Division of Hematology and Oncology, State University of New York Upstate Medical University, Syracuse, New York, USA.
Department of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon.
Eur J Haematol. 2024 Mar;112(3):328-338. doi: 10.1111/ejh.14129. Epub 2023 Oct 30.
Allogeneic hematopoietic stem cell transplant (allo-HSCT) is increasingly being used in the United States (US) and across the world as a curative therapeutic option for patients with certain high-risk hematologic malignancies and non-malignant diseases. However, racial and ethnic disparities in utilization of the procedure and in outcome following transplant remain major problems. Racial and ethnic minority patients are consistently under-represented in the proportion of patients who undergo allo-HSCT in the US. The transplant outcomes in these patients are also inferior. The interrelated driving forces responsible for the differences in the utilization and transplant outcome of the medical intervention are socioeconomic status, complexity of the procedure, geographical barriers, and the results of differences in the genetics and comorbidities across different races. Bridging the disparity gaps is important not only to provide equity and inclusion in the utilization of this potentially life-saving procedure but also in ensuring that minority groups are well represented for research studies about allo-HSCT. This is required to determine interventions that may be more efficacious in particular racial and ethnic groups. Various strategies at the Federal, State, and Program levels have been designed to bridge the disparity gaps with varying successes. In this review paper, we will examine the disparities and discuss the strategies currently available to address the utilization and outcome gaps between patients of different races in the US.
异基因造血干细胞移植(allo-HSCT)在美国和全球范围内越来越多地被用作某些高危血液系统恶性肿瘤和非恶性疾病的治疗选择。然而,种族和民族在该手术的利用以及移植后的结果方面的差异仍然是主要问题。在美国,接受 allo-HSCT 的患者中,少数族裔患者的比例始终不足。这些患者的移植结果也较差。导致医疗干预的利用和移植结果存在差异的相互关联的驱动因素包括社会经济地位、手术的复杂性、地理障碍以及不同种族之间遗传和合并症差异的结果。弥合差异差距不仅对于提供这种潜在的救命手术的公平性和包容性很重要,而且对于确保少数群体在 allo-HSCT 的研究中得到充分代表也很重要。这是为了确定在特定种族和民族群体中可能更有效的干预措施。联邦、州和项目各级都制定了各种策略来弥合差异差距,但取得的成功程度不同。在这篇综述论文中,我们将检查差异,并讨论目前可用于解决美国不同种族患者之间利用和结果差距的策略。