Trend disparities in allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia.

188 Background: Acute myeloid leukemia (AML) is the most prevalent form of leukemia, and allogeneic hematopoietic cell transplantation (Allo-HCT) remains the most effective treatment. With recent advancements in donor availability, nearly all patients now have a suitable donor. Our objectives were to identify factors associated with disparities in Allo-HCT and to examine trends in Allo-HCT disparities in the context of increased donor availability. Methods: Data on AML patients diagnosed between 2004 and 2021 were obtained from the National Cancer Database Participant User File. An adjusted mixed logistic regression model was used to estimate odds ratios and 95% confidence intervals (CIs) for factors associated with Allo-HCT receipt. To further estimate trends of Allo-HCT disparities over time, adjusted mixed linear regression models were applied to calculate annual absolute changes (AACs) and corresponding 95% CIs across levels of the significant factors identified. Results: Among the 93,975 included patients, six factors were significantly associated with Allo-HCT receipt. Hispanics had reduced odds of receiving Allo-HCT compared to non-Hispanic Whites (NHWs). Patients from higher vs. lower education and income level zip codes, with private vs. Medicaid and Medicare insurance, from academic/research vs. non-academic programs, and who lived farther vs. closer from the reporting facility had increased odds of receiving an Allo-HCT. From 2004 to 2021, AACs were not significantly different between each minority race/ethnicity group and NHWs. However, significant differences in the AACs were observed for patients from counties with the highest vs. lowest education (AAC: 0.25%; 95% CI: 0.14%, 0.36%) and income (AAC: 0.20%; 95% CI: 0.10%, 0.31%) levels. Moreover, compared to patients with private insurance, those with Medicaid and Medicare had 0.53% (95% CI: -0.69%, -0.36%) and 0.75% (95% CI: -0.83%, -0.67%) lower AACs, respectively. Patients who were reported from community cancer programs and integrated network cancer programs also experienced lower AACs (-0.36% [95% CI: -0.44%, -0.28%] and -0.10% [95% CI: -0.20%, 0.01%], respectively) vs. those at academic/research programs. Additionally, patients who lived 10–50, 50–100, and ≥100 miles from the reporting facility had 0.20% (95% CI: 0.12%, .28%), 0.34% (95% CI: 0.22%, 0.46%) and 0.43% (95% CI: 0.29%, 0.57%) increased AACs, vs. those living within 10 miles, respectively. Conclusions: Increased donor availability has not translated into equal benefits across patient groups with widening disparities in some groups. Disadvantaged populations who were expected to benefit the most instead experienced smaller increases in Allo-HCT receipt over time. Further research is warranted to explore factors contributing to persistent disparities in Allo-HCT utilization among minority and underserved groups.