Pb1852: comparison of clinical characteristics of adult chilean patients with acute myeloid leukemia (aml), according to their health care system: analysis within the framework of the pthema aml registry

Topic: 4. Acute myeloid leukemia - Clinical Background: AML is the most common acute leukemia in adults, with a median age at diagnosis of 68 years and a 5-year Relative Survival near to 30%. Since 2021, Chile has participated in the AML epidemiological registry carried out by the Spanish group PETHEMA. The present study is oriented to compare the clinical characteristics of our patients according to the Chilean health care system to which they belong (private vs public). Aims: Describe and compare the clinical characteristics of adult Chilean patients with AML according to their health care system: private vs public. Methods: Multicenter, retrospective and prospective epidemiological registry that includes Chilean patients with AML >≥ 15 years at diagnosis, from 16 centers and from the 3 chilean health care systems: private (5), public (9) and Army (2), these last 2 centers has been included in the analysis together with the public centers. Data is registered in the online platform of the Spanish group PETHEMA. All centers have the approval of their Ethics Committee. Results: 695 patients were analyzed, diagnosed between March 1999 and February 2023. The median age at diagnosis was 57 years, with no difference between both health care systems. 52% were men, with a predominance in the private health care system (p<0.01). 82.5% of patients had an ECOG <≤2 at diagnosis (91.6% private vs 79.2% public, p<0.01). 19.8% were secondary AML (31% private vs 15% public, p<0.01). 64.3% had a cytogenetic study at diagnosis (74.7% private vs 61.2% public, p<0.01). Less than 50% of the patients had evaluation of NPM1 and FLT3-ITD mutations at diagnosis (NPM1 57.6% private vs 39.9% public, p<0.01; and FLT3-ITD 56.5% private vs 46.6% public, p<0.01). Overall, 64.6% of the patients received induction chemotherapy (79% private vs 60.2% public, p<0.01), the most frequent scheme was “3 + 7” (anthracycline + cytarabine): 60% private vs 83% public (p<0.01). In the overall group, the response to induction chemotherapy did not have statistically significant differences between the health care systems in terms of CR/CRi, PR and resistance, but it was significant regarding to death in induction (3.9% private vs 11.2% public, p<0.01). Only 9.4% of the patients had access to allogeneic transplant (16% private vs 7.4% public, p<0.01), mainly haploidentical and with myeloablative conditioning regimen. In patients >≥ 60 years, we observed the greatest statistically significant differences between both health care systems, regarding use of induction chemotherapy (69% private vs 32% public), induction mortality (2% private vs 17% public), use of hypomethylating agents (46% private vs 9% public), use of innovative drugs-BCL2 inhibitor (14% vs 3%), access to allogeneic transplant (9.9% private vs 0.4% public). Median OS for all group was 31 weeks (49 private vs 26 public, p<0.01), with 39% OS at 12 months (49% private vs 36% public, p<0.01) and 18% at 36 months (32% private and 14% public, p<0.01). Summary/Conclusion: This is the first multicenter analysis of adult Chilean patients with AML according to their health care system. Significant differences were observed in terms of use of diagnostic techniques, use of induction chemotherapy, induction mortality, access to allogeneic transplant, use of hypomethylating agents and innovative drugs and OS, mainly in patients >≥ 60 years.Keywords: Adult, Acute myeloid leukemia, Clinical data