Inferior Access to Allogeneic Transplant in Disadvantaged Populations: A Center for International Blood and Marrow Transplant Research Analysis

Kristjan Paulson, Ruta Brazauskas, Nandita Khera, Naya He, Navneet Majhail, Gorgun Akpek, Mahmoud Aljurf, David Buchbinder, Linda Burns, Sara Beattie, Cesar Freytes, Anne Garcia, James Gajewski, Theresa Hahn, Jennifer Knight, Charles LeMaistre, Hillard Lazarus, David Szwajcer, Matthew Seftel, Baldeep WirkWilliam Wood, Wael Saber

Research output: Contribution to journalArticle


Allogeneic hematopoietic cell transplantation (alloHCT) is offered in a limited number of medical centers and is associated with significant direct and indirect costs. The degree to which social and geographic barriers reduce access to alloHCT is unknown. Data from the Surveillance, Epidemiology and End Results Program (SEER) and the Center for International Blood and Marrow Transplant Research (CIBMTR) were integrated to determine the rate of unrelated donor (URD) alloHCT for acute myelogenous leukemia (AML), acute lymphoblastic leukemia (ALL), and myelodysplastic syndrome (MDS) performed between 2000 and 2010 in the 612 counties covered by SEER. The total incidence of AML, ALL, and MDS was determined using SEER, and the number of alloHCTs performed in the same time period and geographic area were determined using the CIBMTR database. We then determined which sociodemographic attributes influenced the rate of alloHCT (rural/urban status, median family size, percentage of residents below the poverty line, and percentage of minority race). In the entire cohort, higher levels of poverty were associated with lower rates of alloHCT (estimated rate ratio [ERR],.86 for a 10% increase in the percentage of the population below the poverty line; P <.01), whereas rural location was not (ERR,.87; P =.11). Thus, patients from areas with higher poverty rates diagnosed with ALL, AML, and MDS are less likely patients from wealthier counties to undergo URD alloHCT. There is need to better understand the reasons for this disparity and to encourage policy and advocacy efforts to improve access to medical care for all.

Original languageEnglish (US)
Pages (from-to)2086-2090
Number of pages5
JournalBiology of Blood and Marrow Transplantation
Issue number10
Publication statusPublished - Oct 2019


All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

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