Equal Access to Hematopoietic Stem Cell Transplant in a Minority-Rich, Ethnically Diverse, Socioeconomically Disadvantaged Population with Peripheral T-Cell Lymphomas at the Montefiore Medical Center/Albert Einstein College of Medicine

Introduction:

Peripheral T-cell lymphomas (PTCLs) are rare and heterogeneous with poor prognosis. There is a paucity of data on outcomes in minority populations. We studied relationships between socioeconomic status (SES), race, and ethnicity and access to hematopoietic stem cell transplant (HSCT) and survival. For analyses of SES we used a measure of neighborhood disadvantage called the Area Deprivation Index (ADI), a composite of 17 measures of education, employment, housing quality, and poverty validated across a range of diseases (Kind et al NEJM 2018).

Methods:

To identify subjects with PTCL, we used SQL to query our Enterprise Data Warehouse for ICD 10 codes C84 and C91.5. We used medical record numbers for chart review and recorded the following in Excel: WHO 2016 PTCL classification (Swerdlow et al 2016 Blood), sex, race, ethnicity, address, date of birth, date of death/last contact, stem cell source (autologous [auto] vs. allogeneic [allo]), donor sources for allo (matched related [MRD], matched unrelated [MUD], haploidentical [haplo], or syngeneic), conditioning regimen, and date of stem cell infusion (HSCT D0). ADIs were obtained by geocoding subjects' addresses using an online tool (https://geocoding.geo.census.gov/) and matching census block groups to ADI 2019 national percentiles. Conditioning intensity was determined by the Center for International Blood and Bone Marrow Transplant Research operational definition (Giralt et al 2009). For survival analyses, subjects with more than 1 histology were analyzed according to that at HSCT D0. For subjects who underwent auto with subsequent allo, analyses were carried out on the allo. When there was an interval between last date known alive and first date known to have died, death was assumed at the end of the interval. Overall survival (OS) probabilities were estimated using the Kaplan-Meier method. Python, pandas, Matplotlib, and lifelines were used for data analysis and visualization.

Results:

We identified 407 patients with PTCL, of which 48 underwent HSCT between 9/19/2006 and 4/5/2021 - 22 autos and 26 allos. Data on access to HSCT are summarized in Figure 1 and Table 1. There was not a significant relationship between ADI or ethnicity and access to HSCT. The relationship between race and access to HSCT was significant (p = 0.024). Baseline characteristics of the HSCT cohort are summarized in Tables 2 and 3. Notably, 12/26 allos had adult T-cell leukemia/lymphoma (ATLL). Looking at survival by type of HSCT (Figure 2, Table 4), autos had median OS not reached. Autos' 2 and 4-year OS probabilities were both 81.57%, whereas these were both 40.49% for allos (p = 0.03 for 2 year and 4 year OS). No differences were observed in survival by ADI among autos or allos (Figure 3, Table 5). There was no statistically significant association between race and survival by the log rank test (Figure 4, Table 6). P-values could not be calculated for autos' 2 or 4-year OS. Among allos, p-values suggested a statistical difference in 2 and 4-year OS between white subjects (n = 1) and black/African American (AA) as well as other subjects.

Finally, examining survival by ethnicity, no significant differences were seen between Hispanics and Non-Hispanics (Figure 5, Table 7).

Conclusions:

In our inner-city, minority-rich PTCL cohort, neighborhood disadvantage and ethnicity did not preclude access to HSCT. The autologous transplant survival curve with median OS not reached (longest survivor 14.71 years) indicates that our patients did have optimal, potentially curative outcomes. Although our sample size is small our population is predominantly inclusive of ethnic minorities and low SES. Analyzing larger datasets of ethnically and socioeconomically diverse individuals can provide further insight into HSCT access and outcomes.

Figure 1

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