Non-European HSCT recipients undergo more complex procedures with fewer resources
Hematopoietic stem cell transplant recipients of non-European ancestry had a significantly higher likelihood of receiving allogeneic grafts from HLA-mismatched donors than individuals of European ancestry, study results showed.
Data from the retrospective analysis, presented during a virtual media briefing prior to ASH Annual Meeting and Exposition, revealed that allogeneic HSCT recipients of non-European ancestry typically faced more complex procedures while requiring more financial support.
“We know that these transplants, while they extend access to minority patients, are more specialized and complicated and require a higher level of care,” Warren B. Fingrut, MD, research fellow at Memorial Sloan Kettering Cancer Center, told Healio. “Not only is the medical care more complicated for these non-European ancestry patients, but the population is ... enriched with those who have additional social needs, are socially vulnerable and will require additional resources to support them through this difficult time in their lives.”
Background
Previous studies have linked patient ancestry and socioeconomic status with impact on care outcomes among those who have received HSCT. However, less is known about the impact of donor type among these patients.
Researchers from Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine sought to determine whether low socioeconomic status disproportionately impacts patients of non-European ancestry who received HLA-disparate allografts, including patients who received grafts from cord blood, haploidentical or mismatched-unrelated donors.
Methodology
The retrospective analysis included 372 consecutive adults (median age, 62 years; range, 19-81) who underwent allogeneic HSCT between March 2020 and February 2022. Seventy-three percent of patients received a referral for HSCT due to myeloid malignancy.
The investigators divided patients into groups according to ancestry and donor type and used surrogate indicators of socioeconomic status for the analysis, including area deprivation index, Medicaid as primary insurance at referral and receipt of financial support for cost-of-living or medical expenses in the 6 months before transplant.
The study groups included 257 patients (69%) of European descent and 115 patients (31%) with non-European ancestry (white Hispanic, n = 31; African, n = 40; Asian, n= 34; Middle Eastern, n = 4; and mixed non-European, n = 6).
Key findings
The analysis showed a significantly higher proportion of patients of non-European ancestry received HLA-disparate grafts compared with those of European descent (58% vs. 24%; P < .001).
Investigators noted similar area deprivation index scores regardless of ancestry. However, significantly more patients of non-European ancestry received financial support (29% vs. 15%; P = .002) and had Medicaid as their primary insurance at time of referral (10% vs. 4%; P = .013) compared with those of European ancestry.
Further analysis revealed that patients of non-European ancestry granted financial support received 40% more funding than patients of European ancestry.
Three times as many HLA-disparate graft recipients of non-European descent had Medicaid as their primary insurance (12% vs. 4%; P = .015) compared with their counterparts of European lineage. Additionally, twice as many non-European HLA-disparate recipients received financial support before treatment (33% vs. 15%; P = .001).
Results showed no significant differences according to ancestry among patients who received HLA-matched grafts.
Clinical implications
Investigators observed an intersectionality between ancestry and socioeconomic status, and an association with donor type suggesting the most financially vulnerable and historically underserved patients are receiving the most complex transplants that “require the highest level of expert care,” according to Fingrut.
Future efforts to advance equity will require better classifications of socioeconomic status that include recording of household income rather than the use of surrogate indicators, he added.
“As our as centers continue to extend access [to allogeneic transplant] to minority patients ... it is really important to consider that it’s not just about getting the patients through the front door,” Fingrut told Healio. “In many cases, there will be patients who require additional levels of social resources to help them through the transplant.”
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Fingrut WB, et al. Abstract 127. Presented at: ASH Annual Meeting and Exposition; Dec. 10-13, 2022; New Orleans.