Why Some Myeloma Patients Refuse Stem Cell Transplant

Derick Alison
Derick Alison
3 Min Read

A real-world analysis presented at the American Society of Hematology annual meeting showed that the refusal rate for autologous hematopoietic stem cell transplantation among patients with multiple myeloma is low, at about 2%, but still represents a missed opportunity to receive standard of care.

In this exclusive MedPage Today video, Chakra Pani Chaulagain, MD, of the Maroone Cancer Center at the Cleveland Clinic in Weston, Florida, offers a summary of the analysis.

Following is a transcript of his remarks:

Autologous stem cell transplantation is and has been the standard of care in multiple myeloma, and identifying the factors that contributed to its refusal can help us close the gap and design programs to implement access to autologous stem cell transplantation.

We looked at a little over 200,000 patients, multiple myeloma patients from NCDB [the National Cancer Database], and we identified 43,600 myeloma patients who were recommended to undergo autologous stem cell transplantation after initial induction therapy. All of these are newly diagnosed multiple myeloma patients. And we found that approximately 2% of patients refused transplant. But 98% of them actually did go ahead and complete their recommended autologous stem cell transplantation.

What we found is that higher age [was associated] an increased odds of transplant refusal. If you belong to a low household income bracket, you had higher odds of refusal. Males actually had decreased odds of refusal. African-American patients, for example, had higher odds of transplant refusal compared to white [patients]. Hispanic patients actually had lower odds of refusal compared to non-Hispanic [patients]. And there was also significant disparity in terms of the different parts of the United States, with South Atlantic states having the highest odds of transplant refusals versus other parts of the United States.

Patients who had private insurance had lower odds of refusal and patients who had Medicare, Medicaid, or no insurance had a higher odds of refusal. Similarly, patients who have more comorbidities, more medical problems, they tend to refuse recommended autologous stem cell transplantation.

So, in summary, we found a significant ratio, economic and geographic variation, in utilization of autologous stem cell transplantation in multiple myeloma patients in this very large real-world database, which can possibly help us design prospective clinical studies in the future.

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