Investigation of Socioeconomic Variables and Neutropenia Management on Pediatric Acute Myeloid Leukemia Outcomes

Background

Acute myeloid leukemia (AML) is the second most common pediatric hematologic malignancy and, alarmingly, accounts for a disproportionately high amount of pediatric leukemia mortality. The current standard frontline treatment consists of induction chemotherapy with cytarabine and anthracycline, followed by consolidation chemotherapy and/or hematologic stem cell transplant. Following high-dose chemotherapy, patients experience several days of severe neutropenia. Over half of pediatric AML patients will experience at least one microbiologically documented infection during this time period. There is currently no standard practice for whether to discharge pediatric AML patients a few days after chemotherapy completion or to wait until neutropenia resolves (approximately 35 days). There is documented variation on inpatient versus outpatient neutropenia management across the country.

Project Goal

As part of the Aplenc lab project, I will collect and analyze pediatric AML patient variables from participating sites throughout the country. My contribution will hopefully aid in developing a standardized practice to reduce mortality from neutropenic events during chemotherapy. Outcome disparities are persistent in pediatric acute leukemia and the impact of environmental variables such as socioeconomic status (SES) are few. In my second project, I will use an ArcGIS, an open source geocoding software, to explore the potential interaction between neighborhood-based SES factors and pediatric leukemia treatment outcomes of patients in Philadelphia and Houston. Discovery of a linkage between neighborhood factors and treatment variables would provide a starting point for working towards the elimination of socioeconomic disparities in pediatric acute leukemia treatment outcomes.