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Study Uncovers Demographic Disparities in Access to AutoHCT Therapy for Patients with Multiple Myeloma
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UC Davis Health researchers uncover substantial treatment disparities and inequal access to autologous hematopoietic cell transplantation therapy among multiple myeloma patients.
A new study published in Clinical Lymphoma, Myeloma & Leukemia reveals racial and social disparities that prevent patients with multiple myeloma (MM) from receiving autologous hematopoietic cell transplantation (autoHCT), a type of stem cell therapy. UC Davis Health researchers discovered that individuals from minority communities or those covered by public health insurance (such as Medicare or Medicaid) were less likely to undergo autoHCT treatment.
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AutoHCT is a commonly used procedure that uses a patient’s existing stem cells to target cancerous cells in the body. Stem cells are harvested from the blood or bone marrow and frozen to remove contaminants before being reintroduced to the body. After treatment with high dose chemotherapy or radiation, the stem cells replenish the body’s blood and immune cell populations, allowing for bone marrow recovery and immune system restoration.2
The researchers analyzed data collected from the California Cancer Registry (CCR), the Center for International Blood and Marrow Transplant Research (CIBMTR), and the California Patient Discharge Database. The CCR provided researchers with demographic information including race, ethnicity, insurance status, education, employment status, and other measurements, which were compared against rates of autoHCT treatment in individuals diagnosed with MM between 1991 and 2016.1
Study authors used novel data linkage between the CCR, CIBMT, California’s patient discharge database, and hospitalization records to identify autoHCT treatment in a population-based MM cohort. Hazard ratio and confidence intervals were used to evaluate the association between demographic data and the likelihood of receiving autoHCT therapy. To account for interactions between different treatment stages, study authors used stratified multivariable Cox proportional hazards regression models.1
Of the 29,109 patients included in the study, 18.9% received autoHCT treatment. Although findings showed an increase of patients with MM who received treatment from 5.7% (1991 to 1995) to 27.4% (2011 to 2016), minority and uninsured populations received significantly less access to treatment. Black patients received a lower proportion of therapy at 15.8% (2011-2016 HR 0.83, CI: 0.72-0.95). Hispanic patients were less likely to undergo autoHCT, particularly in the earliest treatment era (1991-1995 HR 0.58, 95% CI: 0.37-0.90; 2011-2016 HR 1.07, CI: 0.96-1.19).1
Patients with public insurance or who were uninsured were less likely to receive treatment [2011-2016 Medicare hazard ratio (HR) 0.70, 95% confidence interval (CI): 0.63-0.78; Medicaid HR 0.81, CI: 0.72-0.91; no insurance HR 0.56, CI: 0.32-0.99).1Alternatively, individuals with private or military health insurance had a higher likelihood of receiving autoHCT therapy, at a rate of 28.4%. This data prompts further investigations into how public health insurance affects patient evaluation for treatment eligibility, referrals to transplant centers, and other potential impacts.2
Researchers also measured neighborhood socioeconomic status (nSES), which accounts for education, employment, poverty, etc., and found this also played a role in a patients’ likelihood of receiving treatment. Patients living in neighborhoods with higher nSES scores showed increased rates of autoHCT usage, while those in lower socioeconomic status neighborhoods were less likely to undergo therapy. However, study authors note these differences decreased over time.1
Identifying the social and economic barriers that prevent patients with MM from receiving autoHCT therapy is crucial to ensuring equitable access to care for all patient populations. Further research into understanding these treatment obstacles enables health care providers and policymakers to develop interventions and systems that ensure access to care and improved patient outcomes.
