Social determinants of health (SDOH) and barriers to allogeneic hematopoietic stem cell transplantation (HCT) in acute myeloid leukemia (AML) in a community setting.

Abstract

e13519 Background: HCT is curative for patients with intermediate- or adverse-risk AML; however, timely referral to transplant centers is often delayed or absent, particularly in underserved populations. In Brooklyn, NY, where approximately 39% of residents are immigrants, patients face unique challenges related to language, insurance, and other social determinants of health (SDOH). We examined patient-, provider-, and institutional-level barriers contributing to delayed or absent access to HCT in a community-based hospital affiliated with a major academic center. Methods: We conducted an IRB-approved retrospective study of adults aged 18 to 79 diagnosed with AML at NewYork-Presbyterian Brooklyn Methodist Hospital (12/2021 – 1/2026), including those referred for HCT at affiliated Weill Cornell Medicine transplant program. Data were extracted from the medical record and BMT registry. The primary outcome was the proportion of HCT-indicated patients, per ELN 2022 criteria, who received a transplant consultation. Secondary outcomes included time from AML diagnosis to HCT consultation, time to HCT, and identification of barriers to transplantation. Results: Twenty patients were identified; 18 (90%) were racial or ethnic minorities (12 Black, 3 Asian, 2 Hispanic, 1 Mediterranean), and 25% required interpreter services. Six patients had favorable-risk disease, while 14 (70%), all non-White, met intermediate- or adverse-risk criteria. Among these, only six (43%) underwent HCT consultation, and all six proceeded to transplantation (4 in CR1 or CRi, 2 in CR2 or greater). Median time from AML diagnosis to HCT consultation was 66 days (range, 30 to 280), and median time to HCT was 154 days (range, 102 to 645). Among transplanted patients, infectious complications (67%), insurance-related delays (33%), and lack of a caregiver (17%) were the most common contributors to prolonged timelines. The median age of transplanted patients was 43 years (range, 31 to 58) compared with 75 years (range, 63 to 79) among non-transplanted patients. Among non-referred patients, 7 of 8 (88%) were aged 71 to 79; one declined, and one had significant comorbidities. Conclusions: While patient-level, structural barriers, and other SDOH significantly affect timely access to HCT, age-related referral patterns emerged as a key and potentially modifiable determinant of transplant evaluation. The marked age disparity between referred and non-referred patients underscores the importance of early, objective HCT assessment informed by contemporary transplant eligibility, including the feasibility of HCT in selected patients over age 70. Strengthening partnerships between community oncology practices and transplant centers through standardized referral pathways and shared decision-making may mitigate subjective biases and improve access to curative therapies.