Socioeconomic status and access to bone marrow transplants

Patients with acute myeloid leukemia who have lower education and income are less likely to receive an allogeneic hematopoietic stem cell transplant for acute myeloid. However, if they can access the treatment, are equally likely to benefit from transplant as patients with more education and higher income, according to a new study from Fred Hutch Cancer Center, presented at the annual meeting of the American Society of Hematology (ASH).

The study, which analyzed zip code-level data showing socioeconomic differences among 692 acute myeloid leukemia patients evaluated for stem cell transplant, showed that lower area-level education and higher poverty indicators, such as reliance on government assistance programs, were associated with increased mortality before transplant and reduced likelihood of receiving transplant.

However, once patients accessed transplants, socioeconomic factors had a less pronounced impact on post-transplant outcomes, indicating that interventions should focus on overcoming barriers to accessing transplantation.

“This study has highlighted the need for targeted interventions to improve access for patients from lower socioeconomic backgrounds,” said senior author Dr. Mohamed Sorror, professor (Hematology and Oncology) and clinical researcher at Fred Hutch Cancer Center. “We need to focus on addressing financial barriers, improving health literacy, and enhancing support systems to ensure equitable access to treatments.”

Patients in the study who lived in neighborhoods with higher proportions of residents who had not completed high school were 30% less likely to receive a transplant and had a 24% higher risk of death without transplant.

Further, reliance on government assistance programs, such as supplemental security income, was associated with a 40% increased risk of death without transplant and a 22% decrease in the likelihood of receiving a transplant.

“This study was born out of our clinical observations that if we could get a low socioeconomic patient over the transplant access barrier, their survival outcomes were equivalent to individuals with higher socioeconomic status,” said lead author Dr. Natalie Wuliji, acting instructor (Hematology and Oncology), who presented the study at ASH. “With this analysis confirming our initial theory, we can now take steps toward solving the challenge of transplant access.”