IntroductionWhile continual advancements in acute myeloid leukemia have augmented response rates and survival, outcomes in clinical trials may not correlate with real-world practice as trials may underrepresent individuals with comorbidities, decreased performance status, and older age. Additionally, clinical trials may underrepresent certain ethnicities, and disparities based on ethnicity, socioeconomic status, and insurance have been demonstrated in acute myeloid leukemia.MethodsWe performed a retrospective chart review of adult patients with acute myeloid leukemia who were treated at Harbor-UCLA from 2014 to 2022 to examine patient characteristics, management patterns, and outcomes in a safety net hospital setting.ResultsThe median age was 56 years old (range 18–84). In regards to risk stratification, 22%, 33%, and 41% had favorable, intermediate, and adverse risk acute myeloid leukemia, respectively. The most common induction regimens included 7 + 3 (55%), azacitidine (10%), azacitidine + venetoclax (7%), and 7 + 3 + midostaurin (7%). The complete remission rate was 51%. Among patients who received intensive induction chemotherapy, 15% underwent re-induction with a second cycle, 51% received consolidation therapy, and 5% received maintenance therapy with a targeted agent. Overall, 12% of patients received allogeneic stem cell transplant. Median overall survival was 12.2 months, and 5-year overall survival was 18%.ConclusionsSuboptimal response rates and survival in this population may be related to low rates of re-induction and allogeneic transplant in addition to high rates of adverse cytogenetics, secondary acute myeloid leukemia, and supportive care only. Efforts to increase access to clinical trials, novel therapies, and transplants for diverse and underinsured populations are essential.

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来自城市安全网医院的急性髓系白血病患者回顾性队列的真实治疗结果

简介虽然急性髓系白血病的不断进步提高了缓解率和生存率，但临床试验的结果可能与现实世界的实践不相关，因为试验可能低估了患有合并症、体能状态下降和年龄较大的个体。此外，临床试验可能不足以代表某些种族，并且在急性髓性白血病中已经证明了基于种族、社会经济地位和保险的差异。方法我们对 2014 年以来在 Harbor-UCLA 接受治疗的急性髓性白血病成年患者进行了回顾性图表审查到 2022 年，检查安全网医院环境中的患者特征、管理模式和结果。结果中位年龄为 56 岁（范围 18-84 岁）。在风险分层方面，急性髓系白血病的有利风险、中等风险和不利风险分别为 22%、33% 和 41%。最常见的诱导方案包括 7 + 3 (55%)、阿扎胞苷 (10%)、阿扎胞苷 + 维奈托克 (7%) 和 7 + 3 + 米斯托林 (7%)。完全缓解率为51%。在接受强化诱导化疗的患者中，15% 接受第二个周期的再诱导，51% 接受巩固治疗，5% 接受靶向药物维持治疗。总体而言，12% 的患者接受了同种异体干细胞移植。中位总生存期为 12.2 个月，5 年总生存率为 18%。 结论 除了不良细胞遗传学、继发性急性髓系白血病的高发生率之外，该人群中次优的缓解率和生存率可能与再诱导和同种异体移植率低有关。白血病，仅支持治疗。努力增加不同人群和保险不足人群获得临床试验、新疗法和移植的机会至关重要。