Improved overall survival in acute myeloid leukemia over the last 15 years.

6543 Background: Overall survival (OS) for acute myeloid leukemia (AML) has remained dismal over the past decades. In the last five years, 11 drugs have been approved for newly diagnosed and relapsed/refractory AML. We, therefore, hypothesized that OS has increased significantly in recent years. Methods: We identified 78,092 pts diagnosed with AML between 2004 and 2019 from the National Cancer Database and divided them into 2 cohorts based on year of diagnosis, 2004-2010 and 2011-2019. The Kaplan-Meier method was used to estimate OS probabilities. Cox regression was used to evaluate the association of patient and disease characteristics with OS and differences in these associations between the two cohorts. Results: Sixty-one percent of patients were ≥60 years old, 46% were female, 85% were white, and 90% had Charlson comorbidity index of 0-1. Forty-five percent were diagnosed in 2004-2010, and the rest were diagnosed in 2011-2019. Chemotherapy use increased over the years, with 81% of patients receiving chemotherapy in 2019 compared to 73% in 2004. Similarly, 12.2% of patients in 2012 received hematopoietic cell transplant (HCT) compared to 6.5% in 2004. One-year, 3-year, and 5-year OS for patients diagnosed in 2011-2019 were 48%, 31%, and 28% compared to 42%, 25%, and 22%, respectively, for patients diagnosed in 2004-2010. On multivariable analysis, OS differed significantly over the years based on race, AML subtype, receipt of chemotherapy, and HCT use. OS for white people was better compared to black in 2004-2010 but similar in 2011-2019. Both white and black people had worse OS compared to other race types in 2004-2010 and 2011-2019. Acute promyelocytic leukemia had the best OS compared to core-binding factor, therapy-related, and other AML types; OS improved the most in acute promyelocytic leukemia and core-binding factor AML over the years. Compared to 2004-2010, OS increased significantly in 2011- 2019 with the receipt of chemotherapy and HCT. Older age, male sex, lower income, no insurance, higher Charlson comorbidity index, and lower educational attainment were associated with worse OS with no significant change in recent years. Conclusions: In one of the largest studies, we identified improved OS in patients with AML in recent years. Improvement in OS is likely multifactorial, including recent drug approvals, increased use of chemotherapy and HCT, and better supportive care. Despite a meaningful improvement in OS, only one out of four patients with AML were alive after five years, highlighting a continued need for further drug development and the importance of HCT.