Racial disparities and survival outcomes in secondary acute myeloid leukemia: A SEER-based analysis.

Abstract

e18540 Background: Secondary Acute Myeloid Leukemia (sAML) comprising AML with myelodysplasia-related changes (AML-MRC) and therapy-related AML (t-AML), has a poor prognosis compared to de novo AML. Understanding racial disparities and survival outcomes is crucial for identifying gaps in care and improving outcomes for these patients. We analyzed racial disparities in the diagnosis and survival of secondary AML using population-level data. Methods: We analyzed data from 8,480 patients with sAML in the Surveillance, Epidemiology, and End Results (SEER) 17 registries database. Patients were classified by diagnosis subtype (AML-MRC or t-AML), race (White, Black, Asian or Pacific Islander, American Indian/Alaska Native, and Unknown), and origin (Hispanic or Non-Hispanic). Survival analysis was performed using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards regression. Covariates included age, sex, race, and diagnosis subtype. Statistical significance was defined as p < 0.05. Results: The median age at diagnosis was 70 years, with most patients (58.2%) aged 61–80 years. White patients comprised the majority (84.3%), followed by Black (7.5%) and Asian or Pacific Islander (7.4%) patients. Hispanic origin accounted for 8.6% of cases. AML-MRC accounted for 71.5% of diagnoses, while t-AML accounted for 28.5%. Kaplan-Meier analysis showed no significant differences in survival by race (log-rank p = 0.131). Mean survival in months was 15.6 for Whites, 13.3 for Blacks, 18.6 for Asians or Pacific Islanders, and 14.3 for American Indians. Cox regression revealed that Black patients had a 19.5% higher risk of death compared to Whites (HR: 1.195, 95% CI: 1.093–1.306, p < 0.001). No significant survival differences were observed for Asian/Pacific Islanders or American Indian patients. Patients with t-AML had a 13% lower risk of death compared to those with AML-MRC (HR: 0.887, 95% CI: 0.839–0.937, p < 0.001). Age remained a significant predictor of worse outcomes, with each 1-year increase associated with a 2.4% higher risk of death (HR: 1.024, 95% CI: 1.022–1.026, p < 0.001). Conclusions: While unadjusted analyses suggested disparities in survival by race, adjusted analyses showed that Black patients had worse survival compared to Whites, while no significant differences were observed for other racial groups. Therapy-related AML was associated with better outcomes than AML-MRC. Age was a critical determinant of survival, underscoring the vulnerability of older patients. These findings highlight the need for targeted interventions to address racial disparities and improve outcomes for sAML patients.