Disparities Research at the Deep South Alzheimer’s Disease Center of the University of Alabama at Birmingham

Residents of the US Deep South (Alabama, Georgia, Louisiana, Mississippi, and South Carolina) have a 20–30% higher risk of developing Alzheimer’s disease or related dementia (ADRD). Moreover, >20% of African Americans, who are at higher ADRD risk than whites, live in this region. Therefore, one important goals of the Deep South Alzheimer’s Disease Center (DS-ADC) of the University of Alabama at Birmingham is to spearhead research to address these disparities. This panel presents current DS-ADC research, with two presentations focusing on the local patient population and the last two on the Deep South population compared to the rest of the nation. Addressing the challenge of recruiting representative samples in clinical research, the first paper is part of a research program to understand difference that may exist between African American and white research participants. The second paper examines patients with multiple conditions, in particular dementia and cancer, showing a marked disadvantage in cognition outcomes for African Americans. The next two papers take a broader perspective to better understand the population of older adults with ADRD in the Deep South and in the rest of the US. The third paper examines socioeconomic and medical contexts of African American and white older Medicare beneficiaries with ADRD, and the fourth paper examines differences in utilization of specialists, ADRD drugs, and hospitalizations in the two regions taking these contexts into account. The discussant will close the session by placing these studies in the larger context of the disparities research at the DS-ADC.

Understanding Driving Avoidance Among Older African Americans And Whites With Diabetes

Diabetes mellitus is one of the most common chronic diseases with half of the new diagnoses affecting adults aged 60 years and older. Although African Americans are more likely to develop the disease, they are also less likely to receive healthcare. Importantly, living with diabetes is likely to negatively impact mobility for aging adults as the disease is associated with lower physical functioning (e.g., ability to maintain one’s balance). Further, diabetes could pose a significant threat to a person with diabetes’ ability to drive and remain in the community. This study examines the relationships and influences of social determinants of health (e.g., race, gender, socioeconomic status) and cognition on avoiding driving maneuvers such as driving at night and in rush hour traffic among older adults with diabetes. Data from the University of Alabama at Birmingham (UAB) Diabetes and Aging Study of Health (DASH) were analyzed and of the 224 participants, 193 (86.16%) were current drivers. There was a gender difference with 94.12% of males and 79.51% of females being current drivers, p < .01. Within the sample of current drivers, 45% were African American and being female, not married, lower levels of education and cognition, low income, and being African American were associated with higher scores on driving avoidance. Cognition explained 30.44% of the racial difference in driving avoidance. Findings from this study will help identify individuals who are at-risk for reduced mobility and identify those who may need to be intervened upon to support a better quality of life.

Hypomethylating Agent/Venetoclax Versus Intensive Chemotherapy in Relapsed or Refractory Acute Myeloid Leukemia

Background: Patients with relapsed or refractory (r/r) acute myeloid leukemia (AML) have limited treatment options. Outside of clinical trials and in the absence of a targetable mutation, there is no consensus on an optimal treatment regimen. Venetoclax (Ven), combined with hypomethylating agents (HMA) such as azacitadine (Aza) or decitabine (Dec), is approved as frontline treatment for elderly or unfit patients with AML. HMA/Ven is also being used frequently in the salvage setting. However, outcomes of HMA/Ven compared to IC for patients with r/r AML are largely unknown. Methods: We conducted a retrospective study to compare outcomes of adult patients (>18y) with r/r AML treated with either HMA/Ven or IC at the University of Alabama at Birmingham. Patients treated with HMA/Ven were matched in a 1:1 ratio to patients receiving IC following a hierarchal algorithm based on age, ELN risk stratification, time to relapse (primary refractory/<6m vs. ≥6m) and line of therapy. Treatment with HMA consisted of either Aza 75mg/m 2 for 7 days or Dec 20mg/m 2 for 5 days. Venetoclax was administered at an effective dose of 400mg daily for 21-28 days per cycle (dose adjusted for concomitant azole use). Results: There were 74 patients included in the analysis (HMA/Ven=37, IC=37). The baseline characteristics (Table 1) were well balanced with the exception of increased bone marrow blast percentage in the IC arm (59% vs. 39%, p=0.03). The median age of the IC and HMA/Ven groups was 56y (24-72y) and 63y (22-75y), respectively (p=0.06). Regimens in the IC arm included FLAG (n=16, 43%), FLAG-ida (n=11, 30%), CLAG-M (n=5, 14%), 7+3 (n=3, 8%), HiDAC (n=1, 2.5%) and MEC (n=1, 2.5%). In the HMA/Ven arm, 21 patients (57%) received Aza and 16 (43%) received Dec. The rate of complete remission (CR) was higher for IC (49% vs. 24%, p=0.02) whereas rate of CR with incomplete count recovery (CRi) was higher for HMA/Ven (35% vs. 8%, p=0.001) (Table 2). There was no difference in composite CR (CR+CRi) rates between the two arms (IC 57% vs. 59% HMA/Ven, p=0.8). Additionally, there was no difference in rate of refractory disease (27% vs. 27%, p=0.9) or 30-day mortality (IC 13% vs 11% HMA/Ven, p=0.6) between the two arms. More patients in the IC arm (41%), compared to the HMA/Ven (19%) arm proceeded to allogeneic stem cell transplantation (allo-sct) (p=0.04). The median overall survival (mOS) for the IC arm was 16m, compared to 8m for the HMA/Ven arm (p=0.1) (Figure 1). The mOS for patients with primary refractory/<6m relapse from remission was 10m for IC and 6m for HMA/Ven (p=0.4). The mOS for patients refractory to one cycle of intensive induction (7+3 in approximately 90% cases in both arms) was 20m for the IC arm and 5m for the HMA/Ven arm (p=0.03) (Figure 2). The mOS for patients relapsing ≥6m from remission was 15m for IC and 9m for HMA/Ven (p=0.5). There was no difference in survival based on age, ELN risk stratification or cytogenetics. Conclusion: Overall, there appears to be no significant difference in outcomes between IC and HMA/Ven for patients with r/r AML. Higher CR rates as well as ability to proceed to allo-sct are observed with IC. For patients refractory to the first cycle of intensive induction chemotherapy, a significant survival benefit was observed in those receiving IC compared to HMA/Ven. A second round of induction, preferably with a high-dose cytarabine based regimen, may provide better long term outcomes for these patients. Figure 1 Figure 1. Disclosures Vachhani: CTI BioPharma Corp: Consultancy; Abbvie: Consultancy; Agios: Consultancy; Blueprint Medicines: Consultancy; Pfizer: Consultancy; Seattle Genetics: Research Funding; Astellas Pharma: Speakers Bureau; Incyte: Consultancy, Speakers Bureau; Novartis: Consultancy; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham: Current Employment; Jazz Pharmaceuticals: Consultancy.