Eapen Mary
Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, 9200 W Wisconsin Ave, WI, 53226, USA.
Best Pract Res Clin Haematol. 2021 Dec;34(4):101321. doi: 10.1016/j.beha.2021.101321. Epub 2021 Oct 23.
Hematopoietic cell transplantation is an important treatment option for malignant and non-malignant hematologic diseases. Despite increasing the potential donor pool for hematopoietic cell transplantation there are many patients who are unable to access this treatment. There are several biologic and non-biologic factors that may explain lower utilization of transplantation. Biologic factors associated with lower utilization include older age, multiple comorbidities, persons of African American descent and high-risk disease that may not respond optimally to hematopoietic cell transplantation. Non-biologic factors associated with lower utilization include lower educational (without a high school diploma) or social status, uninsured, Medicaid or Medicare insurance and in persons aged ≥60 years, when the distance between their residence and hospital was greater than 37 miles. The decision to proceed to hematopoietic cell transplantation is a dialogue between the patient and the treating physician. While some patients may be considered poor candidates for continued treatment including hematopoietic cell transplantation others may be offered novel pharmacologic and cellular therapies with a capacity to deliver specific immunologic antitumor responses. Pharmacologic and cellular therapies are relatively recent, and it is not known whether the biologic and non-biologic factors that limit access to transplantation will limit access to these newer treatments.
造血细胞移植是治疗恶性和非恶性血液系统疾病的重要选择。尽管造血细胞移植的潜在供体库有所增加，但仍有许多患者无法获得这种治疗。有几个生物学和非生物学因素可以解释移植利用率较低的情况。与利用率较低相关的生物学因素包括年龄较大、多种合并症、非裔美国人、以及可能对造血细胞移植反应不佳的高危疾病。与利用率较低相关的非生物学因素包括教育程度较低（没有高中文凭）或社会地位较低、未参保、参加医疗补助或医疗保险，以及年龄≥60岁且居住地与医院距离大于37英里的人群。是否进行造血细胞移植的决定是患者与主治医生之间的对话。虽然一些患者可能被认为不适合继续接受包括造血细胞移植在内的治疗，但其他患者可能会获得能够产生特异性免疫抗肿瘤反应的新型药物和细胞疗法。药物和细胞疗法相对较新，目前尚不清楚限制移植可及性的生物学和非生物学因素是否也会限制这些新疗法的可及性。
