Adverse Social Determinants Independently Predict Outcomes After Allogeneic HSCT

Area of Science:

• Hematology
• Transplant Immunology
• Public Health

Background:

• Allogeneic hematopoietic stem cell transplantation (HSCT) offers curative potential for hematologic diseases.
• However, HSCT is linked to significant morbidity and non-relapse mortality (NRM).
• The influence of adverse social determinants on HSCT outcomes in universal healthcare systems requires further investigation.

Purpose of the Study:

• To investigate the association between adverse social determinants and outcomes following allogeneic HSCT.
• To assess the impact of social factors on overall survival, NRM, GVHD, and mortality causes.

Main Methods:

• Retrospective single-center cohort study of 286 adult HSCT recipients (2012-2022).
• Assessed baseline social determinants: communication barriers, financial hardship, and living alone.
• Analyzed overall survival (OS), NRM, GVHD, and cause-specific mortality using multivariable models.

Main Results:

• Presence of at least one adverse social determinant independently predicted inferior OS (HR 2.39) and higher NRM (HR 2.68).
• A dose-response relationship was observed between the number of adverse factors and poorer outcomes.
• Patients with social disadvantages experienced higher rates of acute and chronic GVHD and increased infection-related deaths.

Conclusions:

• Adverse social determinants are independently linked to worse survival, increased GVHD, and higher NRM post-allogeneic HSCT.
• Social disadvantage significantly impacts transplant outcomes, even within universal healthcare settings.
• Systematic identification of social risks and targeted interventions are essential for improving patient care.