ALBERT

Description: Background The overall prognosis for most acute myeloid leukemia (AML) patients remains poor with only 50-55% of patients achieving durable remission. The majority of adult patients (pts) who do achieve remission, will ultimately need allogeneic stem cell transplant (allo-SCT) to achieve long term survival. Treatment of AML requires intensive therapy, transfusion support, antimicrobials, and repeated admissions to the hospital. Limited data is available comparing epidemiology and treatment according to the distance from patient residence to treatment center. Oklahoma University Health Sciences Center (OUHSC) is the major tertiary center for Oklahoma residents to receive treatment for AML. Few patients receive AML treatment from distant states or oversea areas. We describe a retrospective analysis of adult pts with AML treated at our institution evaluating impact on distance from center. Methods From January 2000 to June 2011,we identified a total of 269 patients with 217 meeting inclusion criteria for the study. We then performed an analysis of variance (ANOVA) on the relationship between distance to treatment center (in miles) and relapse rate or remission rates. Kaplan-Meier method was used to estimate survival rates. Age and cytogenetics were identified as the major confounders. A Cox Proportional Hazards model on overall survival (OS) was implemented using the independent variables age category ( ≤60 and 〉 60), cytogenetic risk status (groups were divided into favorable, intermediate and unfavorable risks), and distance to treatment center. Statistical analysis was performed using SAS 9.2 software (SAS Institute Inc.). Fisher’s exact test was used to compare patients in the different groups. Results Of the 217 pts (52.2% Males, 47.8% Females) included in the study, 81.5% were white, 9.0% African American, and 6.2% Native American. Median age at diagnosis was 51.0 years. Median distance to treatment center was 62 miles (range: 0-420). Distance of residence to treatment center was significantly related to complete remission rates, with patients living at longer distances having lower chances of achieving complete remission( p = 0.03). Distance from residence to treatment center however was not related to the risk of having relapsed disease (p = 0.22). A Cox proportional hazard model was performed including distance to travel, age and cytogenetic risks (unfavorable versus intermediate or favorable) and revealed that all three variables are associated with a trend towards shorter overall survival (p

Description: Background: In patients with acute myeloid leukemia (AML), insurance status has not been demonstrated to adversely impact outcomes. However, insurance status appears to be an independent factor in healthcare utilization. University of Oklahoma Health Sciences Center (OUHSC) is the main tertiary hospital in the State of Oklahoma treating patients with acute leukemia. We hypothesized that treatment patterns might be different between the insured and uninsured patients. We hereby attempt to analyze the association between insurance status, week day of admission and outcomes. Methods: We retrospectively analyzed patients from January 2000 to June 2012 diagnosed with AML over 18 years of age, who were treated at OUHSC with induction chemotherapy. Patients were divided into two groups: Group 1 included patients who were admitted on weekdays (Monday-Thursday) and group 2 included patients admitted on weekends (Friday-Sunday). Patients were also sub-classified as having private insurance, public insurance (Medicaid and Medicare) or no insurance. Primary outcomes were overall survival at follow up (OS), complete remission (CR) and Relapse. Chi-Square analysis was utilized to assess if day of admission and insurance status was related to OS, CR and Relapse. Cox Proportional hazards model was used to measure association of insurance status, day of admission and their interaction and Kaplan Meir Survival curves were used to estimate survival rates for day of admission by insurance status. Results: We analyzed total of 161 patients, 157 met inclusion criteria with 69 (44%) having public insurance, 58 (37%) with private insurance and 30 (19%) were uninsured. Group 1 with 94 (60%) patients was admitted on weekdays (Monday–Thursday), and group 2 with 63 (40%) patients was admitted on weekend (Friday-Sunday). The median age at diagnosis was 49 years, 63.7% male 36.3% female. 77.0% white, 10.6% African American, 6.2% Native American and 3.7% Hispanic. We found a significant interaction between insurance status and day of admission, 63% of uninsured patients being admitted on weekend (Fri-Sun) with (p-value=0.0292). When we stratified patients by insurance status there was no difference in survival outcomes for uninsured patients based on day of admission. However, for patients with insurance who were admitted on weekdays Mon-Thurs (Group 1) had a hazard ratio (HR) of death 0.487 relative to those on weekends Fri-Sun (Group 2) (p=0.0238). Median overall survival (OS) for uninsured patients in (Group 2) was 147.5 days (95% CI=79-252) as compare to insured patients in (Group 1) 252 days (95% CI=116-459) with a P value 0.0182. The proportion of patients achieving CR did not differ by day of admission (p=0.3275) and insurance type (0.5678). Relapse was not associated with day of admission (p=0.2284) or by insurance type (p=0.4057). Conclusions: For the patients with the diagnosis of AML who presented to our institution, there was a noticeable trend of uninsured patients being admitted over the weekend. The overall survival was lower for the uninsured patients who were admitted on the weekend as compare to the insured patients who were admitted on weekdays. This trend is both noteworthy and significant and due to its possible impact on standard of care warrants further investigation. Disclosures No relevant conflicts of interest to declare.

Description: Background: The duration of time from the diagnosis of acute myeloid leukemia (AML) to the initiation of chemotherapy is dependent on multiple factors. Previous studies suggest that delays in the time from diagnosis to treatment do not impact overall survival (OS) and complete remission (CR). As a result, awaiting laboratory analysis of molecular targets for therapy, specifically FLT3, has become more commonly adopted by clinicians. However, this strategy can lead to significant delays in initiation of chemotherapy. The aim of this study is to analyze the impact of delaying chemotherapy on OS and CR in AML patients. Methods: We performed a retrospective analysis on adult patients with AML who were treated with induction chemotherapy at The University of Oklahoma Health Sciences Center from January 2000 to June 2012. Time from admission to treatment (TAT) was calculated from the date of admission to the date of initiation of chemotherapy. In addition, we analyzed the admission day of the week and its association with TAT (days). Association between CR and TAT was assessed using ANOVA and Chi-Square tests. Kaplan-Meier estimates of median OS were calculated for groups defined by categorical variables. A Cox Proportional Hazards model on OS was implemented using TAT, age, risk status (favorable, intermediate and unfavorable risks), day of admission, distance to hospital, and white blood cell (WBC) count. Interaction was assessed and a backward selection procedure was used to find the covariates associated with OS. Statistical analysis was performed using SAS 9.3 software. Results: A total of 160 patients with AML received induction chemotherapy at our institution during the defined time, with 137 meeting inclusion criteria. The median age at diagnosis was 51 years with 63.7% being male and 36.3% being female. Of these patients, 77.0% were white, 10.6% African American, 6.2% Native American and 3.7% Hispanic. The median TAT for all patients was 3.0 days. There were 116 (84.7%) patients treated within 0-4 days (Group 1) and 21 (15.3%) patients treated beyond 4 days (Group 2). Patients in Group 1 had a median survival of 252.5 days compared to those in Group 2 of 188.5 days (p = 0.0958) when analyzed univariately. Multivariable analysis demonstrated TAT of 0-4 days was independently related to OS with a hazard ratio of .604 (95% CI 0.369-0.990, p = 0.0451). The CR rate for Group 1 was 69.8% compared to Group 2 of 54.6% (p = 0.0692). In addition, patients admitted on a weekday (Monday-Friday) were more likely to initiate chemotherapy within 0-4 days as compared to patients admitted on the weekend (Saturday-Sunday) with a p = 0.0102. Conclusion: AML patients treated more than 4 days following admission have decreased OS and a trend toward decreased rate of CR as compared to patients treated within 0-4 days. This finding is independent of age, risk status, WBC count, and distance to hospital. Also, patients admitted on the weekend were more likely to experience delays in initiating chemotherapy compared to those admitted on the weekday. Although a larger sample size and testing in other clinic settings needs to be done to confirm this relationship, this study suggests treating AML patients within 4 days of hospital admission may be associated with improved outcomes. Disclosures No relevant conflicts of interest to declare.

Description: Abstract 4288 Background: Intravenous catheters are widely used in acute myeloid leukemia (AML) patients. Complications associated with these catheters are frequently encountered and contribute to morbidity, mortality, and increased cost of treatment. Studies exploring and comparing complications in the different types of catheters in this unique patient population are lacking. We retrospectively studied infectious and thrombotic catheter-related complications in AML patients treated at the largest tertiary referral center for AML in Oklahoma. Methods: AML patients above the age of 18 who were referred to The University of Oklahoma Health Sciences Center from January, 2000 to June, 2012 were identified and medical records were reviewed. Patients were stratified according to type of first catheter inserted (peripherally inserted central catheter (PICC), infusion port (IP), or Hickman). First catheter-related blood stream infection and deep venous thrombosis (DVT) events were reported (subsequent catheter-related complications were not included). Statistical analysis was performed using SAS 9.2 software (SAS Institute Inc). Fisher exact test was used to compare patients with different types of catheters. Results: 195 patients with AML were identified; of which 125 were included in the analysis (Patients referred for stem cell transplant (SCT) were excluded if not treated with prior chemotherapy at our institution). Median age at diagnosis was 51 years. 87 (70%) were males and 38 (30%) were females. 97 (78%) were White, 11 (9%) Native Americans, and 10 (8%) African Americans. 73 (58%) had PICC, 34 (27%) had Hickman, and 17 (14%) had IP. Blood stream infection occurred in 34% of all patients. Blood stream infection rates in each group were 32% in patients with PICC, 47% with IP, and 31% with Hickman (p=0.47). When divided by age group, infections occurred in 41% of patients 55 years of age or older and in 29% of those