A new study led by researchers in the Clinical Research Division highlights an important but often overlooked issue in cancer care: how a patient’s life circumstances -such as education level and indicators of poverty such as use of government assistance programs like food stamps (SNAP) or disability benefits (SSI) -can affect their chances of receiving a stem cell transplant (or Allogeneic hematopoietic cell transplant (allo-HCT)). Stem cell transplant is the only hope for a cure for some patients with acute myeloid leukemia (AML), a fast-growing cancer of the blood and bone marrow. The study’s findings were recently published in Blood.
The researchers examined three important outcomes for AML patients: mortality among those who never receives a stem cell transplant, chances of those who survived AML to receive a transplant, and mortality among those who underwent the procedure.
Dr. Natalie Wuliji, an assistant professor in the Clinical Research Division and lead author of the study, explained, “This study examines factors influencing access to and outcomes of allogeneic hematopoietic cell transplantation (allo-HCT), the only potentially curative therapy for patients with AML.”
Unsurprisingly, the researchers found that patients living in areas with lower levels of education or higher reliance on SNAP or SSI benefits were more likely to die before getting the chance to receive a transplant and those who did not die were less likely to receive one.
“It shows that individuals from neighborhoods with fewer resources—particularly those in areas with low educational attainment and high reliance on government assistance programs like SSI and SNAP—are less likely to receive allo-HCT,” Dr. Wuliji said. “This represents a significant barrier to potentially curative therapy. Moreover, these factors are associated with increased mortality before transplant, indicating that some patients may not survive long enough to undergo treatment. Importantly, once patients do receive allo-HCT, the influence of pre-transplant factors on outcomes cautiously appears less pronounced, suggesting that the procedure itself may help reduce disparities. However, further research is needed to confirm this.”
Dr. Mohamed L. Sorror, senior author of the study and a professor in the Clinical Research Division added “What is unique about this study is the idea that it followed patients from time of diagnosis of AML, something rarely happened with other studies that focused only on those who received the transplant. Second, the study collected large number of information about patients’ overall and geriatric health and AML aggressiveness features. Adjusting for these factors in the models that analyzed the outcomes ensured that the increased mortality and reduced access to transplant were NOT due to medical reasons but do you to only social determinants of health.”
The study underscores how people from underserved communities face systemic barriers to accessing life-saving treatments. While the data were limited in drawing definitive conclusions about differences by race, the study did find that Black patients were less likely to receive a transplant while Asian patients were more likely. However, their outcomes were cautiously similar to white patients once they underwent the procedure.
Barriers to care may arise from clinicians not referring patients with complex social needs or from transplant centers not offering adequate solutions for patients who might struggle with the extensive paperwork, insurance challenges, and non-medical costs associated with cancer care. These challenges are known as administrative burden. For example, a higher proportion of people receiving SSI benefits can indicate financial or health hardships. Communities with more SSI recipients also had higher mortality before transplant, likely due to greater bureaucratic barriers and fewer resources to navigate the system. Similarly, low education levels may make it harder for patients to understand the transplant process or advocate for themselves within a complicated healthcare system.
To improve access, the researchers suggest providing financial support to patients and families, offering patient navigators to help guide individuals through the transplant process, and enacting policy reforms to reduce paperwork and simplify access to care.
While this work is a great start to understanding some of the barriers affect Hispanic/Latino patient care, the study had some limitations. For instance, it did not include non-English speakers or individuals who had not yet been referred to a cancer center, meaning the true extent of the barriers may be even greater. Additionally, it lacked data on caregiver support or whether patients had matched donors, both of which can significantly impact access to transplantation.
“These findings raise important questions about how certain socioeconomic factors limit access to allo-HCT,” Dr. Wuliji noted. “Future research should focus on collecting individual-level data to better characterize the impact of these factors on access to allo-HCT and pre-transplant mortality. It should also explore the role of caregiver support and the administrative burden of navigating programs like SSI and SNAP to identify practical barriers and guide targeted interventions.”
The spotlighted research was supported by the Patient-Centered Outcome Research Institute award, the Research Scholar Grant from the American Cancer Society and the American Society of Hematology Bridge Award.
Fred Hutch/University of Washington/Seattle Children's Cancer Consortium members Mohamed Sorror, Frederick Appelbaum, Stephanie Lee, Brenda M. Sandmaier, Mary Elizabeth Percival, Jacob Appelbaum, Salene M. W. Jones and Ted Gooley contributed to this work.
Wuliji N et al. Social Determinants of Health and Access to Allogeneic Hematopoietic Cell Transplantation for Acute Myeloid Leukemia. Blood. 2025.
Joss Landazuri is a PhD candidate at the University of Washington in the Microbiology program working at the intersection of biomedical science, public policy, and science diplomacy. As a Latina scientist, communicator, and policy advocate, she is passionate about leveraging her academic training, personal background, and cultural heritage to engage underserved communities in both science and the policymaking process.
For the Media