Natalie Wuliji, DO, and Mohamed Sorror, MD, MSc, on the Impact of Socioeconomic Factors on Access to and Outcomes of Allogeneic Hematopoietic Cell Transplantation for Acute Myeloid Leukemia: A Multi-Center Observational Study

Dr. Sorror: Hello everyone. My name is Mohamed Sorror, I'm a professor at Fred Hutchinson Cancer Center. And I have with me today Dr. Natalie Wuliji, who is an assistant professor at Fred Hutchinson Cancer Center. And we both are today summarizing the results of a study that was presented at the American Society of Hematology annual meeting, looking at the socioeconomic factors and their impact on the outcomes and access to allogeneic transplant for treatment of acute myeloid leukemia. Dr. Wuliji: Mohamed, what if you could tell me a little bit about what was the inspiration for the study? Dr. Sorror: Well, the main inspiration for this study is allogeneic hematopoietic cell transplantation is a complex and costly procedure, and we know it is potentially curative for many patients with acute myeloid leukemia. But we also know that many patients who get diagnosed with acute myeloid leukemia are older patients. And we wanted to understand how much social and economic factors might impact the outcomes of patients with acute myeloid leukemia. And the ability to receive allogeneic transplant and the outcomes after receiving allogeneic transplant. We wanted to understand how these factors are impacting these outcomes, are there any barriers that we need to take into account in the future. Dr. Wuliji: Thank you. Dr. Sorror: So then let me ask you if you can give us a little bit details about the design of the study. Dr. Wuliji: So this was a prospective study longitudinal across 13 US AML treatment centers in the United States. We enrolled patients between ages 18 and 80 who were treated with AML or AML-like therapy. They had either newly diagnosed AML or less refractable disease or higher risk MDS. They needed to have received curative intent therapy. And so what we wanted to look at is how social determinants of health impacted not only the receipt of allogeneic transplant, but also survival outcomes such as mortality without transplant, as well as post-transplant mortality. And so what we found was, as we expected, socioeconomic factors or social determinants of health do impact access to allogeneic transplant as well as mortality before transplant. So patients are more likely to die if they come from what we call high-risk social factors, such as reliance on government assistance programs or from neighborhoods with high proportions of patients with less than high school education. However, what was surprising to us was the fact that once patients receive transplant, the socioeconomic factors or barriers appear to have less effect. This finding actually makes us think that once patients are able to receive transplant, the socioeconomic barriers are much less important. Dr. Sorror: And can you tell me, because many studies have looked at these factors before, why you think this study is unique? Dr. Wuliji: Absolutely. So first of all, this was a prospective study. We examined social determinants of health in detail, so we looked at four key social determinants of health domains that reflected both general risks as well as specific social risks. But also we had a very comprehensive adjustments. We adjusted for patient specific factors, disease specific factors. We adjusted for quality of life infra to measures to truly isolate the impact of social determinants of health on the outcomes. Mohamed, I was wondering if you could tell me a little bit more about what should be the future steps to address the findings. Dr. Sorror: There are different steps that we would like to investigate in the future. One of them actually started, which would be creating material slides and videos prepared by prior patients to speak to future patients from the same background and try to enhance them to trust the system and enroll in trials for allogeneic transplant in the future. Also, we would like to test and research studies some interventions like for example, giving cash money to patients or hiring navigators that can help these patients who come from neighborhoods with a lower education or poverty, how they can manage the system and overcome the barriers to reach transplant centers and be able to receive the procedure. Dr. Wuliji: I think it will be also very important to involve community physicians for acute leukemia in their clinics in our future collaborative efforts.