Treatment inequity among older adults with newly diagnosed acute myeloid leukemia ineligible for intensive therapy.

Abstract

For adults with newly diagnosed acute myeloid leukemia (AML) aged ≥ 75 years or considered unfit for intensive induction therapy, the combination of venetoclax (VEN) and hypomethylating agents (HMAs) has become the standard of care. However, real-world data on demographic disparities in treatment uptake among Medicare beneficiaries remain limited. We conducted a retrospective cohort analysis using Medicaire fee-for-service claims to identify factors influencing the receipt of AML-directed therapy. The study included 12,154 patients with newly diagnosed AML who were either ≥ 75 years and/or unfit for intensive induction chemotherapy. Overall, 5,647 patients received treatment, while 6,507 remained untreated. Treatment utilization increased over time. Untreated patients were older than treated patients (81.2 vs 77.9 years). Females were more likely to be untreated than males. Patients diagnosed in 2019 or later were more likely to receive therapy, and among those, 67.3% received VEN-based therapy. No significant differences in treatment receipt were observed by race or geographic residence. These findings suggest that factors extending beyond disease biology, such as age and sex, influence AML treatment uptake in the Medicare population. Management of AML demands a conscious effort to ensure equitable access to treatment and fair representation in clinical trials.