Access to Allogeneic Hematopoietic Cell Transplantation (HCT) for Patients with Acute Myeloid Leukemia (AML) in the State of Virginia

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Background While HCT provides the best chance for cure for eligible patients with AML, barriers limit the number able to receive HCT. Virginia (VA) has some of the wealthiest and poorest counties in the country. We hypothesize that there are geographic variations in the rate and estimated unmet need of HCT for patients with AML in VA. Understanding geographic differences may help improve access to HCT. Methods All patients aged 20-74 years diagnosed with AML in 2013-2015 were identified by the VA Department of Health and classified by residence into 8 regions: Southwest, Southside, Valley, Central, Northern, Richmond, Eastern, and Hampton Roads. Socioeconomic (SES) factors including sex, age, race, marital status, education, employment, income, and health insurance were examined by region. Number of patients receiving first HCT by region were obtained from CIBMTR data. Unmet need was calculated by estimating the number of potential patients for HCT and subtracting the actual number of HCTs (Besse et al., 2015). Results 690 patients were diagnosed with AML in VA between 2013 and 2015; 153 first HCTs were reported to CIBMTR during the same time period. The rate of HCT and unmet need varied among the different geographic regions (Figure 1). The only SES factor that correlated with HCT rate was race/ethnicity (P=0.0334). The Southside, which had a higher percentage of non-Hispanic Black or African American population (31%), had a lower HCT rate (8%) compared to the Northern region, which had a Black or African American population of 12%, but a HCT rate of 29% (Figure 2). The Northern region had the highest median income ($105,000) and one of the highest rates of proceeding to HCT (29%) (Figure 3). In contrast, the Southside, which had the lowest median income ($40,000), had only 8% of patients proceeding to HCT and an estimated unmet need of 88%. Private vs public insurance, marital status, education, and gender did not correlate with HCT rates. Conclusions There are geographic differences in rates of HCT for patients with AML in VA. Regions with a higher non-Hispanic Black or African American population had lower rates of receiving HCT. Further study is needed to determine if the decreased rates in regions with a higher non-Hispanic Black or African American population are related to donor availability or SES barriers. Future steps to eliminate these SES barriers will be vital to increase the access of patients receiving a potentially curative HCT in VA.