Sociodemographic Disparities in Access to Allogeneic Stem Cell Transplantation Among Patients Hospitalized With Relapsed Acute Myeloid Leukemia

Background: Acute myeloid leukemia (AML) is the most common acute leukemia in adults, and allogeneic stem cell transplantation (allo-SCT) remains a potentially curative treatment option for patients with relapsed disease.In addition to disease-specific factors such as cytogenetic and molecular risk, sociodemographic and socioeconomic characteristics may influence access to transplantation.We evaluated the association between these factors and receipt of allo-SCT among hospitalized patients with relapsed AML.Methodology: We conducted a retrospective analysis using the National Inpatient Sample (NIS) database from 2016 to 2022.Adult hospitalizations for relapsed AML were identified using ICD-10 codes.Multivariable logistic regression was performed to evaluate factors associated with allo-SCT, adjusting for demographic, socioeconomic, and clinical variables.Results: Among 90,605 hospitalizations for relapsed AML, 33,605 (37.1%) involved allo-SCT.Hospitalizations involving female patients were associated with lower odds of allo-SCT than those involving male patients (adjusted odds ratio (aOR), 0.94; P = 0.008).Notably, despite previously documented racial disparities in donor availability and transplantation access, hospitalizations involving Black patients had higher odds of allo-SCT than those involving White patients (aOR, 1.23; 95% confidence interval (CI), 1.13-1.34;P < 0.001).Hospitalizations involving Hispanic patients also had numerically higher odds, although the association did not reach statistical significance (aOR, 1.12; P = 0.054).Compared with the lowest-income quartile, the low-and high-income quartiles were associated with lower odds of allo-SCT (aORs, 0.89 and 0.83, respectively), whereas the highest quartile was associated with higher odds (aOR, 1.10; P = 0.005).Geographically, hospitalizations in the New England states were associated with higher odds of allo-SCT than those in other regions.Conclusions: Sociodemographic and socioeconomic factors are significantly associated with the receipt of allo-SCT among patients hospitalized with relapsed AML.These findings demonstrate sociodemographic differences in inpatient allo-SCT utilization among hospitalizations for relapsed AML.Further studies are needed to determine whether these differences reflect disparities in transplant eligibility, referral, or access.