asian and Non-Hispanic American Indian. The median age at diagnosis was 67 years (SD ± 15). NHB patients had a higher cancer specific mortality risk when compared to NHW patients (HR = 1.17, 95% CI: 1.05–1.31, p = 0.004), despite advancements in FLT3-targeted therapies. Additionally, older age (HR = 1.04, 95% CI: 1.04–1.05, p < 0.001) was associated with worse outcomes, while being of female sex was a protective factor. Conclusions: These findings highlight the persistent racial disparities in AML, despite advancements in targeted therapies. Further research is needed to investigate potential contributors, including disparities in access to FLT3 inhibitors, genetic factors and socioeconomic barriers. Addressing these inequities is critical to improving outcomes for all AML patients in the modern treatment era. Cancer-specific mortality in AML patients. Variable Hazard Ratio 95% CI p value Age 1.04 1.04-1.05 <0.001 Female sex 0.85 0.80-0.91 <0.001 Race  Hispanic 1.10 1.00-1.21 0.046  Non-Hispanic Black 1.17 1.05-1.30 0.004  Non-Hispanic Asian 1.08 0.97-1.20 0.131  Non-Hispanic American Indian 1.10 0.72-1.65 0.649 Income  $40,000-$79,999 0.83 0.62-1.11 0.226  $80,000-$99,999 0.77 0.57-1.04 0.099  ≥$100,000 0.73 0.54-0.99 0.047 Marital Status  Married 0.82 0.76-0.88 <0.001  Widowed 0.89 0.79-1.00 0.051 Area of Living 0.93 0.87-1.03 0.259