Hematopoietic Cell Transplant Access and Patient Diversity

Area of Science:

• Hematology
• Transplant Immunology
• Health Services Research

Background:

• Allogeneic hematopoietic cell transplant (HCT) offers a cure for hematologic cancers but faces challenges in equitable access for underrepresented racial, ethnic, and socioeconomic groups.
• The ACCESS trial aimed to overcome these barriers by enrolling patients who lacked matched donors, utilizing mismatched unrelated donors instead.

Purpose of the Study:

• To compare the baseline characteristics of participants in the ACCESS trial with those in a similar clinical trial and a patient-reported outcome (PRO) protocol cohort.
• To assess the diversity and socioeconomic factors of HCT candidates across different trial designs.

Main Methods:

• A cross-sectional study comparing three cohorts: the ACCESS trial, the BMT CTN 1703 trial, and the CIBMTR PRO Protocol observational study.
• Baseline PRO surveys were analyzed for demographic, socioeconomic (Social Vulnerability Index, Financial Toxicity), and geographic data.
• Cohorts were stratified by conditioning intensity (myeloablative [MAC] vs. reduced-intensity/nonmyeloablative [RIC/NMA]).

Main Results:

• The ACCESS trial enrolled a significantly more racially and ethnically diverse population compared to the other cohorts.
• ACCESS participants were more likely to have Medicaid, lower educational attainment, and lower household income.
• Higher Social Vulnerability Index scores and closer proximity to transplant centers were observed in ACCESS participants, particularly in the MAC group.

Conclusions:

• The ACCESS trial successfully enrolled a more diverse and socioeconomically disadvantaged patient population, indicating that broader eligibility criteria can enhance HCT access.
• These findings underscore the need for systemic interventions to ensure equitable access to life-saving HCT for all patients.
• Innovative trial designs are crucial for addressing disparities in cancer treatment outcomes.