MacNeal Hospital

Purpose: Acute myeloid leukemia (AML) is a high-mortality hematologic malignancy, particularly in older adults. Early palliative care (PC) improves symptom control, quality of life, and outcomes, yet disparities in utilization persist. This study evaluated trends in inpatient PC use among AML patients and associations with mortality, costs, and complications. Patients and Methods: A retrospective cohort analysis was conducted using the 2019-2021 National Inpatient Sample. AML cases were identified via ICD-10 codes and stratified by PC use. The primary outcome was inpatient mortality; secondary outcomes included length of stay (LOS), costs, and complications. Analyses included t-tests, chi-square tests, and logistic regression adjusted for demographic, socioeconomic, and hospital-level factors. Results: Among 220790 AML hospitalizations, 27540 (12.4%) involved PC. PC recipients were older (67.4 vs 58.7years, P < .01) and more often White (75.3% vs 70.7%, P < .01). PC use was lower among Black (OR 0.90, P = .05), Hispanic (OR 0.70, P < .01), and Asian (OR 0.77, P < .01) patients. Utilization was highest in urban teaching hospitals (89.2%, P < .01) and Medicare beneficiaries (OR 1.87, P < .01). PC use was associated with higher mortality (37.4% vs 4.4%, OR 11.74, P < .01), longer LOS (12.9 vs 12.3days, P < .01), increased costs ($214,915 vs $174,193, P < .01), and more complications (all P < .01). Conclusion: PC utilization in AML is associated with poorer clinical metrics, likely reflecting late-stage intervention. Earlier PC integration and addressing disparities are urgently needed to improve equity, outcomes, and resource use in AML care.

7066 Background: Three CAR-T cell therapies i.e. axicabtagene ciloleucel, tisagenlecleucel and lisocabtagene maraleucel are currently approved for relapsed refractory DLBCL after 2 or more prior lines of treatment. Landmark trials have shown promising efficacy however, a notable concern with CAR-T therapy is the potential development of secondary primary malignancies. Methods: A retrospective study was performed using TriNetX, a global research de-identified database with data from 145 health care organisations as of January 2025. ICD-10 codes were used for associated diagnosis and medications. The database was queried to identify RR-DLBCL patients who had received any of axi-cel, tisa-cel or liso-cel. These treatments were set as the index event for outcome analysis. Demographics and prevalence of comorbidities were extracted. Outcome analysis queried for several hematological and solid tumor malignancies. The Measure of Association Analysis was used to calculate Odds Ratio. Results: 1842 adult patients with RR-DLBCL received one of the 3 CAR-T cell treatments as listed above and 12,431 patients with RR-DLBCL did not receive any of the 3 treatments. There were 1:1 propensity score matched adjusting for age, race, sex and tobacco use. Final number for both groups was 1842. For both cohorts, 1367 (73.8%) were white, 1055 were male (57%). The cohort had a mean follow up of 497 days, median follow up of 331.5 days. The CAR-T group had higher rates of MDS (3.9% vs 0.8%, p=&lt;0.001) and AML (3.2% vs 1.2%, p=&lt;0.001) in our database review of the US population. It did not show higher rates of other reported SPMs like Mature T/NK cell lymphoma, Hodgkin's lymphoma, multiple myeloma or solid tumours like lung, breast, prostate primary or malignant melanoma. Data on other SPMs is shown in Table 1. Conclusions: In our retrospective study of real-world population, RR-DLBCL patients who received CAR-T cell therapy with any of axi-cel, tisa-cel or liso-cel showed higher rates of MDS and AML compared to propensity matched patients with RR-DLBCL who did not receive CAR-T cell therapy while rates of other reported SPMs were not significantly different. Frequency of SPMs in CAR-T receiving and no CAR-T receiving patients with RR-DLBCL. SPM Received CAR-T cohort (%) Did not receive CAR-T cohort (%) Odds Ratio p-value MDS 3.9 0.8 4.852 (2.767-8.507) &lt;0.001 AML 3.2 1.2 2.668 (1.624-4.382) &lt;0.001 Mature T/NK cell lymphoma 0.7 1.5 0.466 (0.238-0.909) 0.022 Hodgkin's lymphoma 0.9 1.9 0.469 (0.257-0.854) 0.011 Follicular lymphoma 3.8 3.6 1.055 (0.721-1.545) 0.781 Mantle cell lymphoma 1.0 0.5 1.792 (0.825-3.893) 0.135 Multiple Myeloma 1.4 2.4 0.566 (0.341-0.938) 0.025 Primary Lung site 0.7 0.5 1.292 (0.565-2.954) 0.543 Primary Breast site 0.5 0.7 0.815 (0.351-1.892) 0.634 Prostate cancer 0.5 0.6 0.902 (0.382-2.129) 0.814

12043 Background: Radioimmunotherapy (RIT) utilizing monoclonal antibodies conjugated with therapeutic radionuclides, has emerged as a promising treatment option in oncology. While demonstrating significant clinical efficacy, concerns regarding therapy-related myeloid neoplasms (t-MNs) have been raised in other contexts, particularly following RIT for non-Hodgkin lymphoma. This study aims to investigate the risk of t-MNs following treatment with Lutathera (177Lu-DOTATATE) and Pluvicto (177Lu-PSMA-617) in patients with neuroendocrine tumors and metastatic castration-resistant prostate cancer. Methods: We conducted a multicenter retrospective study using the TrinetX database network, a federated Electronic Medical Record Network including adult patients with a history of using Lutathera and/or Pluvicto and developed t-MNs. Statistical analysis is performed on the TrinetX research platform. Outcome analysis was performed for 1) Incidence of t-MNs. 2) Mortality rates and Survival analysis. Results: A total of 2370 patients who received either Lutathera (n=1368; 57.7%) or Pluvicto (n=1002; 42.3%) were identified in the database. Mean age was 71 years (±11 years), 64.98% (n=1540) were males and 70.08% were whites. Of the 2370 patients, 1.6% (n=39) developed t-MNs (26 MDS (1.09%), 13 AML (0.54%). Among these, 27 were in the Lutathera cohort (1.97% of total patients), and 12 were in the Pluvicto cohort (1.12%). The mean age in the t-MN cohort was 72 years (±9 years) and 50% were males. 16 (41%) patients with t-MN had prior chemo or radiotherapy. The remaining 23 patients (59%) received no anticancer therapy associated with t-MNs. Median survival for patients with t-MNs was 38.1 months, with an overall mortality of 51.2% at median follow-up. Conclusions: This is the largest study reporting the incidence of t-MN associated with RIT. Our study demonstrated a significant risk of therapy-related t-MNs following RIT, even in patients who did not receive additional chemoradiotherapy. Given the short follow-up, we hypothesize that the risk may increase with longer-term follow-up. Using this real-world data, our Next step would be to include Next-Generation Sequencing for further characterization of the genomic landscape of these patients. Demographic, treatment, and follow-up data of the study population. Baseline characteristics RIT RIT with t-MNs Total patients 2370 39 Mean age (in years) (SD) 71 (±11) 72 (±9) Gender*(%)MalesFemales 64.9822.07 50.046.6 Race*(%)WhitesAfrican American 70.087.60 73.338.6 Radiation therapy (%)Chemotherapy (%)CabazitaxelDocetaxelCarboplatinCisplatinDoxorubicinOlaparib 20.2-5.2016.70.730.220.765.0 41.0 Median follow-up (in months) 11.4 27.3 Median survival (in months) (IQR) 44.5 (41.6-48.3) 38.1 (15-51.6) Mortality rates (%) 28.9 51.2 *Indicates remaining Unknown/Other; IQR: Interquartile range.

12064 Background: Acute myeloid leukemia (AML) is a life-threatening hematologic malignancy with high morbidity and mortality, particularly among older adults. Early integration of palliative care (PC) has been shown to improve symptom management, quality of life, and healthcare outcomes in AML patients. However, significant disparities in PC utilization persist, driven by socioeconomic factors such as race, income, and insurance status. This study examines trends in PC use among AML inpatients, focusing on its impact on mortality, hospitalization costs, and complications, while highlighting barriers to equitable care access. Methods: We conducted a retrospective cohort study utilizing the National Inpatient Sample (NIS) database from 2019 to 2021, identifying AML patients via ICD-10 codes, and were classified based on their PC utilization. The Institutional Review Board (IRB) approval was not mandatory since the NIS contains deidentified data. The primary outcome was inpatient mortality, with secondary outcomes including length of stay (LOS), total hospital costs, and key complications. Statistical analysis included t-tests, chi-square tests, and multivariable logistic regression adjusting for demographic, socioeconomic, and hospital factors. Results: A total of 220,790 AML hospitalizations were identified, with 27,540 (12.4%) utilizing PC. PC patients were older (67.41 vs. 58.65 years, p &lt; 0.01) and predominantly White (75.27% vs. 70.70%, p &lt; 0.01). Odds of PC utilization were lower for Black (OR 0.9, p = 0.05), Hispanic (OR 0.7, p &lt; 0.01), and Asian (OR 0.77, p &lt; 0.01) patients. Utilization was highest in urban teaching hospitals (89.2%, p &lt; 0.01) and Medicare patients (OR 1.87, p &lt; 0.01), followed by private insurance (22.99%), Medicaid (8.91%), and self-pay patients (1.38%). Mortality was significantly higher in the PC group (37.4% vs. 4.42%, OR 11.74, p &lt; 0.01). Secondary outcomes included longer stays (12.94 vs. 12.25 days, p &lt; 0.01), higher costs ($214,915 vs. $174,193, p &lt; 0.01), and more complications (tumor lysis syndrome, stroke, thrombocytopenia, sepsis, anemia; all p &lt; 0.01). Conclusions: Palliative care in AML patients was associated with higher mortality, longer hospital stays, increased costs, and complications, likely reflecting its introduction at more advanced stages of the disease. These findings underscore the urgent need for earlier integration of palliative care into treatment protocols. Addressing barriers such as healthcare inequities and improving access to timely interventions could enhance patient quality of life, reduce complications, and optimize resource utilization, ultimately fostering more equitable, efficient, and cost-effective care for AML patients.

5028 Background: Testicular cancer, the most common malignancy in men aged 15 to 45 years, has a high cure rate exceeding 95% with early diagnosis and proper treatment. However, these favorable outcomes are not equitably distributed across all racial and socioeconomic groups. This study aims to analyze these disparities in testicular cancer survival outcomes from 2014 to 2021. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients diagnosed with testicular cancer (ICD-O-3 site codes C620-C629) from 2014 to 2021. Variables including stage, treatment, ethnicity, income level, and geographic location (urban/rural) were extracted. Patients with missing data were excluded from the analysis. Statistical methods included chi-square tests, Kaplan-Meier survival curves, and Cox proportional hazards models. Analyses were conducted using R (v4.4.1). Results: A total of 20,508 patients were included in the study. The population was predominantly White (87%), followed by Asian/Pacific Islanders (5%) and African Americans (3%). The majority of patients were aged 20–39 years (60%), with T1 disease (42.89%) and no nodal involvement (N0- 53.93%). Seminomas accounted for 52.7% of cases, followed by mixed germ cell tumors (25.88%) and embryonal carcinoma (7.73%). Primary treatments included surgery (95%) and chemotherapy (38%). Advanced disease stages (T3–T4, M1, Stage II–III) and extensive nodal involvement were significantly associated with poor survival outcomes (p&lt;0.001). Multivariate stratified analyses revealed higher overall mortality (OM) among African Americans (HR = 1.75, p &lt; 0.001) and Asian/Pacific Islanders (HR = 1.25, p = 0.003) compared to White patients. The Hispanic population exhibited an 8.8% higher hazard compared to non-Hispanics (HR = 1.088, p = 0.02). Patients with annual incomes below $40,000 had significantly elevated OM (HR = 2.41, p &lt; 0.001), whereas those with incomes of $120,000 or more demonstrated better survival outcomes (HR = 0.77, p = 0.019) compared to the reference group ($40,000- $120,000). Multivariate analyses of cancer-specific mortality (CSM) revealed similar findings, with African American patients (HR = 1.69, p &lt; 0.001) and individuals in lower-income brackets (HR = 2.12, p &lt; 0.001) experiencing worse outcomes. Conclusions: This study highlights racial and socioeconomic disparities in testicular cancer survival outcomes, with African American patients and individuals in lower-income brackets experiencing significantly worse overall and cancer-specific mortality. It underscores the need for future research to investigate structural inequities and insurance-related barriers contributing to these disparities and develop actionable strategies to achieve equity in cancer outcomes.

e24097 Background: Cytokine release syndrome (CRS) is a potentially life-threatening complication of cancer immunotherapy with profound economic and clinical consequences. Older adults and underserved populations face unique challenges, including higher rates of comorbidities, limited access to specialized care, and greater financial strain, which exacerbate the burden of CRS. This study sought to evaluate the impact of CRS on key outcomes, including mortality, length of stay, hospitalization costs, and complications while addressing disparities in care delivery to these vulnerable populations. Methods: The National Inpatient Sample (NIS) database (2019–2021) was used to identify patients hospitalized with CRS using ICD-10 codes. Patients were stratified by age (&lt; 65, 65–74, and ≥75 years). Baseline demographics, comorbidities, and hospital characteristics were compared using Pearson Chi-square tests for categorical variables and t-tests/ANOVA for continuous variables. Multivariate logistic regression estimated adjusted odds ratios (aORs) for in-hospital outcomes, accounting for age, comorbidities, and hospital characteristics. Results: Of 16,254 CRS patients analyzed, 59% were aged &lt; 65 years, and 41% were ≥65 years. Males constituted 56.57% of the younger group and 56.12% of the older group (p = 0.78). Older patients had a higher proportion of White individuals (75.54% vs. 56.22%) and fewer Black, Hispanic, and Asian individuals (p &lt; 0.01). In-hospital mortality was significantly higher in the ≥65 years age group, with an odds ratio (OR) of 1.78 (95% CI 1.64–1.94). Length of stay was shortest in the ≥75 years group (10.7 days), while total hospitalization costs peaked in the 65–74 years group at $400,754 (p = 0.03). Age-related complications included increased rates of sepsis, thrombocytopenia, anemia, and neutropenia in older patients, while severe outcomes such as CRS, deep vein thrombosis (DVT), and pulmonary embolism (PE) remained consistent across age groups. Conclusions: This study highlights the disproportionate burden of CRS on older adults, who demonstrated higher mortality and increased complications, including thrombocytopenia, anemia, and neutropenia. Despite shorter hospital stays, costs peaked in older patients. These findings underscore the need for tailored interventions to address age-related risks, optimize outcomes, and ensure equitable cancer care.