What Population-Based Databases Reveal About Equity in Access to Hematopoietic Cell Transplant and Cellular Therapy

A systematic scoping review in Blood Reviews, led by researchers at Duke University and the ASTCT–NMDP ACCESS Initiative, has examined what US population-based databases establish about inequities in access to hematopoietic cell transplantation (HCT) and CAR T-cell therapy. Older adults, racial and ethnic minoritized populations, people living in lower-income neighborhoods, and those with public or no insurance were consistently less likely to receive these treatments. The size and meaning of reported disparities varied, however, according to which database was used and which stage of the care pathway it captured.

Studies published between January 2008 and February 2025 were assessed following PRISMA-ScR guidance. Of 1,625 records screened, 35 met the inclusion criteria and 16 (46%) linked more than one database. Sources included Medicare and commercial claims, SEER, SEER-Medicare, the National Cancer Database, the CIBMTR registry, state cancer registries, and integrated systems such as Veterans Affairs and Kaiser Permanente. Claims databases captured utilization, costs, and insurance patterns but lacked detailed clinical information. Cancer registries provided broader population coverage but recorded treatment pathways incompletely. CIBMTR contained detailed transplant information but excluded patients who were never referred, evaluated, or treated.

HCT and CAR T-cell use generally increased over time across databases, although gains were smaller for non-Hispanic Black and Hispanic patients and for those from socioeconomically disadvantaged areas. The authors emphasize that treatment receipt is only a proxy for access, since most databases cannot identify losses occurring between diagnosis, referral, eligibility assessment, insurance authorization, and treatment. ZIP code-based measures may misrepresent individual socioeconomic circumstances, and variables such as language, immigration status, health literacy, transportation, and digital access are rarely recorded. Recommendations include linking complementary databases, standardizing variables, incorporating social determinants and patient perspectives, and evaluating policy interventions rather than documenting disparities. Improved data infrastructure is considered necessary but not sufficient: achieving equity will also require structural reform in referral practices, insurance coverage, resource allocation, and accountability across the entire care continuum.

Reference:

Hong S, Espinoza-Gutarra MR, Shah R, et al. What population-based databases reveal about equity in access to hematopoietic cell transplant and cellular therapy. Blood Rev. Published online July 1, 2026. https://doi.org/10.1016/j.blre.2026.101417