A surprising study on stem cell transplants from the University of Minnesota found that cancer patients who received transplanted cells from donors living in poor or socioeconomically disadvantaged areas were more likely to die.
Dr. Lucy Turcotte, an assistant professor at Boston University who studies cancer outcomes, said the findings could have implications for how donors and recipients are matched in the future if other studies prove a link between donor poverty and transplant mortality.
But research is already showing the dramatic impact that socioeconomic status can have on an individual’s health: If poverty can deteriorate stem cells and impede the success of transplants, imagine the impact it could have on the day-to-day health of donors, she said.
“This is more than just a transplant analysis,” Turcotte said. “It’s really about the idea that poverty impacts all the way down to the stem cell level, which is a really profound idea.”
the study An analysis of three-year outcomes of 2,005 people who underwent transplants for leukemia and other blood cancers found that those who received transplants from stem cell donors living in low-income areas were 6.6% more likely to die than those who received transplants from donors living in wealthier areas.
The results did not differ depending on whether the transplant recipients themselves were rich or poor, and the disparities persisted even after controlling for differences in race, health insurance status, and other factors already known to affect transplant outcomes.
Previous studies have linked poverty to poor diet, increased exposure to pollutants and increased stress, which can overactivate the immune system and lead to unhealthy levels of inflammation in the body.
“When you have to spend your mental and physical energy playing whack-a-mole — constantly thinking about which crisis needs to be addressed, which child needs what, which bill needs to be paid first — that’s a different kind of stress,” he says. Myrna CanterburyVice President of Community Health and Partnerships at HealthPartners;
The Bloomington-based clinic and hospital has responded by regularly asking patients about poverty-related issues such as food access, housing and safety, and connecting them to charitable programs that can provide relief.
This latest study advances our understanding of the effects of poverty as an increased cause of temporary and chronic illnesses: low socioeconomic status was associated with cellular reprogramming that persisted even when infused into another person.
“This study suggests that poverty has biological effects,” said Dr. Jeff Auletta, senior vice president of health equity at the National Marrow Donor Program, also known as NMDP. Minneapolis-based agency We match patients around the world with bone marrow and stem cells from the most suitable donors for transplant.
NMDP is Research Database They partnered with the University of Wisconsin to study transplant patients, and both participated in a University of Wisconsin-led study.
Turcotte said it was difficult to publish the findings until they were accepted by the influential scientific journal Proceedings of the National Academy of Sciences. Peer reviewers were concerned that the findings might encourage discrimination or discourage minorities who are disproportionately affected by poverty from becoming badly needed donors, Turcotte said.
Transplants are a key step in the treatment of blood cancers, using regenerative stem cells to reconstitute the patient’s immune system, which has been wiped out along with the cancer cells by chemotherapy and radiation therapy. The odds of success are significantly increased if the patient receiving the transplant is a good match for the donor on key biological and demographic markers. Otherwise, there is a risk that the transplanted stem cells may recognize the patient’s unfamiliar body like a virus and attack it, a risk known as graft-versus-host disease.
But even with NMDP’s pool of 41 million potential adult donors worldwide (including 9 million U.S. donors), finding a suitable match can be difficult, especially for patients from certain racial and ethnic minority groups: White recipients have a 79% chance of finding an ideal match, but only 29% for Black recipients, according to the NMDP.
New drugs and transplant protocols Improved outcomes While some transplants may not be an exact match, Auletta said the top priority right now is finding the best donor stem cells as quickly as possible. So while U’s discovery is important, Auletta said it shouldn’t deter cancer patients from undergoing a transplant if they need one, regardless of the donor’s socioeconomic status.
“The risks of delaying transplantation may far exceed those identified in this paper,” he said.
A limitation of the study is that it analyzed transplants that took place before 2013, so it doesn’t take into account recent improvements in transplant safety. The U researchers also didn’t have the detailed data to know for sure whether the donors were rich or poor. Instead, in their analysis, they categorized donors by the ZIP code where they lived, as well as local unemployment rates, housing stability, education, and household income levels.
Auletta said the key message right now is that communities need to tackle poverty because it changes those who live in poverty at a cellular level. If the link with transplant survival is further validated, tackling poverty could also improve the donor pool and transplant outcomes, he said.
