Hematopoietic Stem Cell Transplantation (HCST) Is Underutilized in Black Patients with Myeloid Neoplasms. Results from a Retrospective Study at Chicago's Leading Minority-Serving Hospital

Background: Access to hematopoietic stem cell transplantation (HSCT) is crucial for patients with myeloid neoplasms, yet disparities in its utilization are evident, particularly among ethnically diverse, minority-serving hospitals. These disparities can exacerbate treatment inequities. This study aims to understand how race and ethnicity impact access to and decisions regarding HSCT. Methods: In this retrospective study, we examined patients over 18 with myeloid neoplasms or premalignant conditions, who had undergone genetic profiling. Transplant eligibility was decided through a comprehensive evaluation of patient’s risk classification, comorbidities, and donor availability by the leukemia service and transplant referral center. In eligible patients who had an indication for HSCT but did not undergo transplant, we collected information on reasons for non-transplant. Clinical data were presented according to race and ethnicity and compared using Pearson’s χ2 or Fisher exact tests.
Results: 94 patients, including 45 females (47.9%) were included. 38 patients (40.4%) identified as Black, 28 (29.8%) as White, and 28 (29.8%) as Other (10.6% Asian, 9.6% Mexican/South American, and 9.6% undetermined). 30 patients (32%) identified as Hispanic and 64 (68%) as non-Hispanic. Diagnoses included Acute myeloid leukemia (AML, 32%), Myelodysplastic syndromes (MDS, 13%), Myeloproliferative neoplasms (MPN, 40%), MDS/MPN overlap syndrome (7%), and Clonal Hematopoiesis of Indeterminate Potential (7%). 27 patients (29%) were deemed eligible for HSCT. 38% of eligible white patients received HSCT compared to none of the black or other race eligible patients (p=0.06). Lack of necessary social support (28.6%) and loss of follow-up (14.3%) were the most common barriers to transplant in eligible Black patients. In contrast, lack of insurance (25%) and patient refusal (25%) were common reasons for non-transplant despite eligibility in white patients. An equal number of Hispanic (18%) and non-Hispanic (18.7%) transplant-eligible patients ended up receiving transplant. Lack of insurance/financial support was common reason for non-transplant despite eligibility (44.4%) in Hispanic compared to non-Hispanic patients (7.6%,P= 0.021).
Conclusions:The study highlights significant racial and ethnic disparities in HSCT use among myeloid neoplasm patients, suggesting systemic healthcare access barriers. Key obstacles for Black patients were insufficient social support and loss of follow-up, whereas Hispanics faced predominantly insurance-related barriers. These findings highlight the urgency of targeted strategies to overcome these disparities and ensure equitable HSCT access for all racial and ethnic groups.