Non-Hispanic Black patients and older adults have lower HCT utilization rates

September 2024

An analysis of autologous and allogeneic transplant utilization evaluated whether disparities between racial, ethnic and age groups persist in the context of increased overall hematopoietic cell transplant (HCT) rates and survival. Researchers found that HCT rates among younger patients and patients from Hispanic and non-Hispanic Other backgrounds had increased over time on par with non-Hispanic White patients. In contrast, older patients and non-Hispanic Black patients were found to have lower utilization rates than other groups, highlighting persistent unmet needs for these populations.

HCT is a critical treatment for hematologic cancers, but high cost and complexity contribute to disparities in utilization across different populations. Prior studies have shown increases in HCT volume and survival, but gaps in outcomes by race, ethnicity and age remain unclear. While HCT volume has increased over time across all racial and ethnic groups, survival has not improved for non-Hispanic Black patients. Researchers sought to further expand the understanding of changes in HCT utilization over time by age, race and ethnicity to identify where disparities still exist.

This U.S. population-based retrospective cohort study included 136,280 patients who received HCT from January 2009 to December 2018, including:

• Pediatric/adolescent/young adult patients: 16.7%
• Adults: 83.3% (58% male)
• Hispanic: 10.3%
• Non-Hispanic Black: 11.4%
• Non-Hispanic Other: 3.8%
• Non-Hispanic White: 74.5%

Researchers used Surveillance, Epidemiology and End Results (SEER) census data to inform utilization rates of autologous or allogeneic HCT for patients with hematologic cancers by age, race and ethnicity.

HCT utilization increased during the study period across all diseases, age, race and ethnicity groups. From 2017–2018, adult (40–84 years) allogeneic transplant rates for acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) were similar for Hispanic and non-Hispanic White or Other patients, but significantly lower for non-Hispanic Black patients:

• 19% vs. 13% for AML
• 9–10% vs. 5% for MDS

In patients aged 0–39, allogeneic transplant utilization for acute lymphoblastic leukemia (ALL) was highest among Hispanic patients:

• Hispanic: 19%
• Non-Hispanic White: 18%
• Black: 17%
• Other races: 16%

Autologous transplant utilization for lymphoma was similar for all racial/ethnic groups. However, autologous transplant for multiple myeloma was highest for non-Hispanic White patients and lower for all other groups (31% vs. 26–27%). For allogeneic HCT, the study found unmet need across diseases that tend to affect older patients, including MDS.

Hispanic, non-Hispanic Other and younger age groups had increased utilization over time that was on par with non-Hispanic White patients in the most recent cohort. These findings suggest that progress has been made to address the disparities in HCT utilization among racial/ethnic groups while also highlighting persistent unmet needs for older adults and non-Hispanic Black patients of all ages. Targeted interventions to improve access and outcomes can help further close these gaps.

Hahn T, et al., published in JAMA Open Network