The impact of socioeconomic disparities on the use of upfront autologous stem cell transplantation for mantle cell lymphoma

Abstract

Using the National Cancer Database, we identified 10,290 patients with newly diagnosed mantle cell lymphoma (MCL) treated with chemotherapy with or without upfront autologous stem cell transplantation (ASCT). Only 17% of patients underwent ASCT. Patients who underwent ASCT were younger and more likely to have lower comorbidity scores, private insurance, higher income and education, and treatment received at an academic facility. On multivariable analysis, age, comorbidity index, insurance type, the transition of care, facility type, distance to facility, and diagnosis year were predictive for ASCT use. ASCT use was associated with improved 5-year overall survival in younger (82% vs. 64%, p < .001) and older (70% vs. 40%, p < .001) patients, which was retained in the matched propensity score and 12-month analyses. Female gender, the diagnosis year ≥2009, private insurance, higher income, and education were associated with superior survival, whereas Black race and higher comorbidities predicted inferior survival.

Keywords:

• Mantle cell lymphoma
• autologous stem cell transplantation
• socioeconomic factors
• healthcare disparities

Author contributions

YS, TR and XJ analyzed the data. YS and DJ wrote the manuscript. All authors reviewed and approved the manuscript before submission.

Disclosure statement

YS has received research funding from BMS, Celgene, TG Therapeutics and Beigene. He has consulted for TG Therapeutics and Epizyme outside of the submitted work. BH has received research funding and consulting fees for Kite, Novartis, Pharmacyclis/Abbvie, Genentech, AstraZeneca and Beigene.