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Donor socioeconomic status may impact patient outcomes after HCT

Researchers found that donor socioeconomic status (SES) affects the health outcomes of hematopoietic cell transplant (HCT) recipients. In this study, donor SES was significantly associated with disease-free survival (DFS). Patients who received cells from donors in the lowest SES quartile showed inferior DFS and overall survival (OS) and increased 3-year treatment-related mortality (TRM) compared to patients who received cells from donors in the highest SES quartile. Results emphasize the continued need for strategies and interventions to overcome SES disparities for both donors and recipients.
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Background

SES can affect the outcomes of patients who receive HCT to treat hematological cancer. Patients who live in lower SES environments experience increased mortality after HCT. This disparity is not fully explained by race, insurance status or access to care, with some research suggesting a contribution from SES-related changes in immune cell function. This study explores whether the SES of an HCT donor might affect the treatment outcomes of an HCT recipient.

Methods

Researchers retrospectively analyzed health outcomes of 2,005 HCT recipients from 125 transplant centers in the United States. They tested whether their health outcomes differed as a function of their donor's SES, controlling for other risk factors related to their transplant. The study included patients who were diagnosed with acute myeloid leukemia, acute lymphocytic leukemia, chronic lymphocytic leukemia, or myelodysplastic syndromes between 2000-2013 and received their first NMDP-facilitated unrelated donor 8/8 human leukocyte antigen (HLA)-matched allogeneic transplant using a peripheral blood stem cell graft.

Results

Findings from this study suggest that SES has a biological impact that can affect how donor cells function in a new host environment. Key results include:

  • Donor SES was significantly associated with recipient DFS.
  • Patients transplanted from donors in the lowest SES quartile showed inferior DFS vs. donors from the highest SES quartile.
  • Patients transplanted from donors in the lowest SES quartile experienced a 9.7% reduction in OS vs. patients transplanted from donors in the highest SES quartile.
  • Patients transplanted from donors in the lowest SES quartile experienced a 6.6% increase in TRM within 3 years vs. those transplanted from donors in the highest SES quartile.

The researchers note that these results appear consistent with previous research linking socioeconomic disadvantage to altered immune cell function and hematopoiesis, revealing an unanticipated persistence of those effects after transplant.

Key takeaways

Future research with more contemporary datasets is needed to map the biological mechanisms involved in the social determinants of health and develop interventions to block those effects and enhance the health of both HCT recipients and donors.

These results are from a historical cohort receiving transplants over 10 years ago. Much has changed in the transplant field over the past decade, with advances in supportive care, improved donor selection and improvements in graft-versus-host disease prevention strategies. Whether the observed SES effects persist in the modern era is worthy of further exploration.

To overcome barriers in health equity and HCT access, NMDP has partnered with the American Society for Transplantation and Cellular Therapy (ASTCT) to launch ACCESS Initiative. Through awareness, practice change and policy work, this collaborative effort takes aim at these systemic challenges across the cell therapy and transplant ecosystem.

Figure

This figure shows differences in (A) OS (B) TRM (C) DFS and (D) relapse stratified by donor SES quartiles. All plots are adjusted for relevant clinical and demographic variables.


Graphs of differences in overall survival, transplant-related mortality, disease-free survival and relapse by donor SES.

Turcotte L, et al., published in PNAS