Disparity in utilization of multiagent therapy for acute promyelocytic leukemia in the United States

Abstract Background : Despite high rate of cure in acute promyelocytic leukemia(APL) in clinical trials, outcomes in real-world practice are dismal. We utilized National Cancer Database(NCDB) to explore utilization of multiagent therapy in APL and identify any disparities in treatment in real-world practices. Methods : NCDB categorizes use of systemic chemotherapy into single-agent versus multiagent therapy. Some patients received hormonal therapy, immunotherapy, and unknown therapy; details of these treatments could not be ascertained. We therefore used multiple logistic regression analysis to evaluate effects of covariates on the probability of multiagent therapy use in 6678 patients. Results : Compared to patients>60years, patients aged 0-18years(hazard ratio[HR] 3.2, 95%confidence interval[CI] 1.8-5.5,p Conclusion : To our knowledge, this study is the first and the largest scale analysis of treatment practices in APL in real-world practices. Our findings highlight significant disparities in treatment of APL based on age, insurance, and health-system factors. Microabstract : We explored the utilization of multiagent therapy in acute promyelocytic leukemia(APL) and identified disparities in treatment of APL in real-world practices. Older patients and those with multiple comorbidities or without insurance, and patients treated at non-academic centers, and uninsured patients had less likelihood of receiving multiagent therapy. Suboptimal treatment possibly led by these disparities may have contributed to inferior survival outside of clinical trials.