Study finds barriers to stem cell transplant use among multiple myeloma patients from minority groups

A study by researchers at Mayo Clinic's campus in Jacksonville, Florida has found that barriers to patients receiving stem cell therapy as part of their treatment for multiple myeloma include income, education, insurance status and access to care at an academic center or 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," says Sikander Ailawadhi, M.D., a hematologist at Mayo Clinic in Florida and the lead investigator of this study. "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 stem cell transplant utilization among patients from minority communities to better understand the issue and come up with solutions to eliminate barriers and improve access for all patients. Researchers reviewed medical records for approximately 112,000 patients with a multiple myeloma diagnosis from the National Cancer Database 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," says Dr. Ailawadhi. "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."

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 some 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," says Dr. Ailawadhi. "We noted significant disparities among races for 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."

Dr. Ailawadhi says that while some of these factors are non-modifiable, others including access to healthcare, income, insurance and literacy levels, proximity to treatment center, treating facility type as well as volumes are modifiable.