CML-319: Impact of Insurance Differences in Outcomes in Colombian Patients with Chronic Myeloid Leukemia (CML)

Context Adherence is a key factor for good outcomes in CML. There are two types of insurance in Colombia: Contributory (CS) and Subsidized Systems (SS), which provide highly unequal access to Tyrosine Kinase Inhibitors (TKI) for CML. Objective The aim of this report is to compare outcomes in patients with different access to TKI and analyze other factors that affect progression-free survival (PFS). Design The Colombian Association of Hematology and Oncology (ACHO)'s hematological disease registry (RENEHOC) is a multicenter study; it has collected information on CML patients since 2019, in 14 centers with institutional Ethics Committee approval. Setting RENEHOC is a real-world registry and captures information from academic and general community centers. Patients or other participants 357 CML adult patients treated in the last 20 years. Interventions Treatment was according to investigators' preferences. Imatinib was first-line treatment for 223 patients (62.4%), dasatinib for 69 (19.4%) and nilotinib 53 (14.8%); 47.9% required a second line of treatment. Main outcome measures Primary end points were Optimal Response (OR) according to LeukemiaNet 2020 definition and progression-free survival (PFS) rates. The Kaplan-Meier method was used to assess PFS, and hazard ratios (HR) using Cox proportional regression modeling were estimated. Results Mean age was 54 years (19–92), 60.1% were males, most patient were diagnosed in chronic phase (92%) and 36% were high Sokal. At a median follow for the entire cohort of 69 months (1–228), 60% of patients were in OR, including 11 patients in treatment-free remission (TFR). There were no significant differences between contributory and subsidized cohorts in terms of patient or disease characteristics. 76% of patients were in OP at the last visit in the CS in comparison to 48% for the SS cohort. Ten patients died, all CML-related. The only significant prognosis factors associated with PFS were Sokal score (mean PFS: 57 months low/int vs 39 high; p=0.012) and type of insurance (mean PFS 70 months for CS vs 57.7 for SS; p=0003). Conclusions This report suggests that differences in access to TKI in CML according to insurance regimes results in significantly different PFS. This is the first time in the country that the impact of these attention inequalities in CML patient care have been demonstrated. Funding ACHO has received grants for RENEHOC project from Takeda, Abbvie, Amgen, Dr. Reddy's.