In a new study, researchers found that a strategy to improve access to hematopoietic stem cell transplantation (HSCT) may benefit patients with nonfavorable risk (NFR) acute leukemia and myeloid dysplasia syndrome (AL/MDS). However, they found that Black patients may still face limitations to access based on caregiver requirements. The research was reported in the journal Blood Advances.

The researchers noted that past studies have shown patients of racial minorities can experience greater barriers to HSCT access, and at their research center, they explained that 26% patients having NFR AL/MDS identified as Black/African American.

The researchers chose a strategy of integrating HSCT and leukemia care and emphasizing haploidentical donors for HSCT. They evaluated care in patients below 75 years of age and aimed to assess barriers to receiving HSCT in the setting of this intervention.

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In this study, 256 patients with NFR AL/MDS and an age below 75 years were treated from 2016 to 2021. Patients had a median age of 58 years (range, 18-75). Planned HSCT was administered to 57% of the patients at a median time of 118 days after initial therapy, and to 70% of patients with an age below 60 years.

Factors that were considered significant for a failure to receive HSCT in this study included age, with an odds ratio (OR) of 1.50 for every 10-year increment (P <.001), and race, with an OR of 2.05 for Black vs White patients (P =.023).

The researchers also evaluated reasons given for a failure to receive HSCT. Reasons given for not receiving HSCT most commonly were the presence of comorbidities (37%), an inadequate Karnofsky performance status (19%), lack of caregivers (19%), refractory disease (19%), and patient refusal (17%). The absence of a donor (3%) or insurance (3%) was not commonly linked to failure to receive HSCT.

In subgroup analysis, comorbidities were more often associated with failure to receive HSCT in patients aged 60 years or older, compared with younger patients (49% vs 15%; P <.001). Patients in the older age group were less likely to have caregiver issues (13%) than younger patients were (30%; P =.031). However, overall, significantly more Black patients (37%) than White patients (11%) experienced a lack of caregiver support (P =.002).

A multivariable analysis indicated that receipt of HSCT was associated with significantly better survival overall (hazard ratio, 0.60; 95% CI, 0.40-0.92; P =.020). Better survival rates appeared linked to a younger age and to receipt of initial therapy during the years of 2019 to 2021, compared with 2016 to 2018.

The researchers concluded that HSCT is associated with a significant survival benefit in this patient population. However, Black patients in this study appeared to face barriers to receiving HSCT, even with the study intervention.


Bashey A, Zhang X, Morris LE, et al. Improved access to HCT with reduced racial disparities through integration with leukemia care and haploidentical donors. Blood Adv. 2023 Aug 8;7(15):3816-3823. doi:10.1182/bloodadvances.2023009765