Gaps in Optimal Care for Acute Myeloid Leukemia among Adults in their Communities and a Proposal for Future Care Model

Despite significant diagnostic and therapeutic advances in Acute Myeloid Leukemia (AML) and Myelodysplastic Syndrome (MDS) over the past two decades, a substantial proportion of US patients continue to face systemic barriers that prevent care optimization.This review examines four domains where these disparities are most pronounced: precision at diagnosis using molecular testing, germline genetic counseling, clinical trial enrollment, and allogeneic hematopoietic stem cell transplantation (HSCT).We quantify current gaps in these domains, appraise previous and current efforts to bridge the gaps ending with a proposed path forward.We highlight that patients in community settings are 14% less likely to undergo molecular testing compared to those at academic institutions, directly limiting risk stratification and access to targeted therapies.Fewer than 20% of patients meeting criteria for germline genetic counseling receive it.Clinical trial enrollment remains critically low, with enrollment incidence ratios as low as 0.28 among certain minority populations, reflecting both structural access barriers and the limited effectiveness of existing federal diversity mandates.Allogeneic HSCT rates remain disproportionately low among older, frail, and socioeconomically disadvantaged patients.Various solutions are explored across each domain, with a central theme of reducing systemic burden, expanding community-based support, and building more integrated care infrastructure.The compounding effect of these deficits continues to drive gaps in AML and MDS care; addressing these gaps is essential to achieving equitable outcomes.binaytara.org/