Access to life-saving hematopoietic stem cell transplantation (HCT) and cellular therapies is significantly influenced by various social vulnerabilities, including socioeconomic status, race, culture, and geography. Factors such as insurance coverage, associated costs, and knowledge of referring oncologists also play a role. In an effort to address these barriers, recent strides have been made in refining alternative donor transplantation methods, such as haploidentical and mismatched unrelated transplants. The integration of posttransplant cyclophosphamide has yielded outcomes comparable to matched unrelated donor transplants. Additionally, the location of transplant centers poses a challenge for patients residing in rural areas, as the majority of facilities are concentrated on the East Coast. Lack of referral for a transplant evaluation is another critical issue, with some databases neglecting individuals who could benefit from transplantation but have not been evaluated.
Another focus in the transplant community is the aging population, as over 40% of patients receiving allogeneic transplants in the United States are 60 years or older. Efforts have been made to expand access to patients with active disease or measurable residual disease through clinical trials with novel targeted approaches. It is important to address these complex barriers to ensure equitable access and improved outcomes for all eligible patients, taking into account social, economic, and geographic factors.
