Key Points
Close integration of leukemia and transplant (HCT) services and use of haploidentical donors results in greater access to HCT
2. Racial disparity is reduced by this approach, but caregiver requirements continue to limit HCT access for black patients
Few patients with non-favorable risk (NFR) acute leukemia and MDS (AL/MDS) have historically accessed allogeneic transplantation (HCT). We assessed whether this can be improved by the integration of HCT/leukemia care and use of haploidentical donors (HID). Of 256 consecutive patients aged ≤75 who received initial therapy at our center for NFR AL/MDS from 2016 to 2021, 147 (57%) proceeded to planned HCT (70% for patients aged <60). On logistic regression analysis, age (OR 1.50 per 10-year increment, p<0.001), race- black vs white (OR 2.05, p=0.023), were significant factors for failure to receive HCT. Reasons for no HCT were: comorbidities (37%), poor KPS, lack of adequate caregiver support, refractory malignancy (19% each) and patient refusal (17%). Lack of donor or insurance were rarely cited (3% each). In older patients (≥60 years), comorbidities (49 vs. 15%, p<0.001) and KPS (25% vs. 10%, p=0.06) were more common reasons, and lack of caregiver support was less common (13% vs. 30%, p=0.031). In black vs. white patients, lack of caregivers (37% vs 11%, p=0.002) was more frequent. Median time from initial treatment to HCT was 118 days and was similar for black vs white patients (112 vs 122 days, p=0.80). On landmark analysis, HCT within 6 months of initial treatment resulted in better survival. On multivariable analysis, HCT resulted in a significant survival benefit (HR 0.60, p=0.020). With the above approach, the majority of currently treated patents aged ≤75 can access planned HCT. Black patients remain at higher risk for not receiving HCT.
