Significant Disparities Exist in Real-World Treatment of APL

A recent study illustrated significant disparities by age, insurance, and health-system factors in the use of appropriate multiagent therapy to treat acute promyelocytic leukemia (APL) in a real-world setting.

The study used data from the National Cancer Database to explore use of multiagent therapy in APL. According to the researchers, use of combination all-trans retinoic acid (ATRA) with either arsenic trioxide (ATO) or a chemotherapy regimen is standard of care for APL.

Compared with patients older than 60, patients aged 0 to 18 were three times more likely to receive multiagent therapy (hazard ratio [HR]=3.2; 95% CI, 1.3-1.9; P<0.0001). Patients aged 19 to 40 (HR=1.6; 95% CI, 1.01-2.54; P=0.03), and those aged 41 to 60 (HR=1.6; 95% CI, 1.3-1.9; P<0.0001) were also more likely to receive multiagent therapy than this older group. Hotel The study also showed that Charlson comorbidity index (CCI) was associated with use of multiagent therapy. Those patients with a CCI of 0 (HR=1.6; 95% CI, 1.2-2.3; P=0.001) and those with a CCI of 1 (HR=1.4; 95% CI 1.0-1.9; P=0.04) had a higher likelihood of receiving multiagent therapy than those with a CCI of 3 or greater.

“The use of effective multiagent therapy is crucial to translate successes seen in clinical trials to real-world practices,” the researchers wrote. “Chronological age or comorbidities should not preclude patients from getting appropriate multiagent treatment.”

Treatment at an academic cancer center compared with a comprehensive community cancer center or integrated network cancer center was associated with increased likelihood of receipt of multiagent therapy.

“The reasons for these findings may include poor functional status associated with older age and multimorbidity, and treatment at centers with less experience and resources to timely diagnose and initiate appropriate therapy,” the researchers wrote.

Finally, patients with Medicaid were more likely to be treated with multiagent therapy compared with those with private insurance, but patients who were uninsured were less likely to receive multiagent therapy.

“Suboptimal treatment possibly led by these disparities could be one of the major reasons for inferior survival outside of clinical trials. Further research is necessary to develop strategies to eliminate health care disparities in this highly curable leukemia.