Impact of patient demographics on treatment outcomes in AML: a population-based registry in England, 2013-2020.

We report 1- and 5-year survival following AML diagnosis and early mortality, within 30 days of systemic anti-cancer therapy (SACT) treatments, using national cancer registry data in England. Patients aged 18-99 years diagnosed between 2013 and 2020 were included. Overall survival (OS) was calculated using Kaplan-Meier methodology and hazard ratios (aHRs, adjusted for intensity of treatment, age at diagnosis, gender, ethnicity, socioeconomic deprivation, comorbidity, and year of diagnosis) using Cox proportional hazards regression. Odds of 30-day mortality (aORs, adjusted for characteristics listed above, along with performance status (PS) and body mass index (BMI), were calculated using logistic regression. Amongst 17107 patients identified, older age and comorbidity were associated with worse survival. Asian and Black patients had better survival than White: 5-year OS 34.6%, 29.7%, and 17.8%; aHR 0.86 (95% CI 0.77-0.96) Asian vs White, and 0.84 (0.73-0.96) Black vs White. Socioeconomic deprivation was associated with worse survival. 7906 (46.2%) patients were documented as having received SACT. 30-day mortality was lower for patients receiving intensive rather than non-intensive SACT. After adjustment for co-factors the risk was higher in those treated intensively (aOR 0.74 [95% CI 0.60-0.92]). We show that ethnicity and socio-economic status impacts outcomes in AML. Further work is needed to understand how these effects may differ in different healthcare settings, and whether this due to effects on disease biology, responsiveness to treatment or drug toxicity. Selection of intensive vs non-intensive treatment should be based on individual patient factors, balancing improved long-term survival against higher early mortality.