Disparities in receiving disease-directed therapy, allogeneic stem cell transplantation in non-Hispanic Black patients with TP53-mutated acute myeloid leukemia

Talha Badar, Mark R. Litzow, Rory M. Shallis, Anand Patel, Antoine N. Saliba, Madelyn Burkart, Jan P. Bewersdorf, Maximilian Stahl, Guilherme Sacchi De Camargo Correia, Guru Subramanian Guru Murthy, Yasmin Abaza, Adam Duvall, Danielle Bradshaw, Vamsi Kota, Shira Dinner, Aaron D. Goldberg, Neil Palmisiano, Aref Al Kali, Ehab Atallah

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Although the clinical outcomes of patients with TP53-mutated acute myeloid leukemia (AML) are dismal, subsets of patients eligible for curative-intent therapies may fare better. Because racial disparities are known to affect outcome in hematologic malignancies, the authors sought to explore disparities among patients with TP53-mutated AML. Methods: A multicenter, retrospective study was conducted in a cohort of 340 patients who had TP53-mutated AML (275 non-Hispanic White [NHW] and 65 non-Hispanic Black [NHB]) to analyze differences in treatment and outcome among NHW and NHB patients. Results: The median patient age was comparable between NHW and NHB patients (p =.76). A higher proportion of NHB patients had therapy-related AML (31% vs. 20%; p =.08) and had co-mutations (74% vs. 61%; p =.06). A higher proportion of NHW patients received intensive chemotherapy compared with NHB patients (47% vs. 31%; p =.02). Conversely, a higher proportion of NHB patients received low-intensity chemotherapy (9% vs. 5.5%; p =.02) or best supportive care (22% vs. 7%; p <.001). The complete response rate (including complete responses with or without complete count recovery) was 31% versus 24.5% (p =.39) in NHW and NHB patients, respectively. Only 5% of NHB patients received allogeneic stem cell transplantation compared with 15.5% of NHW patients (p =.02). The proportion of patients who were event-free (18.5% vs. 8.5%; p =.49) or who remained alive (24.9% vs. 8.3%; p =.13) at 18 months was numerically higher in NHW versus NHB patients, respectively, but was not statistically significant. Conclusions: The current study highlights disparities between NHW and NHB patients with TP53-mutated AML. Efforts are warranted to eliminate treatment disparities in minority populations.

Original languageEnglish (US)
JournalCancer
DOIs
StateAccepted/In press - 2022

Keywords

  • acute myeloid leukemia (AML)
  • allogeneic hematopoietic stem cell transplantation (allo-HSCT)
  • disparities in leukemia
  • structural racism
  • TP53mutation

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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