ABCL-038 HIV Status Affects Access to Autologous Stem Cell Transplant in Primary Central Nervous System B-Cell Lymphomas in a Minority Rich, Ethnically Diverse and Socioeconomically Disadvantaged Population at Montefiore Medical Center/Albert Einstein College of Medicine

Abstract

Primary CNS lymphoma (PCNSL) is a rare, aggressive neoplasm showing frequent relapses. Though autologous stem cell transplant (ASCT) has shown survival benefits, data regarding access to and outcomes of ASCT in racial minorities and socioeconomically disadvantaged groups is limited. To identify variables, such as race/ethnicity, socioeconomic status (SES), and HIV status, associated with access to ASCT and outcomes in patients with PCNSL. Retrospective cohort including patients from 06/01/2000 to 04/05/2022. Tertiary oncologic center. Fifty-three PCNSL patients with a median age at diagnosis of 63 years were included. The cohort was 7% Asian, 29% Black, 27% Hispanic, 17% White, and 20% other. Eighteen percent of the patients were HIV positive, thrice the global prevalence of HIV in PCNSL patients. Electronic health records were reviewed. SES was measured using the area deprivation index (ADI), composed of 17 categories and validated for a range of health outcomes and disease domains (Kind et al. NEJM 2018). Correlation of different demographic variables with access to ASCT and overall survival (OS). The most common induction chemotherapy and conditioning regimens were remdesivir and TBC (thiotepa, busulfan, and cyclophosphamide), respectively. Our population had a higher poverty index than the national average (median NY state ADI: 5th percentile). Thirty-two percent of the patients in our cohort received ASCT (17/53), better than the national average of 12.9% in PCNSL patients in 2020. In a logistic regression model, HIV-positive status was significantly associated with decreased access to ASCT (P=0.01). ADI and race/ethnicity did not affect access to ASCT. One-year OS was 80%, and no significant difference was found between those treated with ASCT and those who were not. Median OS was not reached in ASCT recipients. When adjusted for the other variables, Karnofsky scores >90 at diagnosis were associated with increased access to ASCT (P=0.04). In our population, HIV positivity limited access to ASCT, but race/ethnicity did not. Neighborhood disadvantage (ADI) also did not affect access to ASCT as patients were within a narrow range of extremely low socioeconomic status. Analyzing larger datasets of HIV-positive individuals with PCNSL can provide further insights into factors affecting ASCT access and outcomes.