REGIONAL DISPARITIES AND SOCIOECONOMIC FACTORS AFFECTING OUTCOMES OF HEMATOPOIETIC CELL TRANSPLANTATION IN BRAZIL: INSIGHTS FROM THE BRAZILIAN BONE MARROW TRANSPLANT MAP

Abstract

Introduction: The Brazilian Bone Marrow Transplant Map (BMTM) provides public data on hematopoietic cell transplantation (HCT) in Brazil.

Objective: This study analyzes BMTM data to characterize regional disparities, socioeconomic factors, and patient outcomes.

Study design: We retrospectively analyzed data from 31 transplant centers, including autologous and allogeneic HCTs performed between 2019-2023. We evaluated the impact of patient- and state-level clinical and socioeconomic factors on progression-free survival (PFS) and overall survival (OS).

Results: 5,074 HCTs (2,695 allogeneic and 2,379 autologous) were included, primarily male and from the Southeast region, where most transplants were performed. Nearly one in five patients had to relocate to another region for treatment. In the public setting, auto-HCT recipients treated outside their home region were more highly educated. One-year PFS and OS for adult allo-HCT recipients with acute leukemias (AL) were 62% and 65%, respectively, and 71% and 79% in children. In unadjusted analyses of adults with AL undergoing allo-HCT or MM receiving auto-HCT, a Karnofsky performance score <80 was associated with worse survival. Adults with MM undergoing auto-HCT at private centers had superior PFS compared with those treated at public centers. State-level socioeconomic factors also significantly impacted survival. One-year non-relapse mortality after allo-HCT was 25% in adults and 14% in children. Infection was the leading cause of death in adult allo-HCT recipients, both before and after day +100, and until day +100 in children.

Conclusions: Reducing patient migration and improving transplant access requires greater regionalization of HCT care. Lowering infection-related mortality represents an unmet need. These findings warrant further validation in future studies.