Researchers pinpoint barriers to transplant for multiple myeloma

Volume 7, Issue 1, 2018


Race, income, education and insurance drive disparities in the use of stem cell transplants.

Sikander Ailawadhi, M.D.

Sikander Ailawadhi, M.D.

Researchers at Mayo Clinic's campus in Jacksonville, Florida, have found that barriers to patients receiving stem cell therapy as part of their multiple myeloma treatment include income, education, insurance status, and access to care at an academic center or medical facility that treats a high volume of patients.

"Stem cell transplants are a standard treatment for patients with multiple myeloma and have been shown to benefit patients by delaying the recurrence of disease and, in some cases, improving patient survival," said Sikander Ailawadhi, M.D., a Mayo Clinic hematologist in Jacksonville. "While stem cell transplant utilization for patients with multiple myeloma has increased for all racial and ethnic subgroups over time, population-based studies have repeatedly shown that certain racial minorities are less likely to receive it."

Dr. Ailawadhi and his colleagues decided to explore factors that determine treatment with stem cell transplant among patients from minority communities to better understand the issue and come up with solutions to eliminate barriers and improve access for all patients with multiple myeloma.

The researchers reviewed medical records from the National Cancer Database of 112,000 patients with a multiple myeloma diagnosis between 2004 and 2013. Of those, 15,000 patients received a stem cell transplant as part of their treatment.

"We found that there was an overall increase in the use of stem cell transplant for multiple myeloma over time for all races except Asians," Dr. Ailawadhi said. "We also found there was greater use of stem cell therapy among whites and Hispanics with higher income levels and greater use among whites and blacks with higher education levels."

The researchers found that white, black and Hispanic patients with private insurance and those treated at academic medical centers or centers that treat a high volume of patients were more likely to get a stem cell transplant to treat multiple myeloma. They also observed other variables that contributed to disparities, including patient comorbidities, distance from a treating facility and geographic isolation.

"This is the largest analysis exploring socio-demographic factors affecting stem cell transplant use in multiple myeloma treatment," Dr. Ailawadhi said. "We noted significant disparities among races regarding who receives a stem cell transplant as a part of their initial care for multiple myeloma and who does not. Furthermore, we found that the socio-demographic factors that affect receipt of stem cell transplant for myeloma are variable from patients of one race to another."