Stratifying survival: the role of social determinants of health on AML outcomes by ELN 2022 criteria

Previous studies have demonstrated that social determinants of health (SDOH) are associated with overall survival (OS) in patients with acute myeloid leukemia (AML).Their interaction with the European LeukemiaNet (ELN) 2022 genetic risk criteria remains unclear.We evaluated the impact of SDOH, measured by the national Area Deprivation Index (nADI) and categorized as low (50; less advantaged), in 365 patients with newly diagnosed AML treated with intensive chemotherapy.Among ELN favorable (n=115) and adverse (n=166) risk groups, overall survival was similar for high and low nADI groups.Conversely, in intermediate risk patients (n=84), overall survival was higher for more advantaged patients (median 33 vs. 17 months, p=0.04), which persisted in multivariable analysis adjusted for age, race, sex, and hematopoietic cell transplantation as a time-varying covariate (HR 3.09, 95% confidence interval [CI] 1.3-7.34,p=0.01).In this intermediate risk group, response and transplantation rates did not differ by nADI group.Among patients consolidated with transplantation (59/84, 70%), survival was prolonged for more advantaged patients, although not significantly (2-year OS: 69% and 58%; p=0.069), which appeared to be mediated by a higher relapse rate (3-year cumulative incidence of 35% and 69%, p=0.06) rather than non-relapse mortality (20% and 19%, p=0.8).In conclusion, for patients with AML treated with intensive chemotherapy, more advantaged SDOH was associated with improved overall survival solely in the ELN intermediate risk group.This improvement appeared to be mediated by lower post-transplant relapse.