Nearly 1 in 5 patients with high-risk myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) may not be evaluated for transplantation eligibility, according to research published in Transplantation and Cellular Therapy. Patients treated at community sites, furthermore, may be less likely to considered for hematopoietic stem cell transplantation (HCT).
Patient and clinical characteristics that affect outcomes after HCT include age, performance status, patient frailty, and comorbidities, although not all care centers evaluate these when considering patients for eligibility.
For this study, using data from a myeloid disease registry, researchers aimed to determine the proportion of potentially eligible patients with high-risk MDS or AML who are considered for HCT. All data were from 164 community/government (CO/GOV)- or academic (AC)-based sites.
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Overall, of the 778 patients included, 516 and 262 were treated at CO/GOV and AC sites, respectively. In the overall cohort, the median age was 72 years, 63.6% of patients were male sex, 83.8% of patients were White, and the most common clinical diagnosis was high-risk MDS (43.8%). One hundred and thirty-five patients were not assessed for transplant eligibility; 382 patients were not considered eligible and 510 were considered eligible.
Analysis showed that patients treated at CO/GOV sites were less likely to be considered for HCT eligibility (27.9% vs 43.9% of patients at AC sites; P <.0001). Multivariate analysis controlling for age and comorbidities showed an odds ratio of 1.6 (P =.0155) confirmed a lower likelihood for consideration at CO/GOV sites.
There was, however, no statistical difference between CO/GOV and AC sites in the proportion of eligible patients who underwent HCT (45.1% and 35.7%, respectively; P =.12)
In CO/GOV and AC sites, 50.1% and 45.4% were deemed ineligible for HCT. At CO/GOV sites, the most common reason for this was age (71.5%); at AC sites, comorbidities (52.1%).
Overall, 17.4% of patients were not assessed for HCT eligibility, although this was more common at CO/GOV sites (20.7%) than at AC sites (10.7%; P =.0005).
“The results of this analysis reveal that many patients with [high-risk]-MDS and AML who may be candidates for HCT are not receiving assessment or consideration in clinical practice,” the authors wrote in their report. “In support of existing studies, our results demonstrate the need for increased transplant resources and access to resources to ensure that all patients who may benefit, including older patients and those seeking treatment at CO/GOV sites, are appropriately screened and referred for HCT.”
Disclosures: This research was supported by Bristol Myers Squibb. Please see the original reference for a full list of disclosures.
Reference
Tomlinson B, de Lima M, Cogle CR, et al. Transplant referral patterns for patients with newly diagnosed higher-risk myelodysplastic syndromes and acute myeloid leukemia at academic and community sites in the Connect® Myeloid Disease Registry: potential barriers to care. Transplant Cell Ther. Published online April 20, 2023. doi:10.1016/j.jtct.2023.04.011
