Rates of allogeneic hematopoietic stem cell transplantation (alloHCT) in patients with acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML), and myelodysplastic syndrome (MDS) are associated with poverty rates in patients’ geographical areas, according to results reported in Biology of Blood and Marrow Transplantation.

Researchers analyzed data collected between 2000 and 2010 from the Center for International Blood and Marrow Transplant Research (CIBMTR) and the Surveillance, Epidemiology, and End Results Program (SEER) to evaluate rates of unrelated donor (URD) alloHCT in patients with ALL, AML, or MDS younger than 65 years. Rates were examined to determine if associations existed with county size or poverty levels in patients’ counties of residence.

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County size was categorized as metropolitan (population > 50,000 people), micropolitan (20,000-50,000 people), and rural (population < 20,000 people). Poverty was based on incidence of residents below the poverty line.

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The total number of counties examined was 612. The rate of URD alloHCT among patients included in this analysis was 8.77% in metropolitan counties, 8.93% in micropolitan counties, and 7.54% in rural counties.

When poverty levels were split into quartiles, the quartile counties with the most poverty (22.5%-40.3% residents below poverty line) had a 7.44% rate of URD alloHCT while the quartile of counties with the least poverty (3.2%-12.7% residents below poverty line) had an 11.73% rate of URD alloHCT.

The estimated rate ratio for prevalence of alloHCT by poverty rate was 0.86 for every 10% rise in incidence of poverty (P =.003). The estimated rate ratio for alloHCT prevalence by rural status was 0.87, but this was not a significant factor (P =.11).

The researchers noted that patients with ALL, AML, or MDS who lived in areas with high poverty rates were less likely to receive an URD alloHCT, and this association remained significant after adjusting for potential confounds such as rural residency and racial origin. They recommended further research on the most suitable strategies to reduce disparities in access to alloHCT.


  1. Paulson K, Brazauskas R, Khera N, et al. Inferior access to allogeneic transplant in disadvantaged populations: a Center for International Blood and Marrow Transplant Research analysis. Biol Blood Marrow Transplant. 2019;25:2086-2090.