Chemotherapy-related toxicities and healthcare burden in Acute Myeloid Leukemia: A nationwide inpatient analysis

Abstract Background: Acute myeloid leukemia (AML) therapy remains heavily reliant on cytotoxic regimens that carry a substantial risk of systemic toxicity. Contemporary, population-level data on the burden and outcomes of chemotherapy-induced complications in AML are limited. We used the National Inpatient Sample (NIS) to trace recent trends and identify predictors of adverse in-hospital outcomes in adults with AML who were actively receiving chemotherapy. Methods: Using ICD-10-CM codes, we isolated hospitalizations from 2018-2021 listed as primary or secondary diagnosis of AML, Prior history of chemotherapy, and receipt of chemotherapy during the index stay. Chemotherapy-related toxicities—neutropenia, anemia, fever, nausea, vomiting, mucositis, Diarrhea, and bacteremia were captured with validated code clusters. Discharge-level survey weights produced national estimates. Multivariable logistic regression, adjusting for age, sex, race, Charlson comorbidity score, primary payer, median household income quartile, hospital bed size, teaching status, and region, tested associations between individual toxicities and in-hospital mortality and prolonged length of stay. Results: Across the four-year window, we identified 27 million hospital admissions; there were 53,022 admissions with primary and secondary diagnoses of AML meeting inclusion criteria with patients received chemotherapy (10,207)and neutropenia(1,871), anemia (4,900), fever (2,284), nausea and vomiting (1,150), mucositis (779), diarrhea 543 and bacteremia (527) Overall incidence of any coded AML with chemotherapy toxicity was 31,315. Anemia and fever were most common. In-hospital mortality, 4,446 AML patients expired, among whom 47.9% (2,904) AML patients had chemotherapy toxicities. And 5.2%(234) of the expired patients were AML patients admitted for encounter for chemotherapy. Conclusions: Chemotherapy-induced toxicities remain frequent and increasingly burdensome among hospitalized AML patients, with Anemia and fever conferring the highest immediate complications. Escalating resource use underscores an urgent need for earlier toxicity mitigation strategies and optimized supportive-care pathways, particularly during periods of health-system strain. Future work should explore targeted prophylaxis and post-discharge care models to blunt the growing clinical and economic toll.