Why AML patients have a hard time getting bone marrow transplants

SAN DIEGO — Bone marrow transplants can save lives for patients with acute myeloid leukemia, but researchers are learning how socioeconomic factors create barriers to treatment and increase mortality rates for people living in disadvantaged communities. A new study has revealed this.

A scientific team led by researchers at Fred Hutchinson Cancer Center followed AML patients across academic and community treatment centers. They found that patients in disadvantaged areas were more likely to die without a bone marrow transplant and less likely to receive a bone marrow transplant, compared to people in better-educated and wealthier areas. Specifically, living in an area with lower education levels was 33% less likely to receive a bone marrow transplant, a statistically significant effect. In contrast, post-transplant survival was not significantly different for people from disadvantaged areas.

The study results, presented Sunday at a press conference at the American Society of Hematology annual meeting, suggest that the main issue facing patients from lower socioeconomic backgrounds is access rather than efficacy of treatment. The authors of this study say that, to their knowledge, this is the first to examine in detail how specific socio-economic variables influence the probability of receiving bone marrow transplantation and post-treatment survival in patients with AML. He added that it was a study.

“I think the results of this study are novel in the sense that it's a very large patient population from multiple institutions,” said NMDP Health, formerly known as the National Bone Marrow Donor Program or Be the Match. said Jeff Auletta, senior vice president of equity. Not involved in work. “This study delves into some of the social determinants of health that present barriers to access for patients.”

AML accounts for approximately one-third of adult leukemia cases, and the American Cancer Society estimate About 21,000 people in the United States are expected to be diagnosed with the disease this year, and about 11,200 people are expected to die from the disease.

The main treatment for this disease is chemotherapy, but hematopoietic cell transplantation, also known as bone marrow transplantation, may be the best treatment for patients. An infusion of hematopoietic stem cells given after chemotherapy replenishes the patient's immune system. Then, when these new cells are donated by someone else, they recognize the remaining cancer cells as foreign invaders and attack them.

AML is most common An environment where bone marrow transplantation is possible around the world, and some research They found that AML patients who received bone marrow transplants had a 5-year survival rate of approximately 65%, compared to a 24% 5-year survival rate for patients who received no treatment.

meanwhile past works Although researchers have shown that factors such as age, health, and frailty can influence a patient's chances of receiving treatment, the authors of the current study did not consider the influence of socio-economic status. I wanted to understand it more deeply. So they followed nearly 700 AML patients over time at 13 academic and community treatment centers, including Stanford University, Washington University in St. Louis, Duke, and Fred Hutch's own cancer center. Approximately 43% of patients were female, 86% were white, 3% were Asian, and 6% were black.

Researchers examined the effects of four measures of socioeconomic status on a patient's probability of receiving a transplant, dying without a transplant, and dying after treatment. These measures were the proportion of people with less than a high school education based on the zip code in which the patient lived. Percentage of households receiving Supplemental Nutrition Assistance Program benefits (formerly known as food stamps). Percentage of households receiving Supplemental Security Income. and poverty rates.

The authors found that patients in areas where many residents lack a high school diploma or who receive SSI, a monthly stipend for elderly people with disabilities or little income, are more likely to receive a transplant. found that there is a high possibility of death. These factors increased the risk of death by statistically significant 21% and 41%, respectively.

People from areas with lower levels of education were significantly less likely to receive a bone marrow transplant. Patients with higher rates of SSI and SNAP use were also less likely to receive a transplant, but these effects were almost, but not fully, statistically significant.

The authors found that patients in areas high on any of four measures of low socio-economic status had a slightly higher risk of death after transplant, but none of these effects were significant. .

The findings are in contrast past research This study suggests that AML patients in areas with high poverty levels are more likely to die after receiving allogeneic bone marrow transplants, but previous findings were from children and recent studies have It was conducted for.

“The way we interpret it is, [is that] “If patients can overcome the transplant barrier…perhaps their outcomes could be comparable to patients from other socio-economic backgrounds,” said Natalie Urigi, lead author of the study.

There are many ways in which socioeconomic status can be a barrier for patients, said Woolidge, a hematology-oncologist at Fred Hutch, which performs bone marrow transplants. Recovering after receiving a transplant can take several months, and patients must stay close to the treatment center and have a caretaker. This requires time away from work and often finding a hotel or other temporary accommodation for those not already near a treatment center.

Fully understanding the benefits and risks of such intensive treatments can be difficult even for poorly educated patients and can be a challenge when doctors are biased against patients from disadvantaged communities. will get worse, she added.

Wuliji noted that this study suggests that some methods of measuring socio-economic status are more robust than others. For example, income may be an obvious indicator, but assessing whether someone is receiving government benefits can help patients who have lived in poverty for long periods of time and face the greatest barriers. could be better identified.

The group now aims to confirm its findings in a larger group of patients. Researchers also investigated the impact of having available caregivers on bone marrow transplant access and outcomes, identifying patients facing socio-economic hurdles and providing targeted interventions. We also plan to test the pilot strategy we offer.