The Influence of Social Determinants of Health on Treatment Delivery and Outcomes in Acute Leukemia

Abstract Purpose of Review Acute leukemia outcomes have conventionally been predicated on the genomic characteristics of leukemia cells. However, emerging evidence from population-based and national co-operative group studies suggests a pivotal role of social determinants of health (SDOH) on acute leukemia survival outcomes. Recent Findings Acute leukemia outcomes over the past two decades have benefited from advances in molecular diagnostics, which have ushered in a multitude of targeted therapies including small molecule inhibitors and immunotherapies, liberalization of donor matching for transplantation, and early incorporation of supportive care. However, these advances have not benefited all populations equally. Environmental exposures, insurance status, access to transportation, and language barriers are some evaluable domains of social determinants of health (SDOH) that have been linked to leukemia outcomes. SDOH can influence leukemia outcomes through impact on patient access to specialized care, clinical trial enrollment, allogeneic stem cell transplantation, and palliative care. Beyond well-established disparities in access to care, emerging epidemiologic evidence suggests that SDOH may influence the genomic and biological characteristics of leukemia. Clinical prognostic leukemia models such as ELN 2022 do not accurately predict chemotherapy outcomes in diverse patient populations. This may be attributable to biologic differences in leukemia conferred by the social and heritable aspects of race. With the current landscape shifting to incorporate small-molecule inhibitors and immunotherapies into the frontline treatment of leukemia, SDOH-informed risk stratification can optimize prognostication and guide vulnerable patients toward less toxic, equally effective therapeutic alternatives. Summary This review summarizes current evidence on how social determinants of health can influence multiple aspects of leukemia biology and outcomes and provides a framework to address the influence of SDOH along the continuum of acute leukemia care.