Introduction Acute Myeloid leukemia (AML) is the most common form of acute leukemia among adults and accounts for the largest number of annual deaths from leukemia in the United States. As the population ages, the incidence of AML will continue to rise. For practical reasons, many patients with AML will continue to be treated in community hospitals. With continuous development of new AML therapies, we are facing increasing difficulties in standardizing the care, with a need for even more specialized medical staff and implementation of standard operating procedures with the goal of maximizing safety and treatment efficacy. Our hypothesis is that a dedicated leukemia service which assumes responsibility of caring for patients with AML for the entire course of their disease in a community hospital would result in improved patient outcome. Methods In 2021 we established a dedicated leukemia service which included physicians, advanced practice practitioners, nurses, pharmacist, social worker and administrative staff, we instituted weekly meetings to discuss cases and standard operative procedures and education sessions. We planned a retrospective single institution study to analyze outcome of adult patients with AML, excluding APL, treated in our hospital before and after implementation of a dedicated leukemia service. Cohort 1 included patients diagnosed with AML between January 1, 2018 and December 31, 2020 and cohort 2 patients diagnosed between January 1, 2021 and December 31, 2023. Patient characteristics (age, gender, race, comorbidities), AML characteristics (de novo or secondary, risk stratification), treatment (type of chemotherapy, bone marrow transplantation, best supportive care and hospice, lines of therapy), and follow up data (response to therapy, relapse, vital status) were abstracted by chart review. Patients in cohort 1 were followed till December 31, 2021 with a median follow up of 8 months and patients in cohort 2 were followed till December 31, 2024 with a median follow up of 10.7 months. Kaplan Meier, logistical regression and Cox model were used for statistical analysis. For Cox and logistic regression, models were built with input cohort and a set of covariates made up of patient and AML characteristics. Results There were 45 patients in cohort 1 and 64 patients in cohort 2. Median age was 63 years in cohort 1 and 69 in cohort 2. Patients older than 60 represented 67% of each cohort and 24.4% and 18.8% of patients were older than 80 in cohort 1 and 2 respectively. There were 56% male in cohort 1 and 48% in cohort 2, with the remaining patients being female. White patients comprised 80% of cohort 1 and 86% of cohort 2. The mean of comorbidity burden was 2.3 in cohort 1 and 3 in cohort 2, most common comorbidity being endocrine. In cohort 1, 26.7% of patients underwent allogenous bone marrow transplant and 17.2% in cohort 2. Remission rate to first line chemotherapy was 40% in cohort 1 and 54.7% in cohort 2. Cohort 2 had significantly lower 30-day mortality with an odds ratio of 0.118 (95% CI: 0.022, 0.612) and significance was maintained in the subgroup of patients who received non intensive chemotherapy with an odds ratio of 0.086 (95% CI: 0.010, 0.708). Median overall survival (OS) was similar between the two cohorts but was significantly improved for cohort 2 in patients undergoing non intensive chemotherapy (p-value: 0.0053), with a median of 14.93 months compared with 5.1 months for cohort 1. Overall survival was also significantly improved for cohort 2 in patients over 60 years of age (p-value: 0.015). Leukemia free survival (LFS) was similar between the two cohorts but was significantly better for cohort 2 in patients undergoing non intensive chemotherapy (p-value: 0.024), with a median of 15.1 months compared with 5.2 months in cohort 1. LFS was significantly better for cohort 2 in patients over 60 years of age (p-value: 0.0321). Conclusion Our study shows that implementation of a dedicated leukemia service in a community hospital can improve outcome, remission rate, 30-day mortality, and DFS and OS in a subgroup of patients undergoing non intensive chemotherapy and in patients over 60. This study can support the allocation of both human and material resources to create a dedicated leukemia service in a community-based practice

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2025
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