Access to Hematopoietic Stem Cell Transplantation Among Pediatric Patients with Acute Leukemia: A Population-Based Analysis

Introduction Access to hematopoietic stem cell transplantation (HSCT) in pediatric acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) is heavily dependent on disease-related factors but may be influenced by social and economic determinants. Studies from countries with privatized health care systems suggest reduced access by race and socioeconomic status. Objectives We sought to determine whether access to HSCT is affected by socio-demographic (race and income) and regional-geographic factors within a publically funded health care system in a geographically vast country with broad ethnic diversity using a population based dataset. Methods We included all children Results Of children with ALL, 325 of 3992 (8.1%) received a HSCT, with 41.5% occurring in CR1 and 58.5% in CR2. Of children with AML, 278 of 632 (44%) received HSCT, with 62.2% occurring in CR1 and 37.8% occurring in CR2.  In multivariable analysis, factors that were independently associated with increased odds of receiving HSCT in ALL and AML are shown in Table 1.  In both groups, no association was found between race or neighborhood income quintile and eventual receipt of HSCT. Conclusion Patients diagnosed at a HSCT performing center had higher odds of subsequent HSCT in both ALL and AML.  In a vast country, patients with ALL who live furthest away from their treatment center had higher odds of receiving HSCT, suggesting a preference for HSCT if distance was an issue.  Within the Canadian publically funded health care system there was no negative impact with remoteness, race or socioeconomic status on access to transplant care.