Time to Transplantation (TTT) for Acute Myeloid Leukemia (AML) in First Complete Remission (CR1) Is Comparable Among Adolescent and Young Adults (AYAs) and Older Adults

Background AYA patients have a myriad of specific psychosocial and other challenges which may influence their ability to obtain appropriate treatment. Healthcare disparities regarding access to healthcare have been well described in this population. We hypothesized that hurdles faced by the AYA patient population also apply to patients with AML requiring allogeneic hematopoietic cell transplantation (HCT), resulting in AYAs having a longer TTT compared to older adults. Objectives In this study we aimed to compare TTT, defined as time from diagnosis to transplant for AML in CR1 between AYAs and older adults. Additionally, we aimed to determine if TTT has changed over time for this cohort and to identify factors associated with TTT. Methods BMT Program database was used to identify allogeneic HCT recipients with AML in CR1 from January 2007 to June 2018 for AYAs (age 18-39 years) and older adults (age 40-60 years). All the identified patients underwent allogeneic stem cell transplant in complete remission 1 (CR1). Patients receiving cord blood graft source were excluded. AYA and older adults were compared with Wilcoxon, Chi-square, or Fisher's exact test. Change in TTT over time was assessed with Spearman correlation (r). Factors associated with TTT were assessed with Wilcoxon or Jonckheere-Terpstra test. Results A total of 105 patients were identified: 24 AYAs and 81 older adults. Baseline characteristics were similar between AYAs and older adults aside from Karnofsky performance status; AYAs had better performance status than older adults (p=0.012) . Time to Transplant did not differ from between AYA and older adults (median 4.1 vs 4.0 months, p=0.61). There was no evidence of a change in TTT in more recent years in AYA (r=0.15, p=0.48) or older adults (r=-0.02, p=0.85). The only variable associated with TTT, as expected, was donor type (unrelated donors median 4.3 vs related donors 3.8 months, p=0.022) (Table 1). Conclusion Time to transplant for AYAs in AML is comparable to older adults and has not changed over time. Our analysis is limited to experience from a single center and a larger multicenter effort that takes into account other sociodemographic mediators of healthcare disparities is needed to better describe the association of age and time to allogeneic HCT in AML CR1. Our next step is to explore various psychosocial factors in this cohort and determine if they play a role in the TTT and also determine if TTT has an impact on outcomes.