Access to Allogeneic Hematopoietic Cell Transplant for Patients with Hematologic Malignancies in Oregon

Background Hematologic malignancies are the main indication for allogeneic hematopoietic cell transplant (HCT) in adults. Despite advancements over time, access to HCT remains a challenge for certain groups based on non-biological factors. In this retrospective study, we identified sociodemographic factors influencing treatment with allogenic HCT for adult patients with acute leukemia and myelodysplastic syndrome at Oregon Health & Science University (OHSU). Methods Patients 18 years and older with acute lymphoblastic (ALL), myeloid (AML), and mixed lineage (MPAL) leukemia or myelodysplastic syndrome (MDS) who underwent first allogeneic HCT at OHSU between 2019 and 2022 were included. Data collected included age, gender, race/ethnicity, zip-code, insurance type, disease type and status at time of allogenic HCT and allogenic transplant characteristics. Zip-codes were used to calculate poverty index, rural-urban continuum and distance to the treatment center. Results A total of 321 patients with median age 57 years (range, 18-77 years) received an allogenic HCT for ALL (n=75), AML (n=159), MPAL(n=8) or MDS (n=79). Of these, 30% were older than 65 years, 48% female, 17.1% were non-White, 10.6% Hispanic and 6.5% non-White/non-Hispanic. 35% of those younger than 65 years had public insurance, 72% of those over 65 years had Medicare and 6.9% were uninsured. The majority of patients were from metropolitan areas (n=272, 84.7%), while 17% lived greater than 60 miles and 16.8% lived 120 miles or greater from our institution. 53% of recipients lived in neighborhoods at or below the poverty level, much higher than the state median of 12.8%. The median 1-yr survival was 77.3% (95th CI, 72.2-81.6%). There were no differences in survival for groups defined by sociodemographic characteristics (Fig 1). Conclusions Our data suggests that allogenic HCT recipients at OHSU come from diverse socioeconomic backgrounds within Oregon and surrounding region and have equivalent survival outcomes regardless of their sociodemographic differences. Work remains to be done to understand if HCT eligible patients from disadvantaged backgrounds in our region are not being able to access this therapy.