A multi-center study presented at the American Society of Hematology (ASH) annual meeting reveals that socioeconomic factors significantly impact access to allogeneic hematopoietic stem cell transplant for patients with acute myeloid leukemia (AML). The study, led by researchers at Fred Hutch Cancer Center, found that patients with lower education and income levels are less likely to receive this potentially life-saving treatment.
The research analyzed data from 692 AML patients, examining socioeconomic indicators at the zip code level. The findings indicated that lower area-level education and higher poverty indicators, such as reliance on government assistance programs, were associated with increased mortality before transplant and a reduced likelihood of receiving a transplant. Specifically, patients living in neighborhoods with a higher proportion 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. Furthermore, reliance on government assistance programs was associated with a 40% increased risk of death without transplant and a 22% decrease in the likelihood of receiving a transplant.
Impact on Post-Transplant Outcomes
Interestingly, the study also revealed that once patients successfully accessed transplants, socioeconomic factors had a less pronounced impact on post-transplant outcomes. This suggests that the primary challenge lies in overcoming the initial barriers to accessing transplantation.
Expert Commentary
"This study has highlighted the need for targeted interventions to improve access for patients from lower socioeconomic backgrounds," said Dr. Mohamed Sorror, senior author 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."
Dr. Natalie Wuliji, lead author and Fred Hutch physician, added, "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. With this analysis confirming our initial theory, we can now take steps toward solving the challenge of transplant access."
The Importance of Stem Cell Transplant in AML Treatment
Allogeneic hematopoietic stem cell transplant is a crucial therapy for AML patients. In 2024, an estimated 20,800 new cases of AML were diagnosed in the United States. While treatments like transplantation have contributed to a decrease in death rates by an average of 0.8% each year since 2013, the five-year survival rate for patients remains at 31.9%, according to the National Cancer Institute.
Study Details and Future Directions
The study, funded by the Patient-Centered Outcome Research Institute, American Cancer Society, and American Society of Hematology, examined socioeconomic status attributes, including median household income, education levels, households below the poverty level, and households utilizing SNAP. Wuliji and the research team are now focusing on exploring potential interventions to improve access to transplant and help patients overcome socioeconomic barriers.
