Despite progress, disparities in HSCT utilization remain
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Key takeaways:
- Non-Hispanic Black patients had a lower rate of HSCT for all six blood cancers studied.
- Pediatric, adolescent and young adult patients had a higher rate of allogeneic HSCT than adults.
Disparities in hematopoietic stem cell transplantation utilization for blood cancers have narrowed over time but still persist, according to study results.
There is a particularly high unmet need to further reduce disparities among older adults and non-Hispanic Black individuals, findings showed.
Analyses of HSCT utilization among patients with hematologic cancers historically have revealed disparities based on race, ethnicity and age.
Theresa Hahn, PhD, clinical epidemiologist at Roswell Park Comprehensive Cancer Center, and colleagues conducted a U.S. population-based retrospective cohort study to evaluate utilization over time.
The cohort included 136,280 patients (58% men; 83.3% aged 40 to 84 years) who underwent transplants between January 2009 and December 2018 for one of six blood cancers: acute myeloid leukemia, myelodysplastic syndrome, acute lymphoblastic leukemia, multiple myeloma, Hodgkin lymphoma or non-Hodgkin lymphoma,
Three-quarters (74.5%) of the cohort was non-Hispanic white, whereas 11.4% were non-Hispanic Black, 10.3% were Hispanic and 3.8% were non-Hispanic other.
Utilization rates of autologous or allogeneic HSCT by age, race and ethnicity served as the main outcomes.
About two-thirds (63.7%) of the cohort underwent autologous HSCT and one-third (36.2%) underwent allogeneic HSCT.
The HSCT utilization increased over time for all diseases, as well as for all groups analyzed by age, race or ethnicity.
From 2017 to 2018 — the last 1-year period analyzed — utilization rates among patients who received allogeneic transplant for AML or myelodysplastic syndrome appeared similar between Hispanic, non-Hispanic white and non-Hispanic other individuals; however, they remained lower for non-Hispanic Black individuals for both AML (19% vs. 13%) and MDS (9% to 10% vs. 5%).
In that same period, autologous transplant utilization appeared similar by race and ethnicity; however, among patients with multiple myeloma, a higher percentage of non-Hispanic patients than those of other backgrounds underwent transplant (31% vs. 26% to 27%).
Among pediatric/adolescent/young adult patients, utilization of allogeneic transplant for ALL appeared highest among Hispanic patients.
Researchers acknowledged study limitations, including the possibility that demographic and geographic differences in SEER reporting data and the location of centers where HSCT is performed could mean the findings are not representative of the entire U.S. population. They also noted the possible underestimation of the HSCT utilization due to codes used to define hematologic cancers. For example, the code for plasma cell myeloma encompasses several conditions other than multiple myeloma — such as plasma cell leukemia, smoldering multiple myeloma and monoclonal gammopathy of uncertain significance — for which transplant is not performed.
“More work is needed to understand and address the contextual factors to improve HSCT utilization based on the latest scientific evidence and ensure equal access for disadvantaged populations,” Hahn and colleagues wrote.
In an invited commentary, Tolulope O. Rosanwo, MD, a pediatrics fellow at Boston Children’s Hospital, applauded researchers for revealing persisting disparities and the need for solutions driven toward promoting equity.
“Altogether, these observations from Hahn [and colleagues] reveal the sobering reality that many patients are inappropriately lacking in access to a necessary life-prolonging treatment,” Rosanwo wrote. “Campaigns raising awareness of this disparity, patient advocates — particularly for older patients with cancer — and critical scientific discoveries investigating methods to reduce risks [for] graft-versus-host disease in unrelated donor transplant all have a role to play in improving the landscape for HSCT utilization for patients from minoritized groups.” .
References:
- Disparities narrowing among patients undergoing blood stem cell transplant, Roswell Park study reveals (press release). Available at: https://www.roswellpark.org/newsroom/202409-disparities-narrowing-among-patients-undergoing-blood-stem-cell-transplant-roswell. Published Sept. 20, 2024. Accessed Oct. 14, 2024.
- Hahn T, et al. JAMA Netw Open. 2024;doi: 10.1001/jamanetworkopen.2024.33145.
- Rosanwo TO. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.33124.
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