Manuel Ricardo Espinoza-Gutarra

PURPOSE: Financial toxicity is common after bone marrow transplant (BMT) and is associated with worse quality of life, but longitudinal patterns remain poorly understood. METHODS: We conducted a prospective cohort study of insured adults undergoing allogeneic BMT (2018-2023). Financial toxicity (Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy) and quality of life (Functional Assessment of Cancer Therapy [FACT]–General, FACT-BMT) were assessed at baseline and at days (D) 90, 180, and 365. Longitudinal trends were analyzed using mixed-effects models. Relative risks (RR) for financial toxicity and hazard ratios (HR) for post-BMT mortality were estimated using generalized linear mixed-effects and time-varying Cox models. RESULTS: Among 214 transplanted patients, the median age was 58 years (IQR 46-66 year), 62% were male, and 80% were White; 47% had leukemia, 27% myelodysplastic syndrome, and 9% lymphoma; and 31% died by D365. At baseline, 56% reported none/minimal, 26% mild, and 18% moderate/high financial toxicity. Financial toxicity was associated with more cost-cutting behaviors, including reduced spending on food or clothing, use of savings, and prescription nonadherence. Expected probability of ≥mild financial toxicity reduced over time (39% baseline, 34% D90, 30% D180, 26% D365). Across time points, age >65 years and income >$90,000 in US dollars (USD) had 66% and 67% decreased risk of financial toxicity, respectively, compared with counterparts (n = 148, RR, 0.34, 95% CI [0.19 to 0.59]; RR, 0.33 [0.20 to 0.57]). Quality of life (n = 119 alive and with data by D365) with none/minimal or mild financial toxicity improved after transplant compared with baseline but significantly worsened for those with moderate/high financial toxicity over 1 year. Following adjustment for covariables, financial toxicity was not significantly associated with premature death after transplant (n = 214, HR, 1.10 [0.62-1.96]). CONCLUSION: Financial toxicity improved overtime with BMT, but persistent financial hardship was associated with quality of life. These findings support longitudinal screening and financial interventions across the transplant continuum.

Objective: To evaluate associations between early immune reconstitution and transplant outcomes following allogeneic hematopoietic cell transplantation (alloHCT) using tacrolimus/methotrexate graft-versus-host disease (GVHD) prophylaxis.Patients and methods: We conducted a single-center retrospective study of 149 adults undergoing matched-related or matched-unrelated donor alloHCT for hematologic malignancies between 2014 and 2024. Patients developing treatment-requiring acute GVHD (aGVHD) before day 28 were excluded from immune-reconstitution outcome analyses, leaving 133 patients. CD4+, CD8+, natural killer, and B-cell counts were assessed on days 28, 56, and 84.Results: Median day 28 CD4+ T-cell count was 272 cells/µL. Patients with CD4+ counts <272 cells/µL had higher rates of subsequent grade II-IV aGVHD (45.5% vs. 20.9%; p=0.003) and aGVHD-related mortality (15.2% vs. 0%; p<0.001). In multivariable analysis, CD4+ count <272 cells/µL (OR, 2.86; 95% CI, 1.13-7.24; p=0.026) and HLA mismatch (OR, 4.29; 95% CI, 1.46-12.66; p=0.008) were independently associated with grade II–IV aGVHD.Conclusion: Lower day 28 CD4+ T-cell recovery was associated with subsequent aGVHD and aGVHD-related mortality, supporting prospective evaluation as an early risk marker following Tac/MTX-based alloHCT.

Background and Aims: Acute myeloid leukemia (AML) remains the most common cause of death in adults with acute leukemia. Tyrosine kinase inhibitors (TKIs) have shown significant clinical efficacy in defined patient subgroups. Real‐world outcomes of AML patients undergoing TKI therapy have not been widely reported. Methods: In this real‐world retrospective study, we included 482 adult patients with AML treated with a TKI targeting FLT3, IDH1, or IDH2 from January 1, 2015, to December 31, 2023, in the countrywide Flatiron Health electronic health record‐derived deidentified database. We utilized unadjusted Kaplan–Meier methods to calculate median real‐world event‐free survival (rwEFS) and overall survival (rwOS). We utilized a multivariable Cox regression model to evaluate characteristics associated with rwOS, modeling post‐TKI stem cell transplant (SCT) as a time‐varying covariate. Results: Those who received treatment at 1L (first‐line) and 2L+ (second‐line and beyond) had similar length of TKI therapy (3.7 vs. 3.4 months), rwEFS (2.2 vs. 2.5 months), and rwOS (12.3 vs. 13.1 months), respectively. Among all patients, greater rwOS was associated with receiving pre‐TKI SCT ( p < 0.001), commercial insurance (vs. Medicaid; p = 0.035), younger age ( p = 0.043), and favorable 2017 ELN risk classification (vs. adverse; p = 0.032). When restricted to patients treated with TKI at 2L+ without prior SCT, rwEFS were 1.4, 1.6, and 2.1 months by targetable mutation (IDH2, IDH1, and FLT3), and rwOS were 8.7, 15.4, and 9.5 months, respectively. Conclusion: Patients treated with HMA plus TKI did not have significant differences compared to TKI alone. In this substantial, real‐world cohort of AML patients receiving TKIs, clinical outcomes remained deficient irrespective of timing of TKI start, mutational target, and concurrent HMA.

Acute Myeloid Leukemia (AML) is a common hematologic neoplasm in adults and usually carries a grim prognosis. Therapy has traditionally consisted of intensive chemotherapy; however, recent advances have led to the development of Tyrosine Kinase Inhibitors (TKI) as Targeted Therapies for subtypes carrying certain mutations. While the clinical impact of these therapies has been well described, there have been no studies looking at clinical disparities among different racial/ethnic groups receiving these therapies. We leveraged an EHR-derived database to evaluate real-world outcomes in patients receiving TKIs for AML. Our study found no significant differences between real-world Event Free Survival (rwEFS) and real world Overall Survival (rwOS) across patients of different racial/ethnic groups, this suggests that when patients have access to targeted therapy outcomes across different racial/ethnic groups become more equitable.

Background: Cancer is the leading cause of death for Hispanics in the USA. Screening and prevention reduce cancer morbidity and mortality.Methods: This study administered a cross‐sectional web‐based survey to self‐identified Hispanic residents in the state of Indiana to assess their cancer‐related knowledge, beliefs, and behaviors, as well as to identify what factors might be associated with cancer screening and prevention. Chi‐square and Fisher's exact test were used to compare associations and logistic regression used to develop both univariate and multivariate regression models.Results: A total of 1520 surveys were completed, median age of respondents was 53, 52% identified as men, 50.9% completed the survey in Spanish, and 60.4% identified the USA as their country of birth. Most were not able to accurately identify ages to begin screening for breast, colorectal, or lung cancer, and there were significant differences in cancer knowledge by education level. US‐born individuals with higher income and education more often believed they were likely to develop cancer and worry about getting cancer. Sixty eight percent of respondents were up‐to‐date with colorectal, 44% with breast, and 61% with cervical cancer screening. Multivariate models showed that higher education, lack of fatalism, older age, lower household income, and unmarried status were associated with cervical cancer screening adherence.Conclusions: Among a Hispanic population in the state of Indiana, factors associated with cervical cancer screening adherence were similar to the general population, with the exceptions of income and marital status. Younger Hispanic individuals were more likely to be adherent with breast and colorectal cancer screening, and given the higher incidence of cancer among older individuals, these results should guide future research and targeted outreach.