‘Quite striking’: Donor socioeconomic status may affect stem cell transplant outcomes
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Key takeaways:
- Recipients of cells from donors with low socioeconomic status had shorter OS.
- Researchers hope to explore if this relationship exists among children.
The socioeconomic status of cell donors may affect outcomes of people with blood cancer who undergo hematopoietic stem cell transplantation, according to retrospective study results.
Patients who received cells from donors with low socioeconomic status achieved shorter OS and had higher treatment-related mortality at 3 years than those whose donors had high socioeconomic status.
“Our findings are incredibly fascinating,” Lucie M. Turcotte, MD, MPH, MS, associate professor at University of Minnesota Medical School and pediatric hematologist/oncologist with M Health Fairview, told Healio. “We hypothesized we would see differences, but the nearly 10% difference in overall survival [among patients] receiving cells from donors in the highest vs. lowest [socioeconomic status] groups was quite striking.”
Prior research has established low socioeconomic status as a risk factor for immune dysfunction and mortality across various diseases, including cancer.
However, whether social disadvantage of cell donors — as measured by low socioeconomic status — may impact the recipient’s health outcomes had not been established, according to study background.
Turcotte and colleagues retrospectively analyzed outcomes of 2,005 people (median age, 51 years; range, 1-77; 92% white, 44% women) who underwent allogeneic HSCT at one of 125 transplant centers in the United States.
More than three-quarters of HSCT recipients had acute myeloid leukemia (55%) or myelodysplastic syndrome (22%). Median donor age was 34 years (range, 18-62).
Researchers reported significantly lower 3-year OS among patients who received cells from donors in the lowest quartile of socioeconomic status vs. those who received cells from donors in the highest quartile (38.2% vs. 47.9%; P = .001).
Results showed significantly higher treatment-related mortality at 3 years among patients who received cells from donors in the lowest quartile of socioeconomic status vs. the highest quartile (30.8% vs. 24.2%; P = .008).
Donor socioeconomic status also appeared significantly associated with HSCT recipients’ DFS; however, results showed no association between donor socioeconomic status and cancer relapse, acute graft-versus-host disease or chronic GVHD.
Investigators observed no significant associations between HSCT recipients’ socioeconomic composite score and any clinical outcome.
The findings are consistent with prior research that established a link between socioeconomic disadvantage and altered immune cell function and hematopoiesis, researchers wrote.
However, they highlight what researchers characterized as “an unanticipated persistence of those effects after cells are transferred into a new host environment.”
Researchers acknowledged study limitations, including the retrospective and cross-sectional nature of the cohort, lack of data on donor health comorbidities, and a lack of racial diversity in the cohort, which supports the need for validation in more diverse contemporary groups.
Nonetheless, the results demonstrate a “striking biological impact of social disadvantage” and how it can alter health outcomes for people with cancer who undergo HSCT, Turcotte told Healio.
“Further research is needed to validate these findings and to understand the specific molecular mechanisms underlying these health disparities so interventions can be developed to mitigate the adverse health outcomes introduced by socioeconomic disadvantage,” Turcotte said. “We are investigating the underlying biologic and physiologic drivers of these findings, and are also hoping to investigate whether the same findings are observed in children with cancer.”
The findings also may prompt concerns that some donors will be considered less favorable due to their socioeconomic status, researchers wrote.
“However, there is no benefit to serving as a HCT donor — it is an altruistic act, which may be associated with pain or missed workdays,” Turcotte and colleagues wrote. “The overarching goal of HCT is to cure disease; it is important to protect individuals who are socioeconomically disadvantaged from donating if they are not the optimal donor and to select the best available donor for recipients to increase their likelihood of survival.”
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Turcotte LM, et al. Proc Natl Acad Sci U S A. 2024;doi:10.1073/pnas.2404108121.
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