Regional Disparities and Socioeconomic Factors Affecting Outcomes of Hematopoietic Cell Transplantation in Brazil: Insights From the Brazilian Bone Marrow Transplant Map.
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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 and 2023. We evaluated the impact of patient- and state-level clinical and socioeconomic factors on progression-free survival (PFS) and overall survival (OS). RESULTS: A total of 5074 HCTs (2695 allogeneic and 2379 autologous) were included, primarily male and from the Southeast region, where most transplants were performed. Nearly one in 5 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 leukemia (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 nonrelapse 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 d +100, and until d +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.