Utilization of Autologous Hematopoietic Cell Transplantation Over Time in Multiple Myeloma: A Population-Based Study

Details

• Alternative Title:
  Clin Lymphoma Myeloma Leuk
• Personal Author:
  Esteghamat, Naseem S. ; Brunson, Ann ; Rosenberg, Aaron S. ; Schonfeld, Sara J. ; Valcarcel, Bryan ; Abrahão, Renata ; Cooley, Julianne J.P. ; Meyer, Christa L. ; Auletta, Jeffery J. ; Morton, Lindsay M. ; Muffly, Lori ; Wun, Ted ; Keegan, Theresa H.M.
• Description:
  Purpose:
  
  Autologous hematopoietic cell transplantation (autoHCT) is associated with survival benefits in multiple myeloma (MM), but utilization remains low and differs by sociodemographic factors. Prior population-based studies have not fully captured autoHCT utilization or examined relationships between sociodemographic factors and autoHCT trends over time.
  
  Patients and Methods:
  
  We used a novel data linkage between the California Cancer Registry, Center for International Blood and Marrow Transplant Research, and hospitalizations to capture autoHCT in a population-based MM cohort (n=29,109; 1991–2016). Due to interactions by treatment era, stratified multivariable Cox proportional hazards regression models determined factors associated with autoHCT.
  
  Results:
  
  The frequency of MM patients who received autoHCT increased from 5.7% (1991–1995) to 27.4% (2011–2016). In models by treatment era, patients with public/no (vs private) health insurance were less likely to receive autoHCT (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). In each treatment era, Black/African American (vs non-Hispanic White) patients were less likely to receive autoHCT (2011–2016 HR 0.83, CI 0.72 – 0.95). Hispanic patients were less likely to undergo autoHCT, most prominently 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). Patients in lower socioeconomic status neighborhoods were less likely to utilize autoHCT, but differences decreased over time.
  
  Conclusions:
  
  Despite increases in autoHCT utilization, sociodemographic disparities remain. Identifying and mitigating barriers to autoHCT is essential to ensuring more equitable access to this highly effective therapy.
  
  
• Subjects:
  Aged Hematopoietic Stem Cell Transplantation Humans Insurance, Health Medicare Multiple Myeloma Transplantation, Autologous United States
• Keywords:
  Adult Autologous Hematopoietic Cell Multiple Myeloma Transplant Transplantation
• Source:
  Clin Lymphoma Myeloma Leuk. 24(4):e119-e129
• Pubmed ID:
  38195324
• Pubmed Central ID:
  PMC11624524
• Document Type:
  Journal Article
• Funding:
  HHSN261201800009C/CA/NCI NIH HHSUnited States/ ; NU58DP006344/DP/NCCDPHP CDC HHSUnited States/ ; H23 IP000860/IP/NCIRD CDC HHSUnited States/ ; U24 CA076518/CA/NCI NIH HHSUnited States/ ; HHSN261201800015I/CA/NCI NIH HHSUnited States/ ; UL1 TR001860/TR/NCATS NIH HHSUnited States/ ; HHSN261201800032I/CA/NCI NIH HHSUnited States/ ; HHSN261201800015C/CA/NCI NIH HHSUnited States/ ; KL2 TR001859/TR/NCATS NIH HHSUnited States/ ; HHSN261201800009I/CA/NCI NIH HHSUnited States/ ; HHSN261201800032C/CA/NCI NIH HHSUnited States/ ; P30 CA093373/CA/NCI NIH HHSUnited States/
• Volume:
  24
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:faa0275a4d5a6a425ee7209cc76765a8d113fbdc603f20c498c52ac6479648dd40a3da388f96cad713d63a98bb0c7354ac1c5495ac308ebfd4f4891e3fea30a4
• Download URL:
  https://stacks.cdc.gov/view/cdc/174549/cdc_174549_DS1.pdf
• File Type:
  [PDF - 1.21 MB ]