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STEM CELL TRANSPLANTATION

Impact of socioeconomic disparities on outcomes in adults undergoing allogeneic hematopoietic cell transplantation for acute myeloid leukemia

Leukemia volume 38, pages 865–876 (2024)Cite this article

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Abstract

Racial and socioeconomic disparities impact outcomes after chemotherapy and limit access to allogeneic hematopoietic cell transplantation (HCT) in acute myeloid leukemia (AML), yet studies have yielded mixed results on the influence of disparities on post-HCT outcomes. Therefore, we studied 1024 adults with AML who underwent allogeneic HCT between 5/2006 and 10/2021 at a single large university-affiliated cancer center. Collected data included non-biologic and demographic characteristics (including race/ethnicity, marital status, distance traveled, and household size), transplant- and disease-related characteristics, and area-level and individual-level socioeconomic factors (i.e., area deprivation index and occupational status). After multivariable adjustment, no socioeconomic- or non-biologic factors were associated with non-relapse mortality (NRM), overall survival (OS), relapse-free survival (RFS), or relapse except being married (associated with improved NRM: hazard ratio [HR] = 0.7 [0.50–0.97]) and having no insurance (associated with worse OS: HR = 1.49 [1.05–2.12] and RFS: HR = 1.41 [1.00–1.98]). Despite a relatively racially homogenous cohort, Asian race was associated with improved NRM (HR = 0.47 [0.23–0.93]) and American Indian/Alaskan Native race was associated with higher relapse risk (HR = 2.45 [1.08–5.53]). In conclusion, in our retrospective analysis, socioeconomic-, demographic-, and non-biologic factors had limited impact on post-HCT outcomes in AML patients allografted in morphologic remission. Further research is needed to investigate disparities among HCT-eligible patients.

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Original, de-identified data can be obtained via contacting the corresponding author (rwalter@fredhutch.org).

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Acknowledgements

Research reported in this publication was supported by the National Cancer Institute/National Institutes of Health (NCI/NIH; Bethesda, MD, USA) via grants P01-CA078902, P01-CA018029, and P30-CA015704. RBW acknowledges support from the José Carreras/E. Donnall Thomas Endowed Chair for Cancer Research.

Funding

This work was supported by grants P01-CA078902, P01-CA018029, and P30-CA015704 from the National Cancer Institute/National Institutes of Health (NCI/NIH).

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Authors and Affiliations

  1. Department of Medicine, Internal Medicine Residency Program, University of Washington, Seattle, WA, USA

    Daniel J. Olivieri

  2. Public Health Science Division, Fred Hutchinson Cancer Center, Seattle, WA, USA

    Megan Othus

  3. Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA

    Corentin Orvain, Eduardo Rodríguez-Arbolí, Filippo Milano, Brenda M. Sandmaier & Roland B. Walter

  4. Maladies du Sang, CHU d’Angers, Angers, France

    Corentin Orvain

  5. Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia, FHU-GOAL, Angers, France

    Corentin Orvain

  6. Université d’Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, Angers, France

    Corentin Orvain

  7. Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), University of Seville, Seville, Spain

    Eduardo Rodríguez-Arbolí

  8. Department of Medicine, Division of Hematology and Oncology, University of Washington, Seattle, WA, USA

    Filippo Milano, Brenda M. Sandmaier, Frederick R. Appelbaum & Roland B. Walter

  9. Department of Medicine, Division of Hematology-Oncology, Northwestern University, Chicago, IL, USA

    Irum Khan

  10. Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA

    Chris Davis, Ryan S. Basom & Frederick R. Appelbaum

  11. Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA

    Roland B. Walter

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  1. Daniel J. Olivieri
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Contributions

CD and RSB contributed to the collection and assembly of data. MO conducted statistical analyses and participated in data interpretation and drafting of the manuscript. FM, BMS, and FRA contributed to the provision of study material, patient recruitment, and acquisition of data. RBW conceptualized and designed this study and participated in data analysis and interpretation and drafting of the final manuscript and oversaw all aspects of data collection. DJO conceptualized, collected, classified, extracted the data, helped design the study, and participated in data analysis, interpretation, and drafting of the manuscript. All authors revised the manuscript critically and gave final approval to submit for publication.

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Correspondence to Roland B. Walter.

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Olivieri, D.J., Othus, M., Orvain, C. et al. Impact of socioeconomic disparities on outcomes in adults undergoing allogeneic hematopoietic cell transplantation for acute myeloid leukemia. Leukemia 38, 865–876 (2024). https://doi.org/10.1038/s41375-024-02172-3

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