Tackling Racial Disparities in AML Care: Karilyn Larkin, MD

Karilyn Larkin, MD, a hematologic oncologist specializing in acute myeloid leukemia (AML) at The Ohio State University Comprehensive Cancer Center–The James, traces her commitment to health equity back to her childhood in a medically underserved town. Watching her mother weigh whether her brother’s chronic illness warranted a 45-minute trip for care, she said, instilled an early sense that clinicians and health systems must look out for those who are less fortunate.

That instinct followed her into clinical practice, where she noticed something that troubled her: patients with identical risk profiles, disease characteristics, and prognostic counseling often ended up with wildly different outcomes. That observation, she said, is part of what drew her into research through the Clara D. Bloomfield Center for Leukemia Outcomes Research, where she has led and contributed to studies documenting racial disparities in AML survival, including work showing that Black and White patients with the disease have measurably different underlying tumor biology.

Larkin said translating those findings into practice starts with acknowledging what is still unknown. Prospective research is needed to explain why young Black patients with AML fare worse than their White counterparts, she said, and diagnostics must evolve to detect the mutations driving those disparities, alongside preclinical work to target them directly. She also pointed to the field’s reliance on fixed age cutoffs to guide treatment intensity, arguing that trials should instead let biology and physician judgment determine care, enabling unbiased analyses of measurable residual disease and biomarkers.

Equally important, she said, is being candid with patients, including telling Black patients directly that outcomes have historically been worse for them. That honesty, she said, has shaped her own practice: offering stem cell transplant to Black patients with genetically favorable AML subtypes who have nonetheless fared poorly on chemotherapy alone, even though she cannot yet prove transplant will close the gap.

Looking ahead, Larkin said every new AML trial and therapy should be scrutinized for who was represented in the data, particularly as targeted agents reshape treatment. Correlative research built into trial design, she said, is essential so that drug approvals reflect the full range of patients seen in clinical practice.