Hispanics with AML Have Better Outcomes but Less Access to Transplant Than Non-Hispanics

Hispanics have improved overall survival (OS) when compared to non-Hispanic Blacks or non-Hispanic whites in the non-transplant setting in patients with acute myeloid leukemia (AML), according to a presentation at the 2022 American Society of Hematology Annual Meeting. However, access to transplant remains a barrier for this patient group.

Furthermore, the improved OS is concentrated in the high-risk group when compared to other ethnic groups, according to the study’s authors, led by Sharlene Dong, MD, of the Department of Internal Medicine at the University of Texas Southwestern in Dallas.

“Hispanics have improved OS, particularly in the high-risk group, compared to non-Hispanic Blacks or non-Hispanic whites in the non-transplant setting,” Dr. Dong and colleagues wrote.

The investigators reviewed the medical records of 162 adult patients with AML treated at Parkland Health in Dallas, Texas, from January 2007 to June 2022 and collected information on patient demographics, baseline disease characteristics including cytogenetics and genomic profile, and AML-directed therapies.

In terms of race and ethnicity, 82 patients (50.6%) were classified as Hispanic, 36 (22.2%) as non-Hispanic Black, and 44 (27.2%) as non-Hispanic white.

Patient cytogenetic risk was classified as favorable, normal, complex, or other, per the 2017 European Leukemia Net (ELN) risk classification. Genomic testing was performed using the FoundationOne Heme panel. Overall, AML risk was classified per 2017 ELN stratification. Response was assessed using the International Working Group criteria.

The results showed that Hispanics were diagnosed at a significantly younger age compared to non-Hispanic Blacks (42.5 vs 49 years) and non-Hispanic whites (42.5 vs 52.5 years; P=.02).

In terms of cytogenetics, Hispanics were found to have higher rates of complex cytogenetics (20.3% for Hispanics vs 11.8% for non-Hispanic Blacks vs 9.5% for non-Hispanic whites), similar rates of favorable cytogenetics (20.3% vs 20.6% vs 19.0%, respectively), and lower rates of normal cytogenetics (29.1% vs 44.1% vs 40.5%, respectively). Hispanic patients had a lower frequency of NPM1 mutations (P=.058) and a higher frequency of CEBPA, NRAS, MLL, WT1, RUNX1, and TET2 mutations.

Hispanics were less likely to have favorable risk AML (23.2% vs 36.1% vs 29.5%) and more likely to have intermediate- (53.7% vs 44.4% vs 50.0%) or high-risk disease (23.2% vs 19.4% vs 20.5%) than non-Hispanic Blacks or non-Hispanic whites. Hispanics were less likely to receive an intensive induction chemotherapy 7+3 regimen (85.4% vs 97.2% vs 90.9%), despite their overall younger age of presentation, but they achieved similar remission rates post-frontline therapy (78.0% vs 86.1% vs 75.0%).

In terms of survival, Hispanics had a numerically longer OS compared to non-Hispanic Blacks or non-Hispanic whites (43 vs 17 vs 14 months), although differences were not statistically significant (P=.20), likely due to the small size of the cohort, the investigators reported.

When Hispanics were compared with a combined cohort of non-Hispanic Blacks or non-Hispanic whites, they had longer OS in the high-risk group (P=.03). Only 14 patients (8.6%), three of whom had high-risk disease, could proceed to transplant.

“Our results may suggest that when healthcare access is not a barrier to treatment, Hispanic patients with AML can have similar, if not improved, outcomes to other populations,” Dr. Dong and colleagues concluded. “However, access to transplant remains a major barrier that needs to be further addressed to improve outcomes for this patient population.”

Reference

Dong S, Premnath N, Sadeghi N, et al. Racial and ethnic disparities in acute myeloid leukemia: 15-Year experience at a safety-net health system. Abstract #1383. Presented at the 64th ASH Annual Meeting and Exposition; December 10-13, 2022; New Orleans, Louisiana.