Social determinants of health and access to allogeneic hematopoietic cell transplantation for acute myeloid leukemia

Whether allogeneic hematopoietic cell transplant (allo-HCT) to treat acute myeloid leukemia (AML) is equitably accessible regardless of social determinants of health (SDOH) remains unknown. We examined associations of SDOH with access to allo-HCT and other outcomes. Patients presenting for treatment (n = 692) at 13 AML treatment centers were prospectively recruited to a registered clinical trial (number NCT01929408). Various patient-, AML-, and SDOH-specific variables were collected. Outcomes included mortality without allo-HCT, receipt of allo-HCT, and mortality after allo-HCT. Individual multivariable models (Fine-Gray for the first 2 outcomes, Cox regression for the third) were fit for each SDOH variable, adjusting for relevant patient- and AML-specific variables. Allo-HCT was used to treat 46% of patients. A 10% increase in the proportion with less than a high school education, in households receiving Supplemental Nutrition Assistance Program, receiving Supplemental Security Income, or in poverty led to modeled adjusted hazard ratios (aHRs) of 1.21 (0.99-1.46), 1.13 (0.97-1.31), 1.41 (1.01-1.97), and 1.16 (0.96-1.39) for death without allo-HCT. The aHRs were 0.67 (0.55-0.83), 0.88 (0.76-1.01), 0.71 (0.48-1.05), and 0.91 (0.75-1.09) for lessened receipt of allo-HCT. Among those who received allo-HCT, aHRs for mortality were 1.18 (0.87-1.60), 1.13 (0.92-1.38), 1.21 (0.81-1.82), and 1.04 (0.79-1.36). Results highlight increased mortality without allo-HCT and decreased access to allo-HCT, but lesser magnitude of increased mortality after allo-HCT, among patients from lower resourced areas due to limited education and/or increased poverty. Targeted interventions and policy changes are needed to ensure that marginalized patient populations have equitable chances for AML cure compared with others.

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Publication Details

Journal
Blood
Published
2025-03-11
DOI
https://doi.org/10.1182/blood.2024027543
Citations
11
Primary Topic
Childhood Cancer Survivors' Quality of Life
Type
article
Field-Weighted Citation Impact
38.44
Controls
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article

Social determinants of health and access to allogeneic hematopoietic cell transplantation for acute myeloid leukemia

Bruno C. Medeiros, Mohamed L. Sorror, Selina M. Luger, Rayne H. Rouce et al.
11 citations
Blood
Childhood Cancer Survivors' Quality of Life
38.44
article

Social determinants of health and access to allogeneic hematopoietic cell transplantation for acute myeloid leukemia

Bruno C. Medeiros, Mohamed L. Sorror, Selina M. Luger, Rayne H. Rouce, John P. Galvin, Natalie Wuliji, Aaron T. Gerds, Ted Alan Gooley, Stephanie J. Lee, Jacob Appelbaum, Eunice S. Wang, Mitchell Garrison, Maria R. Baer, Mikkael Aaron Sekeres, David A. Rizzieri, Kehinde Adekola, Kiarash Kojouri, Salene M. W. Jones, Tanya M. Wildes, Mary‐Elizabeth M. Percival, Brenda M. Sandmaier, Sudipto Mukherjee, Paul J. Shami, Frederick Appelbaum, Julie Smith
article en
11 citations

Abstract

Whether allogeneic hematopoietic cell transplant (allo-HCT) to treat acute myeloid leukemia (AML) is equitably accessible regardless of social determinants of health (SDOH) remains unknown. We examined associations of SDOH with access to allo-HCT and other outcomes. Patients presenting for treatment (n = 692) at 13 AML treatment centers were prospectively recruited to a registered clinical trial (number NCT01929408). Various patient-, AML-, and SDOH-specific variables were collected. Outcomes included mortality without allo-HCT, receipt of allo-HCT, and mortality after allo-HCT. Individual multivariable models (Fine-Gray for the first 2 outcomes, Cox regression for the third) were fit for each SDOH variable, adjusting for relevant patient- and AML-specific variables. Allo-HCT was used to treat 46% of patients. A 10% increase in the proportion with less than a high school education, in households receiving Supplemental Nutrition Assistance Program, receiving Supplemental Security Income, or in poverty led to modeled adjusted hazard ratios (aHRs) of 1.21 (0.99-1.46), 1.13 (0.97-1.31), 1.41 (1.01-1.97), and 1.16 (0.96-1.39) for death without allo-HCT. The aHRs were 0.67 (0.55-0.83), 0.88 (0.76-1.01), 0.71 (0.48-1.05), and 0.91 (0.75-1.09) for lessened receipt of allo-HCT. Among those who received allo-HCT, aHRs for mortality were 1.18 (0.87-1.60), 1.13 (0.92-1.38), 1.21 (0.81-1.82), and 1.04 (0.79-1.36). Results highlight increased mortality without allo-HCT and decreased access to allo-HCT, but lesser magnitude of increased mortality after allo-HCT, among patients from lower resourced areas due to limited education and/or increased poverty. Targeted interventions and policy changes are needed to ensure that marginalized patient populations have equitable chances for AML cure compared with others.

BloodVol. 145(25)
Northwestern University (US), University of Maryland, Baltimore (US), Roswell Park Comprehensive Cancer Center (US), Cleveland Clinic (US), Cape Town HVTN Immunology Laboratory / Hutchinson Centre Research Institute of South Africa (ZA), University of Miami (US), Baylor College of Medicine (US), University of Washington (US), University of Utah (US), Skagit Valley Hospital (US), Huntsman Cancer Institute (US), University of Illinois System (US), Novant Health (US), University of Illinois Chicago (US), University of Chicago (US), Fred Hutch Cancer Center (US), Levine Cancer Institute (US), Regional Health (US), Stanford Medicine (US), Wenatchee Valley Hospital & Clinics (US), Sylvester Comprehensive Cancer Center (US), Robert H. Lurie Comprehensive Cancer Center of Northwestern University, U-M Rogel Cancer Center (US), University of Nebraska Medical Center (US), University of Pennsylvania (US), Stanford University (US)
No poverty
Openalex Percentile: Top 0%
Childhood Cancer Survivors' Quality of Life
38.44
DOISourceOpenAlex
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