Use of hematopoietic cell transplantation in younger patients with acute myeloid leukemia: A National Cancer Database Study

Abstract

Younger patients with intermediate or high-risk acute myeloid leukemia (AML) obtain overall survival benefit from the upfront use of hematopoietic cell transplantation (HCT). We queried the National Cancer Database to study 19,897 younger patients (18-60 years) with intermediate or high-risk AML reported between 2003-2012. Multivariable logistic regression analysis was performed to identify variables associated with the utilization of HCT. Approximately 18.5% of younger patients received HCT as a part of initial therapy. A lower rate of utilization of HCT was associated with receipt of care in a non-academic hospital, African American race, male sex, age group 50-60 years, Charlson comorbidity score of ≥1, uninsured status, Medicaid or Medicare insurance, and lower educational or income status. The use of HCT in younger patients varies based on non-biologic factors such as race, hospital type, insurance, educational, and income status. Socioeconomic and health system factors contribute to disparity in the uptake of HCT in the US.