Previous studies have determined that allogeneic hematopoietic cell transplantation (alloHCT) is a curative treatment for acute myeloid leukemia (AML). A new study has evaluated patients diagnosed with AML to determine the extent to which social factors play a role in patients receiving alloHCT. At a plenary session at the 66th American Society of Hematology Annual Meeting and Exposition, Natalie Wuliji, DO, of Fred Hutchinson Cancer Center in Seattle, discussed how there are not only socioeconomic disparities in the receipt of alloHCT, but that lower educational attainment also appears to be an important barrier to receiving the curative treatment.
Dr. Wuliji and her team performed a multivariable analysis of 695 patients with AML who were prospectively followed at 13 academic centers. They found little evidence of an association between median area income and overall mortality after alloHCT. Likewise, although there was a numerically increased mortality hazard after alloHCT as the percentage of residents with less than a high school education in a neighborhood increased, that increase was modest. They concluded that socioeconomic status plays a small role in determining the outcome after a patient receives alloHCT.
In contrast, the researchers reported a 32% decrease compared with the baseline in the likelihood of receiving alloHCT for every 10% decrease in the percentage of residents in a neighborhood with less than a high school education. The team also found a 14% decrease compared with the baseline in the likelihood of receiving alloHCT for every 10% increase in households enrolled in the Supplemental Nutrition Assistance Program. They documented a modest increase of 5% in the likelihood of alloHCT receipt as median area income increased by $25,000 relative to areas with a baseline median income. Likewise, they identified a 15% decrease in the likelihood of alloHCT receipt for each 10% increase in the percentage of households below the poverty level and a 34% decrease for each 10% increase in households receiving supplemental security income. The researchers concluded that poverty and low education levels were the main barriers to receiving alloHCT and that deep structural and administrative barriers reinforced this problem.
Mohamed L. Sorror, MD, MSc, professor at Fred Hutchinson Cancer Center and senior investigator on the study, explained that while the hematology community suspected such barriers to curative treatment existed, the study results confirmed the fear. “We need to do a better job,” Dr. Sorror said. “We don’t need to look anymore. We have identified the problem. It’s time to intervene. Now, we need to change things.”
The team concluded that their results highlight the need for targeted interventions to improve access to alloHCT for patients from lower socioeconomic backgrounds. Such interventions could include addressing financial barriers, improving health literacy, and enhancing support systems to ensure equitable access to life-saving treatments. When speaking with ASH Clinical News, Dr. Wuliji suggested “dedicating coordinators to expedite transplantation evaluation. … This is not being done for blood cancer at all.” She pointed to the NMDP (formerly the National Marrow Donor Program) and the American Society for Transplantation and Cellular Therapy ACCESS initiative as examples of stakeholders coming together across the stem cell transplant and cell therapy spaces to create sustained, meaningful improvements in access.
Any conflicts of interest declared by the authors can be found in the original abstract.
Reference
Wuliji N, Gooley T, Jones S, et al. Impact of socioeconomic factors on access to and outcomes of allogeneic hematopoietic cell transplantation (allo-HCT) for acute myeloid leukemia (AML): a multi-center observational study. Abstract 6. Presented at the 66th American Society of Hematology Annual Meeting and Exposition; December 8, 2024; San Diego, California.
