Importance: Allogeneic hematopoietic cell transplant (HCT) is curative for hematologic cancers, yet access remains inequitable for racially and ethnically underrepresented and socioeconomically disadvantaged populations, making the goal of having a suitable donor for every patient who needs a transplant challenging. The ACCESS trial broadened access by enrolling patients without matched donors, who instead received an HCT from a mismatched unrelated donor. Objective: To compare baseline characteristics of ACCESS trial participants with participants enrolled in a similar clinical trial and a patient-reported outcome (PRO) protocol cohort. Design, Setting, and Participants: This cross-sectional study included adult participants (aged ≥18 years) from 3 cohorts-the ACCESS trial (2021-2024), BMT CTN 1703 trial (2019-2021), and Center for International Blood and Marrow Transplant Research (CIBMTR) PRO Protocol observational study (2020-2025) -who completed a baseline PRO survey. The ACCESS and PRO Protocol cohorts were stratified by conditioning intensity (myeloablative MAC vs reduced-intensity and nonmyeloablative RIC/NMA) ; all BMT CTN 1703 participants received RIC/NMA. Exposure: Hematopoietic cell transplant. Main Outcomes and Measures: Racial and ethnic diversity, insurance type, education, and income were compared among cohorts using counts and percentages, and socioeconomic and structural disadvantage were measured using the Social Vulnerability Index and Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy. Results: Baseline surveys were completed by 208 participants in the ACCESS trial (median range age at transplant, 62. 3 20. 4-78. 9 years; 108 male 51. 9%), 122 participants in the PRO Protocol study (median range age at transplant, 63. 9 21. 1-78. 0 years; 67 male 54. 9%), and 342 participants in the BMT CTN 1703 trial (median range age at transplant, 66. 9 20. 7-78. 6 years; 218 male 63. 7%). Participants in ACCESS were more racially and ethnically diverse, with 15 (7. 2%), 25 (12. 1%), 46 (22. 2%), 110 (53. 1%), and 11 (5. 3%) of Asian, Black or African American, Hispanic or Latino, White, and other race and ethnicity, respectively, compared with 4 (3. 3%), 2 (1. 6%), 8 (6. 6%) 104 (85. 2%), and 4 (3. 3%), respectively, in the PRO Protocol and 10 (3. 0%), 0, 16 (4. 8%), 302 (91. 0%), and 4 (1. 2%), respectively, in the BMT CTN 1703 trial. Participants in ACCESS were more likely to have Medicaid (36 18. 1%) vs PRO Protocol (8 6. 7%) and BMT CTN 1703 (16 5. 1%) participants and reported lower education (some college or an associate's degree: 103 49. 5% vs 73 59. 8% in the PRO Protocol; postcollege education: 34 17. 3% vs 35 29. 2% in the PRO Protocol) and household income (<40 000 annually: 25 24. 0% vs 8 11. 6% in the PRO Protocol and 7 38. 9% in the BMT CTN 1703 trial). Median Social Vulnerability Index scores were highest among participants in the ACCESS MAC group (median range, 0. 72 0. 01-0. 97 vs 0. 61 0. 16-0. 78 in the PRO Protocol MAC group), and 16 participants 27. 6% in the ACCESS MAC group reported moderate to severe financial toxicity. The ACCESS participants lived closer to transplant centers, especially in the RIC/NMA group (median IQR, 28 14-75 miles vs 47 16-96 miles for BMT CTN 1703 participants and 49 21-104 miles for PRO Protocol participants). Conclusions and Relevance: This cross-sectional study of clinical trial participants and a clinical cohort found that the ACCESS trial enrolled a more racially and ethnically diverse and socioeconomically disadvantaged population. Trial designs that broaden eligibility could expand access to HCT, highlighting the need for systemic interventions to ensure equity.
Cusatis et al. (Tue,) studied this question.