Abstract 6471: Trends in chemotherapy utilization in acute myeloid leukemia (AML) in last 15 years
Authors: Dhakal Prajwal , Loeffler Bradley , Ravindra Aditya , Pyakuryal Avantika , Bhatt Vijaya Raj 
Published: March 2024

Abstract
Introduction: Chemotherapy (Chemo) can relieve symptoms and improve quality of life and survival in AML, including in many older and frail adults. However, in a prior study from the US, almost a quarter of patients (pts) with new diagnoses of AML between years (yrs) 2003 and 2011 did not receive chemo (Bhatt et al., Blood Advances, 2018). Our study examined trends in chemo utilization in the last 15 yrs to test the hypothesis that chemo use has increased in more recent yrs. We also examined any disparities in chemo use.
Methods: We utilized the National Cancer Database to identify 78,864 pts diagnosed with AML between 2004 and 2019 and divided them into 2 cohorts based on date of diagnosis, 2004-2010 and 2011-2019. We used logistic regression to estimate effect of demographic and disease characteristics on odds of receiving chemo and evaluate differences in these effects between the constructed patient cohorts.
Results: Seventy-seven percent of total pts received chemo. Compared to 73% in 2004, 81% of pts received chemo in 2019. The receipt of chemo declined with increasing age with higher use of chemo in all groups in 2011-2019 compared to 2004-2010: &gt;80 (yrs)= 40 vs 33%, 71-80 yrs= 72 vs 63%, 60-70 yrs= 87 vs 84%, 41-59 yrs= 93 vs 92%, and 18-40 yrs = 95 vs 94%.The receipt of chemo was lowest in white pts overall; in black pts, receipt of chemo increased in 2011-2019
compared to 2004-2010: black= 83 vs 76%, white= 78 vs 75%, and others 83 vs 83%. The receipt of chemo was lowest in therapy-related (t)-AML in 2011-2019 and 2004-2010: t-AML 64 vs 60%, acute promyelocytic leukemia= 88 vs 87%, core binding factor AML 93 vs 88% and other 77 vs 74%. In multivariable analysis, the odds of receiving chemo increased in 2011-2019 compared to 2004-2010 in all pts, particularly in older adults. Compared to white, black pts had similar odds of receiving chemo in 2004-2010, but odds were higher in 2011-2019 (Odds ratio, 1.2, 95% confidence interval, 1.1-1.3. Pts with t-AML were less likely to receive chemo compared to all other subtypes in 2004-2010 and 2011-2019. Female sex, lower income, public insurance, higher comorbidity score, and shorter distance to treatment facility were associated with a lower likelihood of receiving chemo; however, chemo utilization did not differ over the two time periods based on these variables.
Conclusion: To our knowledge, this is the largest scale analysis of chemo utilization in AML in real-world practice. Chemo receipt increased significantly over the yrs, particularly among older adults, black pts, core binding factor, and t-AML. These recent trends are encouraging and represent novel findings. Despite these results, healthcare disparity based on sex, socioeconomic, and healthcare system factors continues to persist. In addition to developing safer and more effective chemo regimens, other innovative strategies to tackle these disparities are crucial to improve outcomes.
Citation Format: Prajwal Dhakal, Bradley Loeffler, Aditya Ravindra, Avantika Pyakuryal, Vijaya Raj Bhatt. Trends in chemotherapy utilization in acute myeloid leukemia (AML) in last 15 years [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6471.