Socioeconomic Factors, Comorbidities Explain Decreased Access to Transplant for Non-Hispanic Black Patients with Lymphoma

Non-Hispanic Black patients with lymphoma were less likely to receive autologous stem cell transplantation (ASCT) compared with non-Hispanic White patients, according to a recent study. However, the difference is partially explained by certain socioeconomic and disease-specific factors.

“Since [ASCT] is a potentially life-saving therapy for patients with lymphoma, it is important to understand whether disparities in treatment exist that might lead to inferior survival for minorities,” study authors wrote.

To explore possible disparities, they used data on 40,605 patients with lymphoma (4% Non-Hispanic Black and 84% Non-Hispanic White) from the Surveillance, Epidemiology, and End Results database. Included patients were aged 65 years or older and diagnosed with Hodgkin or non-Hodgkin lymphoma between 2008 and 2015.

Autologous transplants were performed in 452 patients. The highest rate of transplant utilization occurred for mantle cell lymphoma, followed by T-cell, diffuse large B cell, and Hodgkin lymphoma.

The median time from diagnosis to transplant was 1.0 years for non-Hispanic White patients, 0.6 years for non-Hispanic Black patients, 0.6 years for Asian patients, and 1.1 years for Hispanic patients.

In an unadjusted model, non-Hispanic Black patients were 51% less likely to receive ASCT compared with non-Hispanic White patients (95% confidence interval [CI], 0.26-0.96; P=0.04). After adjusting for age at diagnosis and sex, the decreased likelihood increased to 61% (95% CI, 0.20-0.76; P=0.01).

Once the researchers adjusted for socioeconomic and disease-specific factors the differences between non-Hispanic Black patients and non-Hispanic White patients was attenuated and became non-significant.

“Non-Hispanic Black patients were more than three times more likely to reside in the most economically distressed areas, and they had a higher comorbidity burden at the time of diagnosis,” the researchers wrote. “This suggests that racial/ethnic differences in [ASCT] utilization for lymphoma are partially explained by differences in these factors.”

The researchers noted no statistically significant differences between these two groups in the fully adjusted model.

“Our findings suggest that interventions to improve access to autologous transplantation should focus on reducing financial toxicity of transplantation and developing less toxic conditioning regimens for patients with comorbidities,” the researchers wrote.