Publication date: Aug 01, 2025

Chemotherapy is crucial for treating acute myeloid leukemia (AML), as it improves survival and quality of life. However, prior studies have shown that many eligible patients in the United States do not receive chemotherapy due to demographic and socioeconomic disparities. We utilized the National Cancer Database to analyze chemotherapy utilization in 82,755 patients with AML from 2004 to 2020. We examined trends in 2 time periods, 2004 to 2010 and 2011 to 2019, with a separate analysis for 2020 to evaluate the impact of the COVID pandemic on chemotherapy use. Among all patients with AML, 57. 1% received multiagent chemotherapy, 20. 5% received single-agent chemotherapy, and 22. 4% received no chemotherapy. Chemotherapy use rose from 72. 9% in 2004 to 81. 3% in 2019, then slightly declined to 80. 6% in 2020. The odds of receiving chemotherapy increased significantly in 2011 to 2019 compared to 2004 to 2010 based on age (P = .02), race (P < .01), and AML subtype (P = .03). Patients aged 18 to 40 consistently had higher chemotherapy utilization rates, with treatment odds rising across all age groups. While Black patients were less likely than White patients to receive chemotherapy from 2004 to 2010, their odds improved significantly in 2011 to 2019. Despite increased chemotherapy use across all AML subtypes, therapy-related AML consistently showed the lowest odds of treatment. Lower-income patients, those with more co-morbidities, and female patients had reduced chances of receiving chemotherapy, and these inequities remained largely consistent over time. This large database study highlights improved but persistent disparities based on demographic and socioeconomic status, calling for innovative measures to expand chemotherapy use.

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