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Access Challenges in Allogeneic Hematopoietic Cell Transplant: Identifying At-Risk US States by Exploring Social

Samantha E Watters1,2, Christa L Meyer1,3, Jaime M Preussler1,3

  • 1NMDP, Minneapolis, MN.

JCO Oncology Practice
|June 29, 2026
PubMed

Insights

Social vulnerability and low physician density limit access to allogeneic hematopoietic cell transplantation (alloHCT). Identifying at-risk states like Texas and Florida can guide resource allocation to improve alloHCT equity.

Area of Science:

  • Hematology
  • Public Health
  • Health Services Research

Background:

  • Access to allogeneic hematopoietic cell transplantation (alloHCT) is crucial for treating various hematologic malignancies and other conditions.
  • Existing barriers to alloHCT are multifactorial and require a deeper understanding to develop targeted interventions.
  • Identifying geographic disparities in alloHCT access is essential for promoting healthcare equity.

Purpose of the Study:

  • To investigate the interplay between the Social Vulnerability Index (SVI), physician density (PD), and unmet need for adult alloHCT in the United States.
  • To identify US states facing significant challenges in alloHCT access.
  • To inform targeted strategies for improving alloHCT accessibility.

Main Methods:

  • An exploratory retrospective analysis using aggregated county-level data from 2018-2022.
  • Social Vulnerability Index (SVI) and physician density (PD) were defined and dichotomized into low and high percentiles.
  • Multivariable linear regression models were employed to assess the influence of SVI and PD on alloHCT unmet need.

Main Results:

  • Lower physician density and higher SVI were significant predictors of increased alloHCT unmet need at the county level nationwide.
  • States identified as high-risk for alloHCT access challenges included Texas, North Carolina, Florida, Nevada, and Georgia.
  • Within at-risk states, lower PD remained a key predictor, while SVI components like race/ethnicity and housing/transportation vulnerability significantly impacted unmet need.

Conclusions:

  • The study highlights significant relationships between SVI, PD, and alloHCT unmet need, identifying specific states with access impediments.
  • Data-driven resource allocation is recommended to address barriers to alloHCT.
  • Interventions focused on increasing physician density and mitigating social vulnerability are crucial for enhancing alloHCT access and care equity.
Abstract

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