(342) Factors affecting autologous stem cell transplant access in multiple myeloma patients at a comprehensive cancer center

Background: : Multiple myeloma (MM) is a hematologic malignancy of plasma cells in the bone marrow. Autologous stem cell transplant (ASCT) is a key treatment that increases progression-free survival and lengthens disease remission. However, disparities in ASCT access persist. Factors such as race, socioeconomic status, marital status and health insurance may influence utilization.

Objective: : To investigate whether the aforementioned factors contributed to the likelihood of receiving ASCT at the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (UMGCCC).

Methods: : The UMGCCC registry was used to identify a cohort of Black and White patients aged 18 years or older diagnosed with MM between 2018-2022. Patients with smoldering myeloma or non-Black/White race were excluded. Baseline demographic characteristics included age at diagnosis, sex, race, insurance type, and marital status. Chi-square tests were used to compare distributions between those who received and did not receive ASCT. A multivariable logistic regression was performed to estimate the odds of receiving ASCT, adjusting for these baseline factors.

Results: : Among 346 eligible patients, 49% were Black, 51% were White, 44% were female, 56% were male, and 58% were married. The mean age at diagnosis was 60 (SD=10.4). At diagnosis, 54% of patients had private insurance. Among the rest with public insurance, 34% were Medicare and 8% were Medicaid. Results of the multivariable regression indicated that Black patients did not have significantly lower odds of receiving ASCT compared to White patients (OR = 0.60; 95% CI = [0.33–1.07]). Significant factors associated with ASCT included public insurance as compared to those with private insurance (OR=0.28; 95% CI = [0,14, 0.54]), unmarried status as compared to married (OR = 0.41; 95% CI= [0.23–0.74]), and age 75 and over, compared to those younger than 65 (OR = 0.02: 95% CI= [0.00–0.09]).

Conclusions: : Primary payer at diagnosis emerged as a significant factor associated with ASCT, with 70% of publicly insured patients not receiving transplant. Those who were unmarried at diagnosis and age ≥ 75 were also significantly less likely to receive transplant. However, we found that black and white patients, as well as those aged 65-74 and < 65 had similar odds of ASCT. Interventions that target barriers such as insurance coverage and strengthen care navigation for older and unmarried patients may be important to promote equitable ASCT access for MM patients.

Sponsorship:: University of Maryland Institute for Health Computing