Access to hematopoietic stem cell transplantation

Abstract

Background The purpose of this study was to determine whether utilization of Hematopoietic Stem Cell Transplantation (HCT) to treat leukemia, lymphoma or multiple myeloma differs by race and gender. Methods We estimated the annual incidence of leukemia, lymphoma and multiple myeloma in the United States (US) in people younger than 70 years by race and gender using the SEER Cancer Registry between 1997 and 2002 and US Census Reports for year 2000. The annual incidence of autologous, human leukocyte antigen (HLA) identical sibling and unrelated HCT performed in these groups in the US was estimated using Center for International Blood and Marrow Transplant Research data from 1997 to 2002. Logistic regression was used to calculate the age-adjusted odds ratio of receiving HCT for Caucasians versus African-Americans and men versus women. Results The likelihood of undergoing HCT was higher for Caucasians than for African-Americans [Odds Ratio (OR) =1.40 (95%CI: 1.34-1.46)]. This difference existed for each type of HCT: autologous [OR=1.24 (1.19-1.30)], HLA identical sibling [OR=1.59 (1.46-1.74)] and unrelated donor [OR=2.02 (1.75-2.33)]. Overall, men were more likely than women to receive HCT [OR=1.07 (1.05-1.1) p<0.0001]; however, this difference was significant only for autologous HCT [OR=1.10 (1.07-1.13), p<0.0001]. Conclusions HCT is more frequently used to treat leukemia, lymphoma and multiple myeloma in Caucasians than in African-Americans. African-Americans have lower rates of both autologous and allogeneic HCT, indicating that donor availability cannot fully explain the differences. Women are less likely than men to receive autologous HCT for reasons unexplained by age or disease status.

How Do Differences in Treatment Impact Racial and Ethnic Disparities in Acute Myeloid Leukemia?

“…Many of these previous studies focus on outcomes after bone marrow transplant, using data from the International Bone Marrow Transplant Registry with or without linkage to SEER data. These studies show lower rates of transplant for black patients (19,22) and higher transplant failure rates for Hispanic patients (21). These studies also show a strong correlation between low socioeconomic status (SES) and inferior outcomes after bone marrow transplantation in blacks (17).…”

“…Differences in receipt of appropriate or evidence-based treatment by race and ethnicity correlate with worse outcomes from several solid malignancies (12,17,18). For hematologic malignancies, however, there are few studies that assess whether racial/ethnic disparities in outcomes are due to differences in receipt of treatment (19)(20)(21)(22). Many of these previous studies focus on outcomes after bone marrow transplant, using data from the International Bone Marrow Transplant Registry with or without linkage to SEER data.…”

“…None of these studies, however, analyze differences in the receipt of chemotherapy, nor do they assess the impact of treatment differences on disparate survival outcomes. Finally, these studies include patients with various diseases amenable to transplantation, including multiple myeloma (19), lymphoma (19,22), and leukemia (20)-each associated with unique risks for mortality. To date, there are no population-based studies that evaluate the impact of differences in any treatment on survival disparities in AML.…”

Combination of a haploidentical SCT with an unrelated cord blood unit: a single-arm prospective study

“…This situation is even worse for non-Caucasian people. [3][4][5][6] The paucity of available donors encourages research towards alternative sources of stem cells such as HLA-mismatched/haploidentical family donors or unrelated umbilical cord blood (UCB), which provide the advantages of easy procurement and immediate availability despite their respective drawbacks. In an effort to retain the advantages of both stem cell sources and bypass their drawbacks, we attempted to combine UCB and haploidentical sources for transplantation as a novel approach.…”

Geographic access to hematopoietic cell transplantation services in the United States

“…7 For HCT, both the geographic and non-geographic components of access, as well as population and system-level factors, appear to have significant roles in both utilization and outcomes. Disparities in access to HCT services have been reported for minority and/or socially disadvantaged populations, 12,13 as well as difficulties in securing a suitable donor 14 and limited evidence of worse overall outcomes after HCT. 13 Furthermore, patient sociodemographic characteristics such as age, gender and insurance status have also been shown to influence utilization of HCT services.…”