Patients of non-European ancestry and especially those of low socioeconomic status are more likely to receive the most specialized types of allogeneic stem cell transplantation that require the highest level of care, according to new findings presented by Fingrut et al at the 2022 American Society of Hematology (ASH) Annual Meeting and Exposition (Abstract 127).
Background
Allogeneic stem cell transplantation for the treatment of hematologic cancers requires an allograft from a suitable donor. Clinicians aim to find a donor with the same human leukocyte antigen proteins as the patient to minimize the risk of an adverse immune reaction.
If a human leukocyte antigen–identical donor is not available in the family, clinicians prefer a human leukocyte antigen–matched volunteer unrelated donor. For patients without these options, clinicians can perform a more specialized type of transplant using stem cells from human leukocyte antigen–mismatched cord blood, half-matched family members, or human leukocyte antigen–mismatched unrelated donors.
Study Methods and Findings
While previous studies have shown that patients of non-European ancestry were less likely to receive a transplant from a matched unrelated donor, this new study revealed that the interactions between the patient’s racial background and socioeconomic status—rather than just race and ethnicity alone—are important factors contributing to the types of allografts these patients receive. The study also revealed discrepancies in the metrics used to assess socioeconomic status, underscoring the need for better data.
“Our transplant program is very committed to extending transplant access to minority populations, but our study highlights that many of these patients are both receiving the most complex transplants and facing significant socioeconomic challenges,” highlighted lead study author Warren Fingrut, MD, a research fellow and hematologist in the Department of Medicine at Memorial Sloan Kettering Cancer Center. “Our findings show that addressing financial hardship will be critical to extend transplant access, especially to patients from minority groups.”
The researchers analyzed the health records of 372 patients who underwent allogeneic transplantation and discovered that about 70% of them had European ancestry, while the rest of the patients had White Hispanic, African, Asian, Middle-Eastern, or mixed non-European ancestry. Since household income data were not available, the researchers assessed patients’ socioeconomic status using four surrogate metrics: Medicaid insurance, the area deprivation index, receipt of financial support for cost-of-living, and medical expenses.
Overall, 58% of patients with non-European ancestry received human leukocyte antigen–mismatched transplants, compared with 24% among those with European ancestry. This relationship was more pronounced among patients who were both of non-European ancestry and of low socioeconomic status by at least one measure. However, different metrics classified separate patients as having low socioeconomic status, suggesting that no single surrogate metric perfectly captured all patients who may have been facing economic hardship.
Conclusions
“In order to address disparities, we must describe them, understand them, and delve into their causes,” concluded Dr. Fingrut, underscoring that “It’s not just the highly specialized medical care that’s needed for these more vulnerable patients—our study also speaks to the resources needed to support them.”
To better understand these nuances, researchers emphasized that medical centers should proactively collect data on patients’ income and employ a mix of methods to assess their socioeconomic status.
Disclosure: For full disclosures of the study authors, visit ash.confex.com.
