P157 | GEOGRAPHIC CHARACTERISTICS OF PATIENTS UNDERGOING ALLOGENEIC STEM CELL TRANSPLANTATION AND ITS IMPACT ON TRANSPLANT PROCEDURES AND LONG-TERM OUTCOME: A SINGLE CENTER RETROSPECTIVE ANALYSIS

Patients residing in areas where hospitals specialized for allogeneic stem cell transplantation (Allo-SCT) are lacking may experience differences in healthcare access and long-term outcome. Previous experiences from US hospitals (Rao, 2007; Abou-Nassar 2012) showed increased non-relapse mortality (NRM) for patients coming from rural areas or with longer driving distance. In Italy, healthcare differences persist among different geographic areas, often obliging patients from South and Center Italy to move to northern hospitals. To investigate whether these phenomena are still present in Italy and to explore its potential impact on patient’s outcome we performed a retrospective analysis at our center. Between 2010 and 2024, 652 patients received an Allo-SCT for a hematologic malignancy. Geographic referral did not differ significantly between 2010 and 2024 (Fig1a) with most patients coming from the North, in particular from Lombardia region. Patients from the North were significantly older (median 51y) than those from the Center (44y) and the South (47y) (p<0.001). Main indications for transplant were acute myeloid leukemia/myelodysplastic syndrome (AML/MDS), followed by non-Hodgkin (NHL) and Hodgkin (HL) lymphoma, with more patients with AML/MDS referred from North and South Italy, and more subjects with NHL/HL coming from Center Italy (Fig1b, p=0.001). Time from diagnosis to transplant was significantly longer for patients referred from Center and South relative to North Italy (18,2 vs 18,3 vs 10,9 months; p=0.007). However, disease status before transplant was similar regardless of the referral area (p=0.533). Donor type was significantly different since patients from South and Center Italy were more frequently transplanted from a matched (MRD) or haploidentical (Haplo) relative, while an unrelated donor (UD) source was more frequent in recipients from the North (Figure1c, p=0.003). Long-term outcome was similar among regions: 5-year NRM (Fig1d, p=0.812) did not differ between pts coming from North, Center or South, also when a 6-months landmark analysis was performed (p=0.481) since most recipients go back to their homeland 6 months after transplant. Similar results were found when comparing in and extra region patients. In conclusion, in our experience referral from a different region no longer results in worse outcome and is associated with different patient/donor characteristics, such as older age, disease type and donor source.