Abstract PR011: Investigating the interplay among allostatic load, social determinants of health, and treatment outcomes in chronic myeloid leukemia patients
Authors: Miranda-Galvis Marisol , Sharara Muhannad , Tjioe Kellen C. , Maloney McKenzie Maloney , Kota Vamsi , Jillella Anand , Bryan Locke , Keruakous Amany R. , Cortes Jorge E. 
Published: September 2024

Abstract
Introduction. The advent of tyrosine kinase inhibitors (TKIs) has transformed chronic myeloid leukemia (CML) into a chronic condition, allowing many patients (pts) to achieve survival rates comparable to the general population. Yet, most pts patients require lifelong therapy, regular follow-up, and management of TKI side effects, posing challenges within the healthcare system alongside structural and financial barriers. We have previously found that CML pts with an allostatic load (AL) burden indicating cumulative stress, experience worse treatment outcomes. In light of this, we investigated whether AL is a biological indicator of social determinants of health (SDH) and its correlation with CML treatment outcomes. Methods. We conducted a single-institution retrospective study, enrolling CML pts and assessing 23 biomarkers across four domains (cardiovascular, metabolic, immunologic, and neuroendocrine) required to calculate the AL score at the time of the first visit. Pts were sorted into low and high AL groups using the cohort's median score of 5 as the threshold. SDH was evaluated at both individual and population levels by integrating data from medical records with the SDH database from the Agency for Healthcare Research and Quality. Statistical analyses, including chi-square and Fisher’s exact tests, were conducted with significance set at p&lt;0.05. Results. Between 2003 and 2023, data from 108 CML pts undergoing first-line treatment were retrieved. Pts with high AL were more likely to be older (mean age 53.8 vs. 47.2 years, p=0.03), and a greater proportion were identified as Black compared to those in the low AL cohort (25.5% vs. 12.3%, p=0.01). We identified an association between high AL and overall mortality (13.7% vs. 1.8%, p=0.02), with effects trending towards a higher risk of CML-specific death (6.4% vs. 0, p=0.05). Higher AL was correlated with adverse SDH, such as reliance on public health insurance (32% vs. 52.2%, p=0.04), living alone (67.7% vs. 86.8%, p=0.05), and lack of regular exercise (38.9% vs. 7.4%, p=0.01). Geographic inequality was identified, as patients with high AL were more likely to reside in Georgia (GA) compared to South Carolina and other states (66.7% vs. 27.5% vs. 5.9%, p=0.01). Indeed, pts in GA who traveled shorter distances to the treatment facility and resided in areas with higher particulate matter levels, as an indicator of air pollution, were less likely to achieve major molecular response (p=0.011 and p=0.008, respectively). SDH such as regular exercise, home environment, and health insurance were associated with overall and CML-specific survival. However, birth country, language, household income, and education, were not associated with either AL or treatment outcomes. Conclusion. Adverse SDH significantly amplifies the burden of AL, serving as a comprehensive indicator of chronic stress, health behaviors, and environmental conditions. Our findings highlight the intricate interplay between social, economic, and environmental factors in shaping treatment outcomes among CML patients.
Citation Format: Marisol Miranda-Galvis, Muhannad Sharara, Kellen C. Tjioe, McKenzie Maloney Maloney, Vamsi Kota, Anand Jillella, Locke Bryan, Amany R. Keruakous, Jorge E. Cortes. Investigating the interplay among allostatic load, social determinants of health, and treatment outcomes in chronic myeloid leukemia patients [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr PR011.