Hematopoietic Cell Transplant (HCT) Referral Barriers for Patients with Hematologic Malignancies: A Retrospective Study at the National Institutes of Health (NIH)

HCT is a potential cure for many hematologic malignancies. In the U.S., health insurance is required to undergo HCT, except at the NIH, a research hospital. Studies have identified socio-demographic factors associated with HCT referral and access.1‑7 This study aims to characterize the socio-demographic barriers to successful HCT referral at the NIH. Understanding barriers to HCT access is important in addressing disparities in cancer outcomes.

We conducted a retrospective study of patients with hematologic malignancies referred to the Center for Immuno-Oncology (CIO)-HCT team at the NIH between 1/1/20-12/31/22, with review of post-referral outcomes through 12/31/2023. Data were analyzed using descriptive statistics. This study is under the purview of IRB-approved clinical trials NCT04959175, NCT03983850, NCT05327023, NCT05436418, NCT03922724, NCT05470491.

328 patients were referred to the CIO-HCT team during the 3-year study period, with 81 (25%) reaching HCT. Of these 328 referrals, 236 (72%) were sufficiently engaged in the referral process to get a medical record number (MRN). Of the 92 that did not get an MRN, 40% were in 2020, 36% in 2021, and 24% in 2022. Median time from referral to HCT was 143 days (range 14-1377 days). 98 of 236 patients were married and, of these, 37% underwent HCT; 81 identified as single/divorced/separated and 49% underwent HCT. 146 of 236 were male and 34% underwent HCT; of 90 females, 36% underwent HCT. Among the 236, 49% were Hispanic, 20% were non-Hispanic white, 11% were Black. 48% of Black patients underwent HCT, compared to 39% Hispanics and 38% non-Hispanic white patients.

Even without health insurance as a requisite, only 25% of referred patients underwent HCT, with a higher early disengagement rate in 2020. Successful referrals did not differ by race/ethnicity, sex, or marital status. Ongoing research will determine the association between socio-demographic factors and HCT utilization.

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