Treatment in Clinical Trials Could Mitigate Socioeconomic and Racial Disparities in Acute Myeloid Leukemia

Background Disparities in acute myeloid leukemia (AML) outcomes due to nonbiological factors, including socioeconomic (SE) status and race/ethnicity, have been observed in population-based studies. However, inconsistent assessment of SE status limits translation to clinical practice. Objective To evaluate the impact of neighborhood disadvantage status and race/ethnicity on AML outcomes. Methods Adult patients with newly diagnosed untreated AML, self-reported race/ethnicity, and available Area Deprivation Index (ADI) based on zip code at diagnosis were included. Primary outcome was overall survival (OS). Multivariable Cox regression analyzed factors associated with OS. Results Of 2442 patients, 2032 (83%) were non-Hispanic White, 202 (8%) were non-Hispanic Black, 109 (5%) were Hispanic, and 99 (4%) were Asian. Median ADI rank was 53 (IQR, 32-73). No differences in clinical trial participation across racial/ethnic groups were observed. Stem cell transplant rates were lower in more disadvantaged neighborhoods (higher ADI ranks, ≥ 53: 16% vs. 20%, P = .007). In multivariable analysis, clinical trial participation (HR 0.72, [95% CI, 0.63-0.81], P < .001) and transplant (HR 0.43, [95% CI, 0.36-0.51], P < .001) were associated with improved OS. Neither ADI rank nor race/ethnicity affected OS. Conclusions and Relevance In a large academic center, neighborhood disadvantage and race/ethnicity did not affect AML outcomes. Equitable access to clinical trials and novel therapies appears to mitigate SE and racial/ethnic disparities. These findings suggest academic centers can serve as models for reducing inequities through policy and clinical interventions. Prospective multicenter studies are needed to validate these findings.